There are few more glaring holes in the Indian development story than child health and nutrition.

India has one of the highest rates of child stunting in the world: more than a third of its children under five years are short enough for their age to be counted as “stunted” under the World Health Organisation’s guidelines. This is more than the stunting rate in sub-Saharan Africa, one of the poorest regions in the world.

The World Health Organisation blames stunting on poor nutrition as well as repeated infection. It also warns that a stunted child suffers the consequences all their life, experiencing “poor cognition and educational performance, low adult wages, [and] lost productivity”.

That India performs much worse on stunting than countries poorer than it, has long been a paradox. To explain this, researchers have theorised that it has to do with unhygienic conditions found in India due to the prevalence of open defecation as well as the fact that daughters are mistreated in India compared to sons.

However, a new paper by Ashwini Deshpande, professor of economics at Ashoka University and Rajesh Ramachandran, postdoctoral researcher at the faculty of economics at Heidelberg University, finds that stunting varies starkly when it comes to caste and community in India.

In effect, along with hygiene and gender, a third factor might be making India’s rates of stunting shoot up: caste and communal discrimination.

Lagging Africa

Most research till now has compared India as a whole in trying to determine why it lagged other countries so severely when it came to child health. Take a look at the chart below:

Credit: Ramachandran, Deshpande, The Impact of Caste: A Missing Link in the Literature on Stunting in India

The chart above refers to the proportion of children who are more than two standard deviations below the median height of children of their age, as determined from the World Health Organisation’s child growth standards.

As we can see, Indian children are significantly shorter than those in sub-Saharan Africa.

Till now, this data proves what is long known: India has terrible rates of stunting.

Caste and communal focus

However, the data gets a lot more insightful when it is divided up by community. Look at the chart below.

UC: Upper Caste, SC-ST: Scheduled Castes, Schedules Tribes, OBC: Other Backward Classes. Credit: Ramachandran, Deshpande, The Impact of Caste: A Missing Link in the Literature on Stunting in India

Contrary to the all-India trend, upper caste Hindus actually have stunting rates (26%) lower than sub-Saharan African children.

However, Indian children from Dalit and Adivasi communities (Scheduled Caste/Scheduled Tribe) have stunting rates significantly higher than those of African children. A similar trend holds for Other Backward Classes, a vast group of castes in between upper castes and Dalits in the social order.

Along with caste, the other clear correlation is with religious communities. The paper looks at rates of stunting of upper caste Muslims (consisting of communities such as the Syeds and the Pathans). In spite of being privileged when it comes to their caste status, upper caste Muslim children display high stunting rates similar to OBCs and higher than African children.

Burden of discrimination

In other words, assuming a homogeneous Indian rate of stunting and then comparing it to Africa might not have much meaning given the incredible inequality within Indian society itself. As the paper points out, “The gaps in child heights between the social groups in India are two to three times greater than the India-sub-Saharan Africa child height gap.”

Moreover, looking at community-wise stunting data makes it clear why the all-India average is so poor. “Caste and religious identity have to be explicitly accounted for if the high burden of chronic malnourishment in India is to be addressed,” argues the paper.

Credit: Ramachandran, Deshpande, The Impact of Caste: A Missing Link in the Literature on Stunting in India

The importance of social disability when understanding stunting is further underscored by the fact that the paper plots instances of stunting and untouchability (see chart above) and finds that there is a “striking pattern”: for Dalit children, their rates of stunting sharply increase in relation to the practice of untouchability.

Clearly, a major reason for India’s poor development record lies in the sharp caste and communal discrimination found in society. To overcome this, the paper suggests that “public policy in improving access to sanitation or augmenting human capital” be “targeted by caste and religious identity”.