Household Headship and Inequality of Opportunity in Child Nutrition and Immunisation Coverage in India

This study explores the inequality of opportunity in nutrition and immunisation coverage among Indian children, with particular attention to household headship, using the most recent National Family Health Survey (NFHS)-5 (2019–2021) on children’s health indicators. Children’s health status was assessed through indicators such as stunting (height-for-age Z -score < −2), wasting (weight-for-height Z -score < −2), being underweight (weight-for-age Z -score < −2) and immunisation coverage (Bacillus Calmette–Guérin (BCG) vaccine, diphtheria, tetanus and pertussis (DTaP) vaccine, polio vaccine and measles vaccine). Children aged 0–59 months were included for nutritional assessment, and those aged 12–23 months were considered for immunisation. The study constructs the Human Opportunity Index to measure the inequality of opportunity considering household headship and employs Shapley decomposition to analyse the contributing factors to such an inequality. The findings reveal that households headed by women are more vulnerable to stunting in children compared to those led by men. Furthermore, children from the higher-income groups were observed to have a much lower chance of experiencing stunting, wasting or being underweight. Wealth status is also positively and significantly associated with immunisation coverage. The study shows that household wealth significantly shapes children’s health opportunities, reducing malnutrition and enhancing immunisation outcomes. Sanitation contributes to disparities in nutritional outcomes, particularly among underweight (18.8%) and wasted (17%) children. Religious beliefs were found to influence wasting in children (16.9%) and immunisation choices of households (21.8%), while female-headed households show modest effects (4% on wasting, 1.3% on stunting).