Remoteness, urbanization, and child nutrition in sub‐Saharan Africa

Abstract

Rural populations face a much higher burden of child undernutrition than urban populations, especially in sub-Saharan Africa, a continent where many households still live in remote rural areas. Despite this, relatively little research has analyzed nutrition differences across rural and urban populations, or across gradients of rural remoteness. In this article, we study these differences in sub-Saharan Africa by linking spatial data on travel times to urban centers with 20,000 or more people as our measure of remoteness to Demographic Health Survey data covering 74,398 children from 10,900 communities in 23 countries. We find that children in rural communities have much worse linear growth and dietary outcomes than urban children, but that children in more remote rural communities face only a small nutritional penalty compared to children from less remote communities. Moreover, the harmful effects of remoteness and rural living largely disappear once we control for education, wealth, and social/infrastructural services. This implies that the key nutritional disadvantages faced by rural populations stem chiefly from social and economic poverty. Combating these problems requires a combination of innovative cost-effective mechanisms for extending basic services to isolated rural communities and facilitating welfare-enhancing migration to urban areas.JEL classifications: I15, O12, O18

Prioritizing the Scale-Up of Evidence-Based Nutrition and Health Interventions to Accelerate Stunting Reduction in Ethiopia

“…Indeed, access to basic health services, markets, education, and basic infrastructure are much more limited in rural than in urban areas of Ethiopia [19,20]. More remote areas in Sub-Saharan Africa, including Ethiopia, also have worse linear growth and dietary outcomes [21]. Poorer households may also be more affected by high food prices and seasonality that can restrict their diets to predominantly starchy staples, with little or no consumption of nutrient-dense foods like animal-source foods, fruits and vegetables [22][23][24][25].…”

Agriculture for nutrition: direct and indirect effects.

“…Earlier research concluded that this rural-urban inequality in nutritional status stemmed from differences in 'endowments' -such as wealth, education and access to servicesrather than from the nutritional returns to these endowments (Smith et al, 2004). Headey et al (2017d) extended this research for a broader range of sub-Saharan African countries to examine both rural-urban differences, and differences across different degrees of remoteness (as measured by proximity to small cities). Strikingly, the results implied that proximity to cities is not important independent of its associations with wealth, education and access to services.…”

Agriculture and undernutrition through the lens of economics

“…Earlier research concluded that this rural-urban inequality in nutritional status stemmed from differences in "endowments" -such as wealth, education and access to servicesrather than from the nutritional returns to these endowments (Smith, et al, 2004, Zanello, et al, 2016. A recent paper extended this research for a broader range of sub-Saharan African countries to examine both rural-urban differences and differences across different degrees of remoteness based on proximity to 25,000 person cities (Headey, et al, 2017d). Strikingly, the results imply that proximity to cities is not important independent of its associations with wealth, education and access to services.…”

“…Some of the apparent link between month of birth and height for age is due to random errors in recorded birth months among children without birth registrations (Larsen, et al, 2019), but even after adjusting for those errors there is significant variation in attained height by season of birth (Finaret and Masters, 2019). Research to date has shown how sanitation, food markets and local infrastructure can help households protect their children from seasonal climate fluctuations (Mulmi, et al, 2016, Shively, 2017, Thapa and Shively, 2018, leading to new work focusing on specific kinds of smoothing such as year-round access to a nutritious diet (Headey, et al (2017d), (bai, et al, 2019).…”