NEW DELHI: Data from the National Health Family Survey-5, indicates that 32% of the children below five are stunted in India. While malnutrition is the number one cause for stunting, a new study by Cornell University suggests that increasing the space between two live births can reduce the risk of stunting.
Empirical studies have found mostly that second or higher-order children often lag behind firstborns in height outcomes, especially in developing countries. However, empirical investigations of birth-order effects on child height overlook the potential impact that birth spacing can have. The study – Effects of short birth spacing on birth-order differences in child stunting: Evidence from India – demonstrates that the negative association between increasing birth order and child height is driven by the short length of interval between births. Researchers link height-for-age standardized scores (HAZ) of children under five years, recorded in the latest Indian Demographic and Health Survey (DHS) to an indicator of birth order, disaggregated by the length of preceding birth spacing (PBS).
“We find that the firstborn height advantage is significant if birth spacing between the higher-order child and its immediate elder sibling is less than three years, and this advantage gets steeper with increasing order of birth,” the researchers note in the study. The height gap between third-born and the firstborn is four times the gap between second-born and firstborn. However, it was observed that if the birth spacing between the higher birth-order child and its immediate elder sibling is three or more years, the firstborn height advantage disappears and becomes insignificant. For example, the average HAZ deficit for second-born, relative to firstborn, is 0.1, without adjusting for preceding birth space. After adjusting for spacing length, the deficit more than doubles for second-born with birthing space less than three years.
Although India’s family planning programme has always promoted the message of keeping a gap of 3 years between two children, the study noted that about 85% of the women aged 15 to 19 years and 60% of the women aged 20 to 29 years have birth spacing of less than 32 months.
A World Bank study found that a 1% loss in adult height due to childhood stunting is associated with 1.4% loss in economic productivity. It is estimated that stunted children earn 20% less as adults. Furthermore, if stunting is accompanied by excessive weight gain later in childhood, there is an increased risk of developing adult obesity and nutrition-related chronic diseases, including cardiovascular disease, stroke, and type 2 diabetes in adult life. Stunted girls carry additional risk of having adverse pregnancy outcomes and reproductive complications as adults, leading to detrimental intergenerational effects.
“The causes of inadequate nutrition can be complex, encompassing biological, economic, social and political issues. The findings on birth spacing highlights the missing link in the literature in explaining slow improvement in child height outcomes in India. It assesses how the effects of birth order changes when spacing is accounted for. The results are quite interesting and produce an important public awareness message,” said Prabhu L Pingali, professor of applied economics and director Tata-Cornell Institute, and co-author of the study.