Household Food Insecurity and Maternal and Child Nutritional Status: Evidence from Maharashtra

• Published date: 01 November 2019
• Author: Chandana Maitra,Vani Sethi,Sayeed Unisa,Sriram Shankar
• Date: 01 November 2019
• DOI: http://doi.org/10.1111/roiw.12436

© 2019 Internation al Association for Re search in Inco me and Wealth

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HOUSEHOLD FOOD INSECURITY AND MATERNAL AND CHILD

NUTRITIONAL STATUS: EVIDENCE FROM MAHARASHTRA

by Cha ndana Maitra

School of Eco nomics,The Unive rsity of Sydney, Sydney, Austra lia

Vani Sethi

United Nation s Children Fund I ndia Country Of ce, New Delhi, In dia

Sayeed UniSa

Departme nt of Mathematical De mography and Stati stics,Internatio nal Institute for Populat ion

Sciences , Mumbai, Indi a

AND

SriraM Shankar

Centre for Soci al Research and Metho ds & Research Schoo l of Economics,Th e Australian Nation al

University, Canberra, Australia

In this paper we rigorously examine the association of household food security status with maternal

and child nutritional status exploring a rich micro-level database, the Comprehensive Nutrition Survey

Maharashtra 2012. Using Household Food Insecurity Access Scale (HFIAS) as a metric to measure

household food security, we apply simultaneous probit models to estimate the effect of food insecurity

on maternal and child nutritional outcomes. The modelling framework addresses possible endogeneity

in the above relationship. Findings indicate that household food insecurity increases the risk of mater-

nal and child underweight with no effect on child stunting, wasting or maternal overweight. Women’s

decision-making power mediates these associations. Food security interventions should be effective in

tackling the concerns with undernutrition, however, food alone is not the solution. A mix of nutrition-

specific and nutrition-sensitive policies is warranted. Food security interventions should be integrated

into policies for human development.

JEL Codes: I15, C31, D10, I30, O15

Keywords: experiential, endogeneity, food access, human development, nutritional status, women’s

bargaining power

Note: We are grateful to UNICEF and IIPS for access to the rich microlevel data from

Comprehensive Nutrition Survey Maharashtra, 2012. We sincerely acknowledge the input received

from Dr. Mark Nord (The Voices of the Hungry Project, FAO) in guiding us with the statistical evalu-

ation of the food security indicator. We also thank our three anonymous referees and the participants

of IARIW-ICRIER Conference on “Experiences and Challenges in Measuring Income, Inequality and

Poverty in South Asia” (held at New Delhi, India, on November 2017) for their comments and sugges-

tions which greatly enriched the paper. The usual disclaimer applies.

Correspondence to: Chandana Maitra, School of Economics, Level 5, Social Sciences Building

[A02], The University of Sydney, NSW 2006, Sydney (e:chandana.maitra@sydney.edu.au)

Review of Inc ome and Wealth

Series 65, Numb er S1, November 2019

DOI : 10.1111 /roi w.124 36

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© 2019 Internation al Association for Re search in Inco me and Wealth

1. introdUCtion

The nature and extent of the association of food insecurity with nutritional

status is of interest both from the perspective of economic theory and policy mak-

ing. Research in the developed countries (primarily US) has evidence that lack of

access to sufficient quantity of safe and nutritious food is associated with children’s

health, behavioral, academic and emotional problems beginning as early as infancy

(Skalicky etal., 2006; Cook and Frank, 2008; Gundersen etal., 2011). The potential

channel linking food insecurity to the above outcomes couldbe malnutrition which

encompasses both overweight and undernutrition including micronutrient deficien-

cies; and has direct adverse consequences in terms of disability, disease, brain devel-

opment, learning and earnings (Victora etal., 2008; Black etal., 2008). However, the

association of food insecurity with nutritional outcomes is not yet well understood

(FAO, 2018). Nutrition is a social determinant of health and development (WHO,

2000). Rich longitudinal evidence exists on the economic benefits of avoiding under-

nutrition (Victora etal., 2008). Food insecurity might be a distant cause of malnu-

trition (Murray and Lopez, 1999). Therefore, understanding the exact nature of the

relationship not only facilitates effective policy formulation but also contributes to

the discourse in the development literature on the pathways to inclusive growth via

poverty reduction and human development. Current research sheds some light on

this question, however, further rigorous research is warranted (Maitra, 2018). The

task is complex and is also getting increasingly challenging given the newly emerging

complexities such as multiple burden of malnutrition (Haddad etal., 2015; WHO,

2017) in the global nutrition scenario. Furthermore, the literature investigating

food insecurity-malnutrition linkage suffers from methodological concerns relating

to selection bias, measurement errors and unobserved heterogeneity which often

render food insecurity endogenous with respect to nutritional outcomes. Limited

availability of panel data further complicates empirical research. A recent review of

120 studies on the link between experiential food insecurity and nutritional status of

adults and children across the globe(Maitra, 2018) identifies the failure to address

these methodological issues as a crucial gap in the literature. The few studies that

examine the above relationship in the Indian context (Mukhopadhya and Biswas,

2011; Gupta etal., 2013; Chandrasekhar etal., 2017) offer rich insight on the nexus

between the two phenomena, albeit with similar limitations.

Given the above, in the present paper, we rigorously examine whether house-

hold food insecurity increases the risk of malnutrition in women and children. We

aim to address the current research gap by modelling the above relationship with

due consideration to the concerns relating to endogeneity. We undertake this exer-

cise using a rich household level cross sectional dataset, Comprehensive Nutrition

Survey Maharashtra (CNSM) 2012 (IIPS-UNICEF, 2013). The dataset is based

on a representative sample of 2650 children aged 0–23months and their mothers.

The key indicator of household food insecurity (HFI) in our study is Household

Food Insecurity Access Scale (HFIAS) - an experienced-based food security scale

(EBFSS) which is a direct measure of access to food (Coates etal., 2007). The

nutritional outcomes are captured by anthropometric indicators—stunting (too

short for one’s age), wasting (too thin for one’s height) and underweight in chil-

dren; and BMI status for women (underweight/overweight) (WHO, 2010).

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The intellectual motivation of our query stems from the fact that if food inse-

curity has any causal association with nutritional outcomes it can be theoretically

modelled as an input in the production of human capital, given the robust microeco-

nomic evidence on the intergenerational consequences of malnutrition on learning

outcomes (Lewis, 2009; Grantham-Mcgregor etal., 2007). A malnourished mother

gives birth to a malnourished child and “severe early malnutrition, particularly

during the period of rapid brain growth in the first two years of life, presents a

permanent structural insult to brain function, leading to irreversible intellectual

impairment” (Levitsky and Strupp, 1995, cited in Fishman etal., 2004, p. 101).

Such strong linkage between nutrition and human development suggests almost

an immediate and direct link between food security and human development,

provided we see a close alignment of food insecurity with nutritional outcomes.

Such a possibility allows us to conceive offood security within the framework of

Sen’s (1985) capability approach (see Burchi and Muro, 2016), since “the human

development discourse is conceptually underpinned by the capability approach”

(Osmani, 2016, p. 2). The interaction between entitlement, capability and human

development is also relevant in this context. Food insecurity can be both a cause

and consequence of entitlement failure (Sen, 1981). It may result in entitlement fail-

ure (reduced command over commodities including food) by making an individual

less capable in the labor market via the channels of poor nutrition, poor health

and poor cognitive development. There exists a potentialfeed-back effect from

malnutrition to the capacity of providing food, health, education and care (Burchi

and Muro, 2016). This perspective also allows us to place food security within the

broad realm of well-being, all the possible activities and social expressions a person

would realize—his or her ‘beings and doings’ (Sen, 1985). The latter is also the idea

of ‘agency’ as conceived by Sen (1999). Within this framework, we can extend the

concept of food security in a manner that it ultimately strengthens human secu-

rity–ensuring security by investment in human development, not in arms (UNDP,

1994). The usefulness of such a framework is, it has long term implications for food

security policy formulation. It leads us away from the sole focus on entitlement,

income or livelihood and allows us to think about food insecurity as a cause and

consequence of lack of education, health and other basic capabilities that con-

stitute people’s wellbeing. This approach is people-centric and it also helps us to

embrace the ‘stability’ aspect of food security (UNDP, 1994) which has the element

of time embedded in it — “capability to be food secure”, having a longer-term

perspective (Burchi and Muro, 2016).

The above intellectual pursuit is further motivated by the fact that the food

insecurity-malnutrition link reflects an underlying conceptual association between

the access and utilization dimensions of food security. With the introduction of

UNICEF’s conceptual model (UNICEF, 1990) (Fig. B.1)1 which provides a com-

prehensive framework to understand the causes of malnutrition, the definition of

food security was broadened to include utilization as an additional element along

with availability and access to food in the World Food Summit 1996 (WFS, 1996).

Conceptually, food utilization relates to the capacity of an individual to absorb the

nutrients in the food consumed and is determined by practices, beliefs, eating

1Figure B.1 presents an adapted version of UNICEF framework reported in Black etal. (2008).