Understanding the Inequality of Opportunity in Stunting Among Chinese Children and Adolescents: An Urban–Rural Comparison

ABSTRACT Inequality of opportunity (IOp) in stunting arises when disparities are linked to observable circumstances beyond a child/adolescent's control, such as socioeconomic background or environmental characteristics. We use data from the 1991–2015 China Nutrition and Health Survey (CNHS) to investigate the overall level and temporal changes in inequality of opportunity (IOp) in stunting among Chinese children and adolescents aged 0–18 years while also investigating the underlying factors contributing to this inequality. Additionally, we identify the differences in IOp between children and adolescents in rural and urban areas, how these differences change over time, and how circumstances affect IOp differently in rural and urban areas. For the entire sample, the relative share of IOp in stunting in China is 3.34%, with similar levels in urban (3.47%) and rural areas (3.44%), possibly due to the presence of similarly disadvantaged subgroups in both settings, albeit driven by differing underlying factors of disadvantage. The IOp in stunting mostly stems from region and household socioeconomic status. Over time, the incidence of IOp in stunting has decreased, with differences between urban and rural children and adolescents shrinking. The contribution of parental health has become more significant over time. Heterogeneity analysis further revealed that boys, older children and adolescents, and those from the western region experienced greater IOp in stunting. Continued efforts are thus needed to improve access to affordable nutritious foods, healthcare, and nutrition education, especially in rural and Western China.