research and policy advocacy for health & wellbeing in India.

Sanitation

Exploring the causes and consequences of widespread open defecation in India

Read More
Sanitation

Social Inequality

Understanding how social discrimination impacts child and maternal health in rural India

Read More
Social Inequality

Maternal Health

Exploring challenges and policy responses to adequate nutrition in motherhood to improve child health

Read More
Maternal Health

optimal guidelines: a pain in the gluteal region

Diane got bit by a dog a little the other day.  She's really quite fine, it was nothing.  There is every reason to believe this dog doesn't have rabies, but we decided to get Diane the post-exposure prophylaxis (she already had the pre shots, so she only needed the two follow-up shots).  Things have much progressed from the horrifying shots into the belly that I remember seeing pictures of in a library as a little boy: now it is just a shot in the arm. Surprisinly often, people tell me that we shouldn't be complaining about the improbability of India's Swatch Bharat Mission eliminating open defecation in the next 4.5 years, because the government has formulated such perfect, optimal guidelines.  But I'm increasingly persuaded that writing optimal guidelines is a deeply suboptimal approach: instead, we should be attempting to design robust policies, doing our very best to admit challenges at the outset and design systems to fail well and to achieve something valuable in a wide range of realistic scenarios. Anyway, apparently both nurses, at two separate facilities, very much wanted to give Diane her rabies shot in what the WHO guidelines delicately call the gluteal region.  It turns out, this...Read More..

  • Tags:

Sanitation in the new IFPRI Global Food Policy Report

GFPR14-15_ch03_fig01_744 This afternoon in Washington DC, IFPRI will release its new 2014-2015 Global Food Policy Report.  The report covers an impressive range of important topics.  Among them, is a chapter that I was honored to be asked to contribute, in collaboration with Lawrence Haddad: our chapter reviews the accumulating new evidence for the old observation that sanitation policy can be -- and should be -- part of nutrition policy. Much of the new evidence that has emerged in the last year or so is from careful observational studies, such as Derek Headey and John Hoddinott's work about Nepal, or Audrie Lin and coauthors in Bangladesh.  But a new -- and surprising large -- set of intervention studies is also emerging. One of the central points of our chapter is a reflection on a special challenge for intervention studies: you can only learn about the anthropometric consequences of a change in open defecation if you succeed in changing open defecation.  That is what the arrow diagram above is about: even if all you care about is the "second stage" effect of open defecation on child height, your ability to learn about it depends on your ability to achieve a "first stage" effect on open defecation.  Put...Read More..

  • Tags:

big numbers

states I'm often asked why I work in India rather than other places.  When I answer that it is substantially because there are so many people here, people sometimes react as though that is bafflingly irrelevant. I'm thinking of this today because I have been editing our paper that uses joint rural households to identify an effect of women's social status and empowerment on their children's health (that old draft will be replaced soon, with any luck).  This is a very important question: many development programs are built on the belief that empowering moms is a good way to improve their children's outcomes, but it turns out to be very difficult to conclusively show. In our paper, we were resisting the urge to apologize and wring our hands over the fact that, of course, not every Indian child lives an a joint rural household.  We are zooming in on a special case that we think we can learn from.  However, I stopped feeling apologetic when I realized that the number of children under 5 living in joint rural households in India is over 7 million -- approximately the total number of people of all ages living in Diane's and my home states...Read More..

  • Tags:

More articles covering Diane’s PNAS paper on maternal health in India

Dean posted yesterday about Diane's new paper in the PNAS, which showed that maternal nutrition in India was much worse than previously thought. As the abstract of the paper says, 42.2% of Indian women are underweight when they begin pregnancy compared with 16.5% of African women. In both regions, women gain little weight during pregnancy, but because of prepregnancy deficits, Indian women end pregnancy weighing less than African women do at the beginning. Apart from the New York Times, The Hindu and the Business Standard, the article was also covered by The Economic Times, NDTV, Deccan Chronicle and LiveMint. We imagine that more newspapers will follow through. We usually post news articles covering rice research in the news section, but since there are so many of them for this paper, we will just be posting the articles that have the most information on the news tab. Do share this important paper with your friends and colleagues. Update:  The article has also been covered now in the Reuters,  HuffPost India, British Medical Journal, and Quartz!...Read More..

  • Tags:

Nutrition in pregnancy in India far worse than believed: Coffey in PNAS, NYT, Hindu

photo Diane Coffey's new article "Prepregnancy body mass and weight gain during pregnancy in India and sub-Saharan Africa" was published today in the Proceedings of the National Academy of Sciences.   Diane's article is important because it shows that maternal nutrition in India is even worse than previously believed: 42.2 percent of women who become pregnant are underweight in India, compared with 16.5 percent in Africa. Weight gain in pregnancy is too low in both India and Africa, but the result is that women in India end pregnancy weighing less, on average, than women in Africa do when they begin pregnancy. “In India, young newly married women are at the bottom of household hierarchies,” Diane said to Gardiner Harris of the New York Times. “So at the same time that Indian women become pregnant, they are often expected to keep quiet, work hard and eat little.”       Check out more coverage of this research: "Study says pregnant women in India are gravely underweight." New York Times. The Hindu "Maternal Health in India Much Worse than Previously Thought." Princeton University's Woodrow Wilson School. "Maternal health in India worse than sub-Saharan Africa." Business Standard....Read More..

  • Tags:

We cook friendship here

MDM,Latehar(jessica pudussery) A recent ad on Mid-day meal Scheme in India, made by UNICEF and uploaded on Youtube by Ministry of Human Resource and Development, is exciting. It shows little kids sitting together and enjoying nutritious meals offered in their schools. The lyrics of the ad are, yahan dosti khob pakti hai, meethi- meethi se lagti hai, which means, we cook friendship here and it tastes sweet. Malnutrition is more common in India than in Sub-Saharan Africa. One in every three malnourished child in the world lives in India. To tackle malnutrition the Government of India is implementing its mid-day meal scheme, which offers meals in the state run or state assisted schools.  Proper nutrition in the early stages of life is critical to the development of the physical and cognitive potential of an individual. Abundant literature available on community health suggests, providing cooked meals at school reduces students’ protein, calorie and iron deficiencies. In addition to its benefit of reducing malnutrition among children, the mid-day meal also promote social harmony by eroding caste prejudices and promoting equality. Cooked meals at school enable children from all castes and classes to share food, an act which many Indians, due to the archaic notions...Read More..

  • Tags:

“begin by admitting the problem”: Diane on the CLTS knowledge hub

check out Diane's recent note summarizing our field research on the exceptional persistence of open defecation in rural India, online at the CLTS knowledge hub.  As she writes, uncomfortable conversations about sanitation  policy are going to be necessary if we are going to prevent many deaths and stunted lives. [caption id="attachment_2530" align="aligncenter" width="474"] they like big pits (and we should not lie)[/caption]...Read More..

  • Tags: