Effect of the Mahatma Gandhi National Rural Guarantee Act on infant malnutrition: a mixed methods study in Rajasthan, India

Thesis

Background

Malnutrition is a major risk factor of infant mortality in India. Policies targeting poverty and food insecurity may reduce infant malnutrition. The Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA), a wage-for employment policy of the Indian Government, targets deprivation and food insecurity in rural households. MGNREGA could prevent infant malnutrition by improving household food security or increase the risk of malnutrition by reducing the time devoted to infant care if mothers are employed. This study analyzed the effect and the pathways of effect of households’ and mothers’ participation in MGNREGA on infant malnutrition.

Methods

A community based mixed methods study using cross-sectional survey and focus group discussions (FGDs) was conducted in Dungarpur district of Rajasthan, India. Cross-sectional study included 528 households with 1,056 participants who were infants 1 to <12 months and their mothers/caregivers. Selected households were divided into MGNREGA-households and non-MGNREGA-households based on participation in MGNREGA between August-2010 and September-2011. Anthropometri indicators of infant malnutrition–underweight, stunting, and wasting (WHO criteria) were the outcomes. Eleven FGDs with 62 mothers were conducted.

Results

Of 528 households, 281 participated in MGNREGA (53%). Mothers were employed in 51 (18%) households. Prevalence of wasting was 39%, stunting 24%, and underweight 50%. Households participating in MGNREGA were less likely to have wasted infants (OR 0•57, 95% CI 0•37–0•89; p=0•014) and underweight infants (OR 0•48, 95% CI 0•30–0•76; p=0•002) than non-participating households. Stunting did not differ significantly between groups. Although MGNREGA reduced starvation, it did not confer food security to the participating households because of lower than standard wages and delayed payments. Results from path analysis did not support an effect through household food security and infant feeding, but suggested a pathway of effect through birth-weight. Mothers’ employment had no significant effect on the outcomes in the cross-sectional study, but the qualitative study indicated that it could compromise infant feeding and care.

Conclusion

Participation in MGNREGA was associated with reduced infant malnutrition possibly mediated indirectly via improved birth-weight rather than improved infant feeding. Providing child care facilities at worksites could mitigate the negative effects of mother’s participation in MGNREGA. Further, improving mothers’ knowledge of appropriate feeding practices in conjunction with providing employment (to address deprivation and food insecurity) is key in the efforts to reduce infant malnutrition.

Authors: Nair, M

• DOI: 10.5287/ora-mj2akzjnn
• Type of award: DPhil
• Level of award: Doctoral
• Awarding institution: University of Oxford
• Language: English
• Keywords: malnutrition; employment; social determinants; infant nutrition; policy
• Subjects: Public health