IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0318425.html
   My bibliography  Save this article

Inequality of opportunity in child nutrition in Pakistan

Author

Listed:
  • Shyamkumar Sriram
  • Lubna Naz

Abstract

Introduction: Malnutrition among children is one of the major health challenges in Pakistan. The National Nutritional Survey 2018 revealed that 44% of children are stunted. Different circumstances surrounding a child’s birth can lead to inequality of opportunity in early childhood, with significant nutritional inequalities between rural and urban areas. This study aims to identify the drivers of inequality of opportunity in stunting among children under-five years of age in Pakistan. Methods: This study used Pakistan Demographic and Health Survey, 2017–18 to identify the factors contributing to inequality of opportunity in child’s stunting. The Dissimilarity index (D-index), along with Oaxaca decomposition, and Shapely decomposition were employed to measure and decompose inequality in opportunity in stunting. Regional variations in stunting among children under various circumstances were analyzed using Geographic Information System or GIS. Results: The burden of stunting is exceptionally high in Pakistan, with the prevalence in rural areas significantly exceeding that in urban areas from 1990 to 2018. Shapley decomposition of the contributors to inequality in opportunity indicates that maternal education accounted for 24% of total inequality among rural children and 44% among urban children. Water and sanitation contributed 22% to overall inequality in rural areas but only 2% in urban areas, highlighting the critical role of inadequate water and sanitation in rural settings. The wealth index was a predominant contributor to inequality both nationally and in urban areas. Southern regions exhibit a higher prevalence of stunting and a greater proportion of households lacking adequate water and sanitation. Additionally, the concentration of uneducated mothers and stunted children is notably high in Balochistan and Sindh. Conclusions: The lack of maternal education, inadequate access to water and sanitation services, and lower socio-economic status are key factors contributing to inequality of opportunity in stunting among children under five in Pakistan. Understanding the critical role of these circumstances can help policymakers address the situation and implement concrete steps to enhance equal opportunities for child health.

Suggested Citation

  • Shyamkumar Sriram & Lubna Naz, 2025. "Inequality of opportunity in child nutrition in Pakistan," PLOS ONE, Public Library of Science, vol. 20(2), pages 1-19, February.
    • Handle: RePEc:plo:pone00:0318425
    DOI: 10.1371/journal.pone.0318425
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0318425
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0318425&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0318425?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Paul Schultz, T., 2002. "Why Governments Should Invest More to Educate Girls," World Development, Elsevier, vol. 30(2), pages 207-225, February.
    2. Uzma Iram & Muhammad S. Butt, 2006. "Understanding the health and nutritional status of children in Pakistan: A study of the interaction of socioeconomic and environmental factors," International Journal of Social Economics, Emerald Group Publishing, vol. 33(2), pages 111-131, February.
    3. Corsi, Daniel J. & Mejía-Guevara, Iván & Subramanian, S.V., 2016. "Risk factors for chronic undernutrition among children in India: Estimating relative importance, population attributable risk and fractions," Social Science & Medicine, Elsevier, vol. 157(C), pages 165-185.
    4. Gaston Yalonetzky, 2012. "A dissimilarity index of multidimensional inequality of opportunity," The Journal of Economic Inequality, Springer;Society for the Study of Economic Inequality, vol. 10(3), pages 343-373, September.
    5. Dilshad Ahmad & Muhammad Afzal & Aisha Imtiaz, 2020. "Effect of socioeconomic factors on malnutrition among children in Pakistan," Future Business Journal, Springer, vol. 6(1), pages 1-11, December.
    6. Aizawa, Toshiaki, 2021. "Inequality of opportunity in infant mortality in South Asia: A decomposition analysis of survival data," Economics & Human Biology, Elsevier, vol. 43(C).
    7. Liu, Hong & Fang, Hai & Zhao, Zhong, 2013. "Urban–rural disparities of child health and nutritional status in China from 1989 to 2006," Economics & Human Biology, Elsevier, vol. 11(3), pages 294-309.
    8. Ebaidalla, Ebaidalla M., 2023. "Inequality of Opportunity in Child Health in Sudan: Across-Region Study," Journal of Economic Development, The Economic Research Institute, Chung-Ang University, vol. 48(1), pages 59-83, March.
    9. Ragui Assaad & Caroline Krafft & Nadia Belhaj Hassine & Djavad Salehi-Isfahani, 2012. "Inequality Of Opportunity In Child Health In The Arab World And Turkey," Middle East Development Journal (MEDJ), World Scientific Publishing Co. Pte. Ltd., vol. 4(02), pages 1-37.
    10. Agee, Mark D., 2010. "Reducing child malnutrition in Nigeria: Combined effects of income growth and provision of information about mothers' access to health care services," Social Science & Medicine, Elsevier, vol. 71(11), pages 1973-1980, December.
    11. Pérez-Mesa, David & Marrero, Gustavo A. & Darias-Curvo, Sara, 2021. "Child health inequality in Sub-Saharan Africa," MPRA Paper 108801, University Library of Munich, Germany.
    12. Smith, Lisa C. & Ruel, Marie T. & Ndiaye, Aida, 2005. "Why Is Child Malnutrition Lower in Urban Than in Rural Areas? Evidence from 36 Developing Countries," World Development, Elsevier, vol. 33(8), pages 1285-1305, August.
    13. Corina Shika Kwami & Samuel Godfrey & Hippolyte Gavilan & Monica Lakhanpaul & Priti Parikh, 2019. "Water, Sanitation, and Hygiene: Linkages with Stunting in Rural Ethiopia," IJERPH, MDPI, vol. 16(20), pages 1-21, October.
    14. Naz, Lubna & Patel, Kamalesh Kumar, 2020. "Decomposing socioeconomic gap in chronic malnutrition among preschool children in Pakistan," Children and Youth Services Review, Elsevier, vol. 119(C).
    15. Mkupete Jaah Mkupete & Dieter Von Fintel & Ronelle Burger, 2022. "Decomposing inequality of opportunity in child health in Tanzania: The role of access to water and sanitation," Health Economics, John Wiley & Sons, Ltd., vol. 31(11), pages 2465-2480, November.
    16. Hatem Jemmali & Mohamed Amara, 2018. "On Measuring and Decomposing Inequality of Opportunity among Children: Evidence from Tunisia," Applied Research in Quality of Life, Springer;International Society for Quality-of-Life Studies, vol. 13(1), pages 137-155, March.
    17. Shorrocks, A F, 1982. "Inequality Decomposition by Factor Components," Econometrica, Econometric Society, vol. 50(1), pages 193-211, January.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Mkupete Jaah Mkupete & Dieter Von Fintel & Ronelle Burger, 2022. "Decomposing inequality of opportunity in child health in Tanzania: The role of access to water and sanitation," Health Economics, John Wiley & Sons, Ltd., vol. 31(11), pages 2465-2480, November.
    2. Pérez-Mesa, David & Marrero, Gustavo A. & Darias-Curvo, Sara, 2021. "Child health inequality in Sub-Saharan Africa," MPRA Paper 108801, University Library of Munich, Germany.
    3. Andrea Salas‐Ortiz & Andrew M. Jones, 2024. "Inequality of opportunity in the double burden of malnutrition in Mexico," Health Economics, John Wiley & Sons, Ltd., vol. 33(10), pages 2342-2380, October.
    4. Assaad, Ragui & Krafft, Caroline, 2015. "Is free basic education in Egypt a reality or a myth?," International Journal of Educational Development, Elsevier, vol. 45(C), pages 16-30.
    5. Adediran, Olanrewaju Adewole, 2024. "The effect of women's decision-making on child nutritional outcomes in South Africa," Economics & Human Biology, Elsevier, vol. 53(C).
    6. Vincenzo Carrieri & Apostolos Davillas & Andrew M. Jones, 2020. "A latent class approach to inequity in health using biomarker data," Health Economics, John Wiley & Sons, Ltd., vol. 29(7), pages 808-826, July.
    7. Luca Tasciotti & Natascha Wagner, 2018. "How Much Should We Trust Micro-data? A Comparison of the Socio-demographic Profile of Malawian Households Using Census, LSMS and DHS data," The European Journal of Development Research, Palgrave Macmillan;European Association of Development Research and Training Institutes (EADI), vol. 30(4), pages 588-612, September.
    8. Aramide Kazeem & John M. Musalia, 2018. "The Implication of Early Childhood Malnutrition for Age of Entry into Primary School in Nigeria," Child Indicators Research, Springer;The International Society of Child Indicators (ISCI), vol. 11(4), pages 1337-1368, August.
    9. Ernesto Cardenas & Ana María Osorio & Orlando Joaqui Barandica & Sayda Milena Pico Fonseca, 2022. "Mind the Gap! Socioeconomic Determinants of the Stunting Urban-Rural Gap for Children in Colombia," Child Indicators Research, Springer;The International Society of Child Indicators (ISCI), vol. 15(2), pages 415-432, April.
    10. Saidi Anis (a) , Hamdaoui Mekki (b) and Ochi Anis (b), 2021. "Inequality of Opportunity and Degree of Human Development: Evidence from Tunisia," Journal of Economic Development, Chung-Ang Unviersity, Department of Economics, vol. 46(1), pages 107-137, March.
    11. Anis Saidi & Mekki Hamdaoui & Wajdi Moussa, 2021. "Assessing Policy Effectiveness in Reducing Inequality of Opportunity in Access to Public Services and Education Among Tunisian Children," Journal of the Knowledge Economy, Springer;Portland International Center for Management of Engineering and Technology (PICMET), vol. 12(3), pages 993-1018, September.
    12. Dwayne Benjamin & Loren Brandt, 2002. "Agriculture and Income Distribution in Rural Vietnam under Economic Reforms: A Tale of Two Regions," Working Papers benjamin-02-01, University of Toronto, Department of Economics.
    13. Das Gupta, Monica & Bongaarts, John & Cleland, John, 2011. "Population, poverty, and sustainable development : a review of the evidence," Policy Research Working Paper Series 5719, The World Bank.
    14. Hongyao Wei & Zhengyi Yang, 2022. "The Impact of Inheritance on the Distribution of Wealth: Evidence from China," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 68(1), pages 234-262, March.
    15. Missbach, Leonard & Steckel, Jan Christoph & Vogt-Schilb, Adrien, 2024. "Cash transfers in the context of carbon pricing reforms in Latin America and the Caribbean," World Development, Elsevier, vol. 173(C).
    16. Djavad Salehi-Isfahani & Nadia Belhaj Hassine, 2012. "Equality of Opportunity in Education in the Middle East and North Africa," Working Papers e07-33, Virginia Polytechnic Institute and State University, Department of Economics.
    17. Alonso-Villar, Olga & del Río, Coral, 2010. "Local versus overall segregation measures," Mathematical Social Sciences, Elsevier, vol. 60(1), pages 30-38, July.
    18. Mauricio De Rosa, 2018. "Wealth distribution in Uruguay: capitalizing incomes in the dark," Documentos de Trabajo (working papers) 18-07, Instituto de Economía - IECON.
    19. Juan Antonio Duro & Jordi Teixidó-Figueras & Emilio Padilla, 2017. "The Causal Factors of International Inequality in $$\hbox {CO}_{2}$$ CO 2 Emissions Per Capita: A Regression-Based Inequality Decomposition Analysis," Environmental & Resource Economics, Springer;European Association of Environmental and Resource Economists, vol. 67(4), pages 683-700, August.
    20. Janina Hundenborn & Ingrid Woolard & Murray Leibbrandt, 2016. "Drivers of Inequality in South Africa," SALDRU Working Papers 194, Southern Africa Labour and Development Research Unit, University of Cape Town.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0318425. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.