Parental Misperceptions on Child Nutrition in India

Policy Context

Child undernutrition is a major challenge worldwide and has been shown to have significant effects on mortality, physical and cognitive development, school completion rates and test scores, and earnings (Strauss and Thomas 2007, Smith et al. 2012, Hoddinott et al. 2008). India accounts for almost one-third of all the world’s stunted children (46.6 million) and half of the wasted children (25.5 million) (Fanzo et al. 2019). Previous studies have also documented a dissonance between actual and self-reported diet adequacy among individuals in India. Data from the National Sample Survey (2004-05) showed that the share of well-nourished rural households was only 24.2%, but 97.5% of the respondents reported that “everyone in their household got enough food every day” (Deaton and Dreze 2009). A policy report by the International Growth Center suggested that even in households with malnourished children, parents often believe that their children are adequately nourished, treating government supplementary nutrition programs as optional rather than essential (Abraham and Fraker 2014).

This project aims to examine the role of parental misperceptions and information gaps in contributing to the persistently high rates of child undernutrition in India. It is guided by two core hypotheses: 1) Parents systematically overestimate the nutritional status of their children (if parents form expectations about how healthy their child is by observing other children around them, then parents in areas with high levels of undernutrition may be more likely to believe that their own child is relatively healthy), and 2) Parents systematically underestimate the returns to child nutrition on long-term health, education, and labor market outcomes. These misperceptions, if proven true, may create a suboptimal equilibrium for child nutrition outcomes, trapping families in a cycle of inadequate nutrition. Moreover, improving child nutrition may have important externalities that are currently not accounted for by parents and researchers.

Study Design

The research design involves an individual-level randomized controlled trial with mothers of children aged 7-24 months in Telangana, India, implemented with the support of the Department of Women Development and Child Welfare (DWDCW). It includes two treatment arms and a control arm (N = 500 in each arm):

• Treatment 1 – Update mothers’ beliefs on the height-for-age and weight-for-age percentiles of their child relative to a reference group of healthy children based on WHO standards
• Treatment 2 – Treatment 1 + information on the impacts of child undernutrition on health (risk of chronic and infectious diseases, mortality), education (high school test scores, years of education), and labor market (earnings) outcomes, synthesized from existing literature

The main outcomes of interest are – a) willingness-to-pay (WTP) for a protein supplement/food bundle for the child, measured at the end of the baseline survey, b) beliefs on child nutrition, c) child feeding practices (frequency of meals, diet diversity, diet adequacy, protein consumption) measured through a 24-hour diet recall module, d) consumption of government-supplied therapeutic food, e) child height, weight, and anthropometric z-scores, f) child health outcomes: episodes of illness, g) household food expenditures, and h) child cognition measures, measured during the endline survey.

Results and Policy Lessons

Forthcoming.