Unequal Households or Communities? : Decomposing the Inequality in Nutritional Status in South Asia

Half of all undernourished women and children in South Asia are not found in the bottom 40 percent of wealth-poor households. This paper quantifies the extent to which this inequality in nutritional status arises within households versus between households. In contrast to previous literature, it shows that between-household inequality explains 3.5 times as much of the variation as does inequality within households. Within the household, gender, age, and birth order are key correlates of nutritional outcomes. At the household level and accounting for community-level factors, both an index of sanitation infrastructure and the presence of an improved toilet matter independently to household wealth for nutritional outcomes. The paper concludes with a comparison of the effectiveness of targeting undernourishment using household wealth, a community sanitation infrastructure index, and, separately, the proportion of improved toilets in a community. The findings show that access to improved toilets, despite its relative simplicity, performs almost as well as household wealth and better than the community sanitation index. These findings highlight that (a) inequality between households within the same communities is an overlooked but important driver of inequality in nutritional status, and (b) community-level sanitation infrastructure may be a better indicator of nutritional status than more complicated household-level targeting measures