Double burden of malnutrition at household level: an analysis of undernourished child and overweight mother pairs in India during 2005–2021

Clear socio-demographic pattern is observed in the emergence and transition of the double burden of malnutrition at community level. However, co-existence of underweight and overweight problems in the same household appears to be perplexing, being associated with completely diverse factors. Hence, this study examines the prevalence and progression of underweight child/overweight mother (UCOM) and stunted child/overweight mother (SCOM) pairs in India across selected socio-economic and demographic factors. Mother-child pairs from NFHS-3 (2005-06), NFHS-4 (2015-16) and NFHS-5 (2019-21) were analysed, which comprised of mothers aged 15–49 years and children aged 1–4 years. The Asian population-specific Body Mass Index classification (WHO, 2004) was used for evaluating maternal nutritional status. Children having Z-scores lower than two SD below the average for weight-for-age and height-for-age were considered to measure underweight and stunting respectively. Descriptive analysis show that prevalence of UCOM and SCOM pairs have doubled in India between 2005 and 2021, which is indeed concerning. Even though household level double burden of malnutrition is closely associated with factors determining maternal overweight, the rural-urban and rich-poor gap have reduced, signalling towards trickling down of overweight problems towards rural and underprivileged sections. The results from the logistic regression analyses across three NFHS rounds, demonstrate that nutrition transition is effective primarily among adult population. The rise in UCOM and SCOM proportions across socio-culturally and economically diverse states of India demands researchers and policy makers must delve deeper into the issue focusing upon intra-household dynamics and child feeding practices leading to such paradoxical mother-child nutritional pairs.