Maternal Age and Offspring Human Capital in India
A discussion paper titled 'Maternal Age and Offspring Human Capital in India' by Marcello Perez-Alvarez and Marta Favara, has been published by the Courant Research Centre, Georg-August-Universität Göttingen https://www.econstor.eu/bitstream/10419/200168/1/1668994607.pdf
Early motherhood remains a widespread phenomenon in low- and middle-income countries (LMICs). While the consequences of early motherhood for the mother have been extensively investigated, the impact on their children is severely understudied, especially in LMICs, which host 95% of teen births globally (WHO, 2014). Using panel and sibling data from India, this paper investigates the effect of early maternal age on offspring human capital development in terms of health and cognition, and relies on mother fixed effects to allow for household and mother unobserved heterogeneity. Furthermore, this paper explores the evolution of these effects over time during childhood and early adolescence for the first time. Results indicate that early maternal age has an overall detrimental effect on offspring health and cognition. We show that children born to early mothers are shorter for their age and perform poorer in the math test. Interestingly, the effect on child’s heath is observed at early ages and weakens over time, while the cognition effect surges only in early adolescence. The analysis on heterogeneous effects suggests that children and in particular girls born to very young mothers are worst off. The transmission channel analysis tentatively hints at some behavioral channels driving the relationships of interest and documents a positive (and modest) association between height-for-age and subsequent math performance. Overall, our results support both restorative policies assisting children born to early mothers and preventive policies tackling early pregnancy.
Growth and Nutrition: Preliminary Findings from the Round 5 Survey in India
Round 5 Longitudinal Growth and Nutrition Fact Sheet
This fact sheet presents findings from the fifth round of the Young Lives survey of children in United Andhra Pradesh in 2016. Young Lives has followed two cohorts of children since 2002. This fact sheet gives a snapshot of key growth and nutrition indicators for 15-year-olds in 2016 (Younger Cohort) and considers changes since this cohort was age one in 2002. The fact sheet also compares that to the data for 15-yearolds in 2009 (Older Cohort) to show changes in the context of children’s nutrition and growth over that seven-year period.
- Despite significant economic growth, over one quarter of our cohort of 15-year-old children continued to suffer from malnutrition (28% stunting and 25% thinness). But we observe a considerable reduction of malnutrition in 2016 compared to 15-year-olds in 2009 (28% compared to 36%).
- Significant inequalities persist in malnutrition status across socio-economic groups. For example, 17% of Other Caste children were stunted in 2016 compared to 37% of Scheduled Caste children.
- The food intake of children is changing over time. In 2016, 56% of Younger Cohort children had eaten pulses, legumes and nuts within the previous 24 hours, which is a substantial increase from 32% in 2009 for children of the same age.
- Sanitation must be a priority since only half of the households in our sample possessed sanitation facilities in 2016.
- Socially marginalised groups and the poorest households needs to be targeted in efforts to reduce malnutrition.
Child undernutrition: opportunities beyond the first 1000 days
Stunting often begins in utero and increases, on average, for at least the first 2 years after birth. The first 1000 days between conception and a child's second birthday has been identified as the most crucial window of opportunity for interventions.1 Evidence suggests that stunting is largely irreversible after the first 1000 days, leading to an intergenerational cycle of poor growth and development, in which women who were stunted in childhood remain stunted as adults and tend to have stunted offspring. However, evidence indicates that accelerated linear growth in childhood and adolescence following stunting in infancy (ie, catch-up growth) can occur. Evidence from the Young Lives international cohort study in Ethiopia, India, Peru, and Vietnam, found that around 50% of children who were stunted at age 1 year showed improvements in height and were no longer stunted at age 8 years in the absence of an intervention. Other longitudinal observational studies have also reported catch-up growth in childhood. Read the full article at the Lancet's website...
Birth Size, Stunting and Recovery from Stunting in Andhra Pradesh, India: Evidence from the Young Lives Study
Few Indian studies have examined the relationship between birth size and stunting in children. Studies on recovery from stunting in India are even fewer. This study, thus, investigates the relationship between birth size and stunting in Andhra Pradesh, India and further examines the factors associated with recovery from stunting using a longitudinal data.
The authors used data from the three waves of Young Lives Study conducted in Andhra Pradesh in the years 2002, 2006–2007, and 2009 respectively. The authors used data from 1965 children in wave 1 to examine the association between birth size and stunting. For examining the factors associated with recovery from stunting between 1 and 5 years of age, and between 5 and 8 years, they used data from 582 and 670 children who were stunted at age 1 and age 5 respectively. THey used multivariable logistic regression models to fulfil the objectives of the paper.
The children who were of average- or large- size at birth were significantly less likely to be stunted than children who were of small size at birth (OR 0.61 and 0.47 respectively). Children of average/tall mothers were 0.41 times less likely to be stunted than children of shorter mothers. Severely stunted children were less likely than other stunted children to recover from stunting between 1 and 5 years of age, and between 5 and 8 years. Mother’s height was statistically associated with recovery. Change in wealth status of the household was statistically associated with recovery between 1 and 5 years of age. In comparison, child immunization was associated with recovery between 5 and 8 years.
This study contributes to the understanding of the impact of birth size on childhood stunting, and to the extent of recovery from stunting in India. Further follow-up is necessary to demonstrate the impact during adolescence and adulthood.
Birth size, Stunting, Recovery from stunting
Download Birth Size, Stunting and Recovery from Stunting in Andhra Pradesh, India: Evidence from the Young Lives Study Singh, A., Upadhyay, A.K. & Kumar, K. Matern Child Health J (2017) 21: 492. doi:10.1007/s10995-016-2132-8
Household food group expenditure patterns are associated with child anthropometry at ages 5, 8 & 12 years in Ethiopia, India, Peru & Vietnam
Population-level analysis of dietary influences on nutritional status is challenging in part due to limitations in dietary intake data. Household expenditure surveys, covering recent household expenditures and including key food groups, are routinely conducted in low- and middle-income countries. These data may help identify patterns of food expenditure that relate to child growth.
We investigated the relationship between household food expenditures and child growth using factor analysis.
We used data on 6993 children from Ethiopia, India, Peru and Vietnam at ages 5, 8 and 12y from the Young Lives cohort. We compared associations between household food expenditures and child growth (height-for-age z scores, HAZ; body mass index-for-age z scores, BMI-Z) using total household food expenditures and the “household food group expenditure index” (HFGEI) extracted from household expenditures with factor analysis on the seven food groups in the child dietary diversity scale, controlling for total food expenditures, child dietary diversity, data collection round, rural/urban residence and child sex. We used the HFGEI to capture households’ allocations of their finances across food groups in the context of local food pricing, availability and preferences
The HFGEI was associated with significant increases in child HAZ in Ethiopia (0.07), India (0.14), and Vietnam (0.07) after adjusting for all control variables. Total food expenditures remained significantly associated with increases in BMI-Z for India (0.15), Peru (0.11) and Vietnam (0.06) after adjusting for study round, HFGEI, dietary diversity, rural residence, and whether the child was female. Dietary diversity was inversely associated with BMI-Z in India and Peru. Mean dietary diversity increased from age 5y to 8y and decreased from age 8y to 12y in all countries.
Household food expenditure data provide insights into household food purchasing patterns that significantly predict HAZ and BMI-Z. Including food expenditure patterns data in analyses may yield important information about child nutritional status and linear growth.
Household food expenditures; Child growth; Weight gain; Longitudinal cohort study; Household food purchasing patterns
Download Household food group expenditure patterns are associated with child anthropometry at ages 5, 8 and 12 years in Ethiopia, India, Peru and Vietnam Debbie L. Humphries, Kirk A. Dearden, Benjamin T. Crookston, Tassew Woldehanna, Mary E. Penny, Jere R. Behrman.
The Sooner The Better But It’s Never Too Late: The Impact of Nutrition at Different Periods of Childhood on Cognitive Development
Although it has been argued that undernutrition and its consequences for child development are irreversible after the age of 2, the evidence in support of these hypotheses is inconclusive. This working paper investigates the impact of nutrition at different periods from conception to middle childhood on cognitive achievement in early adolescence using data from Ethiopia, India, Peru, and Vietnam. In order to address estimation problems the paper develops a conceptual framework that delineates the channels through which child health impacts cognitive development and uses exogenous variation in nutritional status arising from weather shocks.
Results suggest that child growth both before and after the first 1,000 days is responsive to weather shocks and impacts cognitive achievement in early adolescence. The research also finds that part of the effect of early growth on later cognitive achievement manifests through growth in interim periods. Another novel result is that parental investment responses to a change in child health depend on the timing of this change.
These findings have important policy implications. On the one hand, results indicate that nutrition early in life is important for physical growth and cognitive development in subsequent stages of childhood, but on the other hand they suggest that nutrition-promoting investments after infancy and early childhood can act as a remedy for early nutrition and cognitive deficits and protect from nutritional insults in later stages that may also lead to developmental setbacks. Overall, the evidence suggests that nutrition-promoting interventions that start early in life and continue to subsequent stages of childhood, combined with support in other areas such as cognitive stimulation and parental involvement, may hold the most promise for the promotion of child development.
Do boys eat better than girls in India? Longitudinal evidence on dietary diversity and food consumption disparities among children and adolescents
This paper examines the dynamics of gender-based disparities in the intra-household allocation of food during childhood and adolescence in Andhra Pradesh and Telangana by using three rounds of longitudinal data from two cohorts. While boys are advantaged at all ages (except for the Younger Cohort at 12 years old), the pro-boy gap widens markedly at 15 years old. Specifically, mid-adolescent girls tend to consume fewer protein- and vitamin-rich foods such as eggs, legumes, root vegetables and fruit. This result is robust to gender differences between adolescents in terms of puberty onset, school enrolment, time use and dietary behaviours. Finally, gender disparities in dietary diversity during early and mid-adolescence do not vary by maternal education, poverty or place of residence, whilst they are moderated by levels of caregiver’s educational aspirations at 15 years old.
- The author investigates gender disparities in dietary diversity and food consumption among children and adolescents in India.
- Boys are advantaged at all ages (except 12 years) but the pro-boy advantage widens especially at 15 years old.
- Adolescent boys are more likely to consume nutritious foods than girls.
- The gap is robust to gender differentials in puberty, school enrolment, time use and dietary behaviours.
- Adolescent boys with caregivers that have high education aspirations are particularly advantaged in the intrahousehold distribution of food
gender; dietary diversity; India; intra-household dynamics; adolescents
The nutrition transition and adolescents’ diets in low- and middle-income countries: a cross-cohort comparison
This paper examines how diets have changed for 12-year-olds growing up in the same communities in Ethiopia, India, Peru and Vietnam between 2006 and 2013. The paper focuses on dietary diversity – the sum of the entire foods group eaten by the adolescent in the previous 24 hours – and individual food groups.
Individual dietary diversity –an indicator of overall quality of the diet and proxy for nutritional adequacy – improved markedly in Ethiopia and Peru. While no changes in overall dietary diversity were evident in the case of adolescents living in India and Vietnam, the composition of their diets, however, changed. In particular, Indian and Vietnamese 12-year-olds in 2013 were more likely to consume animal-source proteins such as eggs and dairy products to the detriment of consumption of pulses, legumes and seeds, as compared to their peers in 2006. Other notable changes related to a stark increase in the consumption of meat in Peru (+72%) and vegetables and fruits in Ethiopia (+36%) between 2006 and 2013. Consumption of added sugars increased starkly in Ethiopia (+35%) and Vietnam (+44%) in 2013 as compared to 2006.
In the same period, disparities in dietary diversity based on household wealth and place of residence generally decreased, while no strong gender inequalities in diets were evident in either period.
These results highlight rapid changes in the diets of adolescents in a very limited timespan in four different low- and middle-income countries and reflect the hypothesis of a ongoing nutrition transition, i.e. the substitution of traditional diets based on vegetable-source foods for animal-source foods and increased intake of added sugars.
Unhealthy diets are the biggest driver of disease globally. Given the speed in which diets are transforming, global, regional and context-specific policies are urgently needed to avert negative and costly consequences for health-care systems and societal well-being. For children and adolescents in particular, school-based policies and interventions hold promise for promoting healthy diets over the life course.
The online published version of the article is available on the journal website.
What do Indian children say about nutrition, food insecurity and food programmes?
The United Nations Food and Agriculture Organization estimates that about 795 million people in the world are food insecure. Out of those, one in four lives in India, and given the demographic structure of the country, there are good chances it can be a child. Similarly, the country has the gloomy record of highest burden of child malnutrition globally, with 48 million of stunted children under 5. An indicator of chronic malnutrition, stunting has lifelong repercussions on children through impaired learning, health and productivity, and even socio-emotional aspects such as self-esteem and aspirations.
Amidst the numerous statistics about child food insecurity and nutrition, however, the views seldom heard of are those of the children themselves. By ignoring these, are we risking underestimating the impact of food insecurity on children’s overall well-being and life chances?
These are the topics of a recent paper Ginny Morrow and I wrote, in which we investigated the experiences of food insecurity and food programmes of young people aged between 8 and 15 years old in Andhra Pradesh and Telangana, Southern India, and how these affect their food choices and, more broadly, their lives.
So, what did we learn?
First, healthy foods and diets were central to what constituted “a good life” for those children. Regardless of their age, caste or gender, or of whether they live in an urban slum or a remote tribal settlement, it was astonishing how many times food, food insecurity and food programmes were mentioned in a wider study that was asking children to talk about their well-being.
Second, children had a very clear understanding of the relevance of varied diets for their education, health or productivity. For instance, Krishna, from Patna (a rural community), mentioned: “We need to study, we need to answer the question, and we must eat well...If we eat well, we can study.” Or Santhi, who had been ill, knew that food could help her to recover from illness: ‘Now my health is not good. I should take proper food. Food long can do me good... I take more milk, I might get enough strength’.
Third, even more striking was the extent to which, from a very early age, young people grasped the complex social, economic and political factors that permeate the concept of food. For instance, the quality of the food was often associated to social status status (“Poor people ate rice with chetni while the rich ate good food”), or to the ability to participate to be part of community celebrations (“Those who have money cook delicious food on festive occasions whereas the poor do not do so.”).
Further, children were fully aware of the impacts of economic, family and natural shocks on their family’s diet. The food price increases of 2008/2009 were mentioned often, particularly by adolescent boys, who are often responsible for the weekly shop in communities like Polur (an urban slum in Hyderabad) where girls’ mobility is limited: “Since the food prices rose, the dal is not thick anymore.” Vinay (another 15-year-old-boy) said that because of the price rises, they had stopped eating curries at home, and that “the dal was watery”.
Finally, children were able to critically assess the impact of government food programmes, and mostly spoke positively about them. In Polur, Sania, for example, maintained that they help poor people “to lead life without starvation and children are able to eat full meals regularly”. School meals were seen favourably by both children and their families as fulfilling multiple objectives, ranging from improvement of nutritional status to encouraging children to attend school in the first place. This is coherent with the evidence, which has shown a positive impact of the scheme on nutrition, classroom effort, and even recovery from early childhood shocks.
Do Boys Eat Better than Girls in India?
This paper examines gender inequalities in the quality of children’s diet, as defined by dietary diversity, among children growing up in Andhra Pradesh and Telangana. Dietary diversity is a fundamental aspect of good nutrition: a varied diet is essential for ensuring an adequate intake of the macro- and micro-nutrients (vitamins and minerals) that are required for children’s healthy growth and proper physical and cognitive development.
The empirical results show that:
- While there are no gender disparities in dietary quality for children aged 5, 8 and 12 years old, a wide pro-boy gap emerges in the middle of adolescence at 15 years old.
- 15-year-old girls are less likely to consume the foods that contain most of the protein and micronutrients that are necessary for healthy development, such as eggs, legumes, root vegetables, fruit and meat.
- Boys whose caregivers who have high aspirations for their children’s education are particularly advantaged in the allocation of food within the household.
The results are robust even when controlling for factors that may explain the observed gender gap (onset of puberty, time-use and time spent working or at school, as well as dietary behaviours such as skipping meals).
In the context of India, these findings are important for a number of reasons. First, India is home to the largest youth population in the world and adolescent health is a key policy priority. Second, the burden of malnutrition among both girls and young women is the highest in the world. Furthermore, improving adolescent girls’ diets, beyond being a development objective per se, can also help to break the intergenerational cycle of malnutrition.