While wealth provides greater access to food and healthcare, malnutrition remains a problem across all socioeconomic classes in India. Data shows a relationship between household wealth and vaccination rates, anemia, and stunting, with poorer households facing higher risks. However, even children in wealthy households experience high rates of anemia, showing that undernutrition has causes beyond poverty alone. Improving access to nutrition information and promoting appropriate feeding practices, rather than just focusing on poverty alleviation, are emphasized as potential solutions to reducing malnutrition in India.

1. Disparity between nutritional status
in context of ‘wealth docile’
Sandeep Pawar
1
CTARA
IIT Bombay

2. HEALTH is WEALTH
BUT
Does having WEALTH guarantees HEALTH?
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3. Economic status
• For a household it is calculated by
– Consumer durables
– Land size
– Housing quality
– Water and sanitation facilities
• Households in the highest wealth quintile are not
necessarily wealthy in monetary terms, but they
are better off socioeconomically than four-fifths
of the population in India.
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Source: Nutrition in India – NFHS 3, August 2009

4. Poverty on malnutrition
• Hard to buy enough food
• Poor diet
– Affordability and access to food
– Inadequate feeding practices
– Proper healthcare services (Source: Saha, 2008)
• Less likely to go to the doctor when fall sick
• Inadequate nutrition
• Poor sanitation and clean water availability
issues
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5. Findings from the survey data
• In general, those who are poor are at risk for
under-nutrition, while those who have high
socio-economic status are relatively more
likely to be over-nourished.
(Source: Kenjilal, B; et al (2010))
• Anaemia is negatively correlated with wealth.
(Source: NFHS 3 – Nutritional status of adults)
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6. Vaccination: Effect of poverty and
wealth (economic status)
• There is an almost direct relationship between household
wealth and vaccination rates.
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Source: Joseph Mathew, Advanced Pediatric Center, India (2012)
47.3
61.8 66.4 70 76.5
1 2 3 4 5
%
Wealth Quintile
Complete Vaccination
13.7
6.3
4.2 4.7
2.7
1 2 3 4 5
%
Wealth Quintile
Unvaccinated infants

7. NFHS-3 data findings
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Children age 6-59 months living in
households with adequately iodized
salt w.r.t. household wealth
Stunting, wasting and underweight
among children <5yrs by household
wealth
Source: Nutrition in India – NFHS 3, August 2009

8. NFHS-3 data findings
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Lowest Second Middle Fourth Highest
76 74
69 65
56
Anaemia by household wealth
Among children age 6-59 months
Even in the highest wealth group more than
half of the children are aneamic
51 47
38
28
18
2 3
7
15 30
1 2 3 4 5
Total malnutrition- wealth wise
Underweight Overweight
Malnutrition of women 15-49 years by
household wealth
Source: Nutrition in India – NFHS 3, August 2009

9. Nutrition awareness Vs. Wealth
• According to NFHS III across all wealth classes, mothers who have
discussed nutrition with their health workers, including Anganwadi
(child welfare centres) workers, were more likely to follow the
Indian government’s guidelines while feeding their children.
• Nutrition information and advice offered by Anganwadi workers
and other health professionals significantly improved the feeding
practices.
• “Appropriate infant and young child feeding practices even in the
highest wealth quintile are extremely poor. This indicates that
undernutrition in India is not a poverty or food insecurity issue
alone, and that child care and feeding information and awareness
play an important role.”
-Onno Ruhl, World Bank Country Director in India, Nov. 2014
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10. Where is the actual problem?
• Poor feeding practices
– Exclusive breastfeeding in first 6 months
• Low nutrition information
• Hidden hunger – irrespective of wealth quintiles
• Opportunities
– Nutrition education (Give it a first priority)
– Major interventions on improving children feeding
practices and their nutritional needs
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Source: Nisha Malhotra, Child malnutrition in India- The Economist Sept. 2010

11. Conclusion
• Wealth is definitely an essential condition for
eradication malnutrition but it is definitely not
a sufficient condition
• More emphasis should be on improving
feeding practices for children rather than
other interventions especially eradication
poverty only for the sake of improving the
malnutrition status.
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