Child malnutrition is a chronic problem and a long-lasting challenge. The first National Health Survey in 1992-1993 found that India was the worst performing country on child health indicators. The Survey had concluded that more than half the children below four years of age were underweight and stunted and every sixth child was wasted. According to the Global Hunger Index (2021), India is placed at the 101st spot among 116 countries. The Global Hunger Index is calculated on the basis of undernourishment of the population, child stunting, wasting and child mortality. The bane of child and maternal malnutrition is responsible for 15% of India’s total disease burden. The NFHS5 conducted in 2019-20 shows that the prevalence of underweight, stunted and wasted children under five was at 32%, 36% and 19 %.

Most of the undernourished children grow up underweight. It is not only poor nourishment, but factors like substandard health care facilities, exposure to communicable diseases and fertility decisions that lead to impending long term effects. Higher birth order and lower birth spacing also lead to underweight children.

Existing literature shows that higher birth order does correlate with children at a higher order being underweight. Furthermore, lower birth spacing in violation of World Health Organization norms also increases the probability of children being underweight. A possible channel through which this could affect the probability of being underweight is the gendered dimension. When looking at the birth spacing channel, we find that if the previous child is female, then preceding birth interval decreases.

Authors, Agustin et al (2006), shows that longer and shorter intervals between pregnancies have been associated with increased risk of several adverse perinatal outcomes, such as preterm birth, low birth weight, small for gestational age and perinatal death. The paper argues that short intervals between pregnancies merely designate women at higher reproductive risks, either because of underlying disorders, socioeconomic status or lifestyle factors. The finding of the paper shows that infants born of women with interpregnancy intervals shorter than six months had pooled unadjusted ORS (95% CIs) of 1.77 (1.54-2.04), 2.12 (1.98-2.26), and 1.39 (1.20-1.61) for preterm birth, Low birth weight (LBW) and Small for Gestational Age (SGA) respectively, compared to children born to women with intervals of 18 to 23 months. Similarly women with intervals of 6 to 17 months were 8% to 23% more likely to give birth to infants with these adverse outcomes.

The paper by (Hantamalala Rafalimanana and Charles F. Westoff (2009), hypothesized that people prefer to avoid short intervals, and if these aspirations are realized, maternal and child mortality and morbidity would reach lower levels. The potential effect of spacing preferences on the level of fertility and on the prevalence of short (less than 24 months) birth intervals and child malnutrition are greatest. The covariates of the preferred birth interval have been examined. The paper observed a sharp decline in fertility recently experienced through this research.

The identification for analyzing the causal effect of any public works program including birth order effects/birth spacing is a challenging task primarily due to the heterogeneity that exists not only at the household level but also at state and community levels. Furthermore, most of the programs or policy experiments conducted by the government facilitate or target a certain group or community making randomized controlled experiments impossible.

The study adds to the Literature by examining the impact of birth order, birth spacing and the sex of the preceding child on being underweight in India. The result of this study supports the hypothesis – that an increased birth order, decreased birth spacing and when the last-born child is a male, the probability of children being underweight in India increases. Further, the paper produces evidence to support the trends outlined in the wealth of literature already available. However, while it attests to the trends found in the existing literature, this paper tries to look at the impact of all three factors (birth order, birth spacing and last child being male) on being underweight.

*The Kautilya School of Public Policy (KSPP) takes no institutional positions. The views and opinions expressed in this article are solely those of the author(s) and do not reflect the views or positions of KSPP.