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<p>Despite improvements in maternal and child health in India, childhood stunting remains highly prevalent in socio-economically disadvantaged Aspirational Districts, where high-risk fertility behaviours (HRFBs) are also concentrated. Using data from the National Family Health Survey-5 (2019–21) on 39,855 children aged 0–59 months, this study examined the spatial distribution of childhood stunting and its association with maternal HRFBs across India’s Aspirational Districts. Descriptive statistics, exploratory spatial data analysis, spatial mapping, and multilevel mixed-effects logistic regression models were employed. Childhood stunting affected 41.3% of children in Aspirational Districts, exceeding the national average, while maternal HRFB prevalence was also substantially higher (35.7%) in these districts. Stunting prevalence increased progressively with HRFB exposure, rising from 38.3% among non-high-risk births to 50.8% among multiple-risk births. Significant positive spatial clustering was observed for childhood stunting (Moran’s I = 0.41), maternal HRFBs (0.36), and their bivariate spatial association (0.38) (all <i>p</i> &lt; 0.001), with convergence clusters concentrated across several districts in eastern and central India. Adjusted analyses showed that children exposed to single and multiple HRFBs had 20% and 36% higher odds of stunting, respectively, compared with children born without HRFB exposure. These findings underscore the importance of integrated, district-specific approaches addressing fertility-related risks and child nutrition in high-burden settings.</p>

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Maternal high-risk fertility behaviour and childhood stunting in Aspirational Districts of India using spatial and multilevel analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月21日

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  • Asif Ali,
  • Susanta Sen,
  • Amit Banerjee,
  • Namita Chakma

摘要

Despite improvements in maternal and child health in India, childhood stunting remains highly prevalent in socio-economically disadvantaged Aspirational Districts, where high-risk fertility behaviours (HRFBs) are also concentrated. Using data from the National Family Health Survey-5 (2019–21) on 39,855 children aged 0–59 months, this study examined the spatial distribution of childhood stunting and its association with maternal HRFBs across India’s Aspirational Districts. Descriptive statistics, exploratory spatial data analysis, spatial mapping, and multilevel mixed-effects logistic regression models were employed. Childhood stunting affected 41.3% of children in Aspirational Districts, exceeding the national average, while maternal HRFB prevalence was also substantially higher (35.7%) in these districts. Stunting prevalence increased progressively with HRFB exposure, rising from 38.3% among non-high-risk births to 50.8% among multiple-risk births. Significant positive spatial clustering was observed for childhood stunting (Moran’s I = 0.41), maternal HRFBs (0.36), and their bivariate spatial association (0.38) (all p < 0.001), with convergence clusters concentrated across several districts in eastern and central India. Adjusted analyses showed that children exposed to single and multiple HRFBs had 20% and 36% higher odds of stunting, respectively, compared with children born without HRFB exposure. These findings underscore the importance of integrated, district-specific approaches addressing fertility-related risks and child nutrition in high-burden settings.