INTERNATIONAL FOOD POLICY RESEARCH INSTITUTEsustainable solutions for ending hunger and poverty 2.1 The causes of child malnutrition, death, and disability 2.2 Women's status, care for children, and children's birthweights 3.1 Distribution of index of women's relative decisionmaking power 3.2 Distribution of index of societal gender equality 4.1 Percentage of stunted, wasted, and underweight children, by region 4.2 Women's status indexes, by region 4.3 Predicted child nutritional status Z-scores, by indexes of women's status 4.4 Predicted probability of child malnutrition, by indexes of women's status 4.5 Effect of women's relative decisionmaking power on child weight-for-age Z-scores, South Asian countries 4.6 Effect of women's relative decisionmaking power on child weight-for-age Z-scores, Sub-Saharan African countries 4.7 Effect of women's relative decisionmaking power on child weight-for-age Z-scores, Latin American and Caribbean countries 4.8 Effect of societal gender equality on child weight-for-age Z-scores, South Asian countries 4.9 Effect of societal gender equality on child weight-for-age Z-scores, Sub-Saharan African countries 4.10 Effect of societal gender equality on child weight-for-age Z-scores, Latin American and Caribbean countries 5.1 Percentage of nonpregnant women with low and high body mass indexes 5.2 Predicted women's body mass index, by indexes of women's status 5.3 Predicted probability of a woman being malnourished, by indexes of women's status 5.4 Percentage of women who receive any prenatal care and who give birth in a medical facility 5.5 Predicted prenatal care variables, by indexes of women's status vii 5.6 Predicted probability of a woman giving birth in a medical facility, by indexes of women's status 6.1 Predicted breastfeeding variables, by indexes of women's status 6.2 Predicted complementary feeding variables, by indexes of women's status 6.3 Predicted health-seeking variables, by indexes of women's status 6.4 Type of caregiver while woman is working (%) 6.5 Predicted probability of child having an adult caretaker while mother is working, by women's status 7.1 Contribution of level difference in women's status to the child nutritional status gap between South Asia and Sub-Saharan Africa: A hypothetical graphical illustration 7.2 Contribution of effect difference in women's status to the child nutritional status gap between South Asia and Sub-Saharan Africa: A hypothetical graphical illustration B.1 Predicted probability of a woman having "high" status, by indicators of women's relative decisionmaking power B.2 Predicted probability of a woman having "high" status, by index of woman's relative decisionmaking power C.1 Creation of economic status groups: Destitute, poor, middle, and rich viii FIGURES Foreword Many researchers in the international development field have been startled to note that although child malnutrition is rampant in both Sub-Saharan Africa and South Asia, it is much more widespread in South Asia. According to other Millennium Development Goal indicators, chi...

hile ample evidence documents that urban children generally have better nutritional status than their rural counterparts, recent research suggests that urban malnutrition is on the rise. The environment, choices, and opportunities of urbanites differ greatly from those of rural dwellers-from employment conditions to social and family networks to access to health care and other services. Given these differences, understanding the relative importance of the various determinants of child malnutrition in urban and rural areas-and especially whether they differis key to designing context-relevant, effective program and policy responses for stemming malnutrition. Purpose of This Paper This study uses Demographic and Health Survey data from 36 developing countries to address the question of whether the socioeconomic determinants of child nutritional status differ across urban and rural areas. The purpose is to answer the broader question of why child malnutrition rates are lower in urban areas. The socioeconomic determinants examined are women's education, women's status, access to safe water and sanitation, and household economic status. The Data The research employs data from 36 of the most recent Demographic and Health Surveys conducted between 1990 and 1998 in South Asia, Sub-Saharan Africa (SSA), and Latin America and the Caribbean (LAC). The countries were chosen based on the availability of data on child nutritional status. The sample analyzed for this paper includes 129,351 children under age 3 and 117,007 women of childbearing age, usually their mothers. The DHS data sets are from nationally representative surveys of households. Due to similar survey instruments and data collection methodologies, the data are largely comparable across countries. The determinants of child nutritional status examined in the present research are all closely related to at least one of the three underlying determinants of child nutritional status-household food security, care for women and children, and quality of the health environment. These determinants are fundamental to a child's dietary intakes and health status, which are more immediately related to nutritional status. This study further divides these underlying determinants into two groups: "proximal" (mother's nutritional status, prenatal and birthing care for mothers, and caring practices for children), and "socioeconomic" (maternal education, women's status, access to safe water, access to sanitary toilet facilities, and economic status).

This paper is a product of the research consortium Transform Nutrition, and the Vulnerability, Hunger and Nutrition (VHN) research cluster and is funded by UK aid from the UK government. The views expressed do not necessarily reflect the UK Government's official policies. For more information see www.transformnutrition.orgThe Vulnerability, Hunger and Nutrition (VHN) research cluster at IDS produces research on nutrition and undernutrition, and our work with partners aims to inform and shape current debate. VHN researchers look at how to tackle the crisis of hunger and under nutrition. While undernutrition is increasingly a priority on the international development agenda, the knowledge base on how to accelerate undernutrition reductions has stalled. IDS's work, (which includes the Transform Nutrition Programme and the LANSA programme) aims to address this knowledge gap and promote better nutrition outcomes. This publication is copyright, but may be reproduced by any method without fee for teaching or non-profit purposes, but not for resale. Formal permission is required for all such uses, but normally will be granted immediately. For copying in any other circumstances, or for reuse in other publications, or for translation or adaptation, prior written permission must be obtained from the publisher and a fee may be payable. SummaryAs the post-MDG era approaches in 2016, reducing child undernutrition is gaining high priority on the international development agenda, both as a maker and marker of development. Revisiting Smith and Haddad (2000), we use data from 1970-2012 for 116 countries, finding that safe water and sanitation, women's education and empowerment, and the quantity and quality of food available in countries have been key drivers of past reductions in stunting. Income growth and governance played essential facilitating roles. Complementary to nutrition-specific and nutrition-sensitive programmes and policies, accelerating reductions in undernutrition in the future will require increased investment in these priority areas.

As the post-MDG era approaches in 2016, reducing child undernutrition is gaining high priority on the international development agenda, both as a maker and marker of development. Revisiting Smith and Haddad (2000), we use data from 1970 to 2012 for 116 countries, finding that safe water access, sanitation, women's education, gender equality, and the quantity and quality of food available in countries have been key drivers of past reductions in stunting. Income growth and governance played essential facilitating roles. Complementary to nutrition-specific and nutrition-sensitive programs and policies, accelerating reductions in undernutrition in the future will require increased investment in these priority areas.

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