The determinants of inequality in child nutrition status: Evidence from Jordan

• Published date: 01 February 2022
• Author: Caroline Krafft
• Date: 01 February 2022
• DOI: http://doi.org/10.1111/rode.12839

112 

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     wileyonlinelibrary.com/journal/rode  Rev Dev Econ. 2022;26:112–132.

© 2021 John Wiley & Sons Ltd

Received: 21 June 2020 

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  Revised: 13 July 2021 

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  Accepted: 23 September 2021

DOI: 10.1111/rode.12839  

REGULAR ARTICLE

The determinants of inequality in child

nutrition status: Evidence from Jordan

CarolineKrafft

Department of Applied Economics, 

University of Minnesota, St. Paul, 

Minnesota, USA

Correspondence

Caroline Krafft, Department of 

Economics and Political Science, 

St.Catherine University, St. Paul, 

MN55105, USA.

Email: cgkrafft@stkate.edu

Present address

Caroline Krafft, Department of 

Economics and Political Science, 

St. Catherine University, St. Paul, 

Minnesota, USA

Abstract

Early childhood is the period when inequality originates 

and  the  intergenerational  transmission  of  poverty  and 

inequality  begins.  It  is  therefore  important  to  under-

stand  what  drives  inequality  in  early  childhood  health 

and  nutrition  in  order  to  provide  children  with  equal 

chances for healthy growth. In Jordan, there are substan-

tial  socioeconomic  disparities  in  children's  health  and 

nutrition; children  from wealthy  households grow  nor-

mally while other  children falter.  This  paper examines 

the determinants  and mediators  of health disparities  in 

children's height and weight in Jordan, including paren-

tal health  knowledge, food  quantity and quality,  health 

conditions, the health  environment, and prenatal devel-

opment. While  this paper  demonstrates that  the health 

environment  and  food  quantity  and  quality  contribute 

to inequality in child  health, these effects explain only a 

small share  of disparities. A  large share of  inequality in 

children's health is determined prenatally, and nutrition 

policies need to prioritize this period.

KEYWORDS

child health, early childhood development, inequality, Jordan, 

nutrition

JEL CLASSIFICATION

I14; D63; J24; I12; I15

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KRAFFT

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INTRODUCTION

The first few  years of children's lives provide  a crucial window for  human development. When 

children suffer from malnutrition in the early years, it  damages their psychosocial development 

(Dercon & Sánchez,2013), causes poorer school performance (Glewwe & Miguel,2008), impairs 

adult health (Victora etal.,2008), and ultimately lowers wages (Grantham- McGregor etal.,2007; 

LaFave &  Thomas,2017).  Early childhood1  is  also the  period when  inequality  originates and 

the intergenerational  transmission of  poverty begins.  It is  therefore of  paramount importance 

to identify the causes  of poor early nutrition,  and to understand what drives inequality  in early 

nutrition, in order to provide children with equal chances for healthy growth.

The specific focus  of this paper  is understanding the contributions  of socioeconomic status, 

the prenatal environment, and  the  early environment  to inequalities  in height  and  weight in 

Jordan. The paper measures inequality in  height and weight using a generalized entropy index. 

Following the inequality of  opportunity paradigm (Roemer,1998), the  paper estimates the role 

of various circumstances in inequality. Estimates decompose inequality using a standardized ap-

proach, first quantifying the role of socioeconomic status circumstances in child anthropometric 

inequality. Estimates then decompose inequality into the contributions of  socioeconomic status 

and a number of other early and prenatal environment factors, which might also be mechanisms 

through which socioeconomic inequality occurs.

While numerous papers  have examined the role  of socioeconomic  status in child health  in-

equality (e.g., Assaad  etal.,2012; Monteiro et al.,2010; Wagstaff & Watanabe,2000),  there has 

been little  research on the  role of  prenatal and early  environments in inequality. Prenatal  and 

early environments may mediate  socioeconomic disparities as  well as have their own indepen-

dent effects. Such  research is critically important to  designing policies and programs  to redress 

inequality. A large  number of  different early environment factors,  such as  feeding practices or 

sanitation, can contribute substantially to deficiencies in height and weight. Shortfalls in growth 

may also be shaped by children's development prior to birth, mediated through maternal health 

and nutrition and fetal growth.

To understand the determinants of child health inequality in Jordan, this paper uses the 2012 

Jordan Population and Family Health Survey (JPFHS). While children in Jordan from high socio-

economic status backgrounds experience a healthy pattern of growth, children from poorer back-

grounds falter in their  early growth. This clear differentiation in child  health by socioeconomic 

status makes Jordan an ideal case for studying the determinants of health disparities. Essentially, 

the differences between the rich and  poor have the potential to fully illustrate the determinants 

that yield good or faltering early nutrition.

The findings of  this paper demonstrate that  the factors that tend to be  the targets of  malnu-

trition interventions, such as feeding practices and health knowledge (Horton etal.,2010; World 

Bank,2006, 2010),  are not the most  important drivers of  inequalities in child health in Jordan. 

Prenatal factors, especially birth weight (a measure of fetal growth) play the largest role in dispar-

ities in child health. These findings suggest that addressing inequality and deficits in child health 

will require sustained  targeting of maternal  health and nutrition before  and during pregnancy. 

Policies and programs that target malnutrition during the early years may already be too late for 

many children in Jordan.

The  paper  proceeds  as  follows.  Section 2  discusses  the  literature  on  inequality  in  child 

health and  nutrition. Section3  provides a conceptual framework  for child health  and inequal-

ity. Section4  describes the  methods for  measuring and  decomposing inequality  in height and 

weight. Section5  describes the data  used in the analysis.  Section6 presents the  results, first in