Dual Burden Households and Nutritional Inequality in Indonesia

Overweight is an increasing problem in many developing countries, coexisting with underweight and contributing to a dual burden of malnutrition, sometimes in the same households. We analyze the dual burden phenomenon in Indonesia, using panel data that span a time period of 15 years. Today, 17 percent of the Indonesian households are classified as dual burden. In these households, children are often underweight, whereas adults are overweight. The nutrition transition seems to have differential impacts on the body mass index of different age cohorts. Dual burden is a transitory phenomenon. It started in the richer population segments, but today the highest prevalence is observed in the lowest expenditure quintile. Most households that moved out of the dual burden category end up as overweight. We also develop a continuous Theil index of intra-household nutritional inequality. While the prevalence of dual burden households has hardly changed over the last 10 years, the Theil index increased steadily. The reason is that intra-household inequality is also rising within household categories. Such inequality makes policy design more complex; food and nutrition interventions need to be targeted more specifically at subgroups within households. Further socioeconomic determinants are analyzed econometrically. Female decision-making reduces intra-household nutritional inequality.