District level disparities in multidimensional child malnutrition and effects of initial phase POSHAN Abhiyaan in India

This study examines spatial and temporal disparities in child malnutrition across Indian districts and assesses the impact of early POSHAN Abhiyaan implementation using multidimensional and quasi-experimental approaches. Drawing on NFHS-4 (2015–2016) and NFHS-5 (2019–2021) data, the composite MANUSH index is employed to capture multidimensional child malnutrition, validated through Linear Aggregation, Min–Max Normalization, and Principal Component Analysis. A Difference-in-Differences (DiD) framework is applied to estimate the causal effects of POSHAN Abhiyaan, while quantile regressions explore distributional impacts. Placebo tests further validate causal inferences. Results reveal significant spatial variations: Uttar Pradesh showed marked improvement, moving from “Extremely Alarming” to “Moderate” status and reducing “High-High” malnutrition clusters. Affluent states such as Maharashtra and Gujarat continue to exhibit persistently high malnutrition. DiD estimates confirm significant improvements in MANUSH scores in early POSHAN districts, with a 0.046-point greater reduction compared to non-POSHAN districts. The findings indicate that, despite national progress, substantial regional inequalities in child malnutrition persist, with tribal and marginalized districts of affluent states continuing to face severe challenges.