HEALTH INEQUALITY AND NUTRITIONAL STATUS OF CHILDREN AND WOMEN IN PAKISTAN: CONCENTRATION INDEX EVIDENCE FROM THE PAKISTAN DEMOGRAPHIC AND HEALTH SURVEY 2017-18

Abstract

Pakistan carries one of the heaviest burdens of child undernutrition in the world while overweight and obesity are rising rapidly among adult women. This study measures socioeconomic inequality in the nutritional status of children and women in Pakistan and identifies its principal sources. We analyzed unit-record data from the Pakistan Demographic and Health Survey 2017-18 for children under five with valid anthropometry, non-pregnant ever-married women of reproductive age, children in the complementary feeding age range and women with a recent live birth. Inequality was measured with concentration curves and concentration indices ranked on the continuous household wealth score with cluster-bootstrap standard errors and Erreygers-corrected indices. The concentration index for stunting was decomposed into its determinants and survey-weighted probit and ordinary least squares models identified the correlates of child stunting and women’s body mass index. More than a third of children were stunted and stunting, underweight and wasting were all concentrated among the poor. Among women, underweight was concentrated among the poor whereas overweight or obesity which affected about half of women was concentrated among the better-off. Minimum dietary diversity, minimum acceptable diet and antenatal iron supplementation were all pro-rich. Household wealth, maternal education and region explained most of the inequality in stunting. Children in the richest quintile were substantially less likely to be stunted than those in the poorest and small size at birth and short birth intervals independently raised the risk. Nutritional inequality in Pakistan is steep and runs in opposite directions for undernutrition and overnutrition. Because household wealth and maternal education jointly account for the bulk of the inequality in child stunting, equity-oriented social protection, investment in girl’ education, birth-spacing services and region-specific health investment should be pursued together.