Accounting for Regional Differences in Mother and Child Health: Bangladesh, West Bengal, Bihar, and Jharkhand

Abstract

The Policy Research Working Paper Series disseminates the findings of work in progress to encourage the exchange of ideas about development issues. An objective of the series is to get the findings out quickly, even if the presentations are less than fully polished. The papers carry the names of the authors and should be cited accordingly. The findings, interpretations, and conclusions expressed in this paper are entirely those of the authors. They do not necessarily represent the views of the International Bank for Reconstruction and Development/World Bank and its affiliated organizations, or those of the Executive Directors of the World Bank or the governments they represent. Policy Research Working Paper 8798Using recent Demographic Health Survey data for Bangladesh and the neighboring Indian states of Bihar, Jharkhand, and West Bengal, this paper reexamines the determinants of child wasting and maternal anemia. The findings bear out the importance of commonly cited factors, such as mother's education and age, household wealth, and child birth order. However, the findings also highlight significant and large regional differences between Indian states and Bangladeshi provinces. For example, the results for Jharkhand state in India and Barisal province in Bangladesh indicate that controlling for those commonly cited determinants, the poorest, least-educated mothers and their children in Barisal have better health outcomes than the wealthiest, best-educated counterparts in Jharkhand. Mapping analysis of the spatial variations in child wasting and maternal anemia shows clear patterns of clustering over large areas that frequently overlap state/province and national boundaries. Possible sources of these striking differences include spatially differentiated prices and availability of critical nutrients; dietary preferences related to religion and ethnicity; nutrition education; and administration of public health and nutrition policy.

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“…Results show that, even after explaining variations in the probability of maternal anemia and child wasting due to commonly cited determinants (for example, mother's age, mother's education, household wealth, and child birth order), significant interregional variations remain (map 3.2). These variations are explained by spatial clustering of health services, political instability, religious culture, and flood-proneness-a proxy for the relative prices of fish and milk, as well as the relative scarcity of clean water for drinking, food preparation, and washing (Dasgupta and Wheeler 2019a).…”