Partly in response to concerns about chronic undernutrition, there is an expanding effort at social protection in developing countries and this effort is typically focused on transfers targeted to poor families (as discussed in Chapter 10 of The Economics of Poverty). These policies regularly assume that targeting poor households suffices in reaching poor individuals. Is that right?
A new paper, “Are poor individuals mainly found in poor households?“, with Cait Brown and Dominique van de Walle, studies the effectiveness of these household targeting efforts when one is trying to reach poor individuals, as identified by the nutritional status of women and children. Our answers will surprise many readers.
As expected, there is a “wealth gradient” in that poorer families are more likely to include undernourished women and children. But other factors are at work, including intra-household inequality and shared risks from the health environment. In our comprehensive assessment for 30 countries in sub-Saharan Africa we find that undernourished women and children are spread quite widely across the household wealth and consumption distributions.
Strikingly we find that roughly three-quarters of underweight women and undernourished children are not found in the poorest 20% of households, and around half are not found in the poorest 40%. Countries with higher undernutrition tend to have higher shares of undernourished individuals in non-poor households.
It is clear from our results that to have any hope of reaching undernourished women and children in Africa, policy interventions will either require much more individualized intra-household information or they will need to be nearly-universal in coverage.