As the stunting risk associated with the nutritional status of the mother and child during pregnancy diminishes for older children, the stunting risk associated with the family’s ability to adequately supply nutrition to the child postnatally increases. Children in households that consume eggs, meat and milk or have tools that improve their capability to safely consume them are less likely to be stunted. The presence of a refrigerator and use of improved cooking fuels are both associated with lower stunting risk. Several possibilities might explain this. Both tools protect against illness (by lowering the degree of indoor air pollution and by preventing food spoilage and food borne illness) and facilitate care and feeding at home (a refrigerator enables households to purchase nutrient-rich perishable foods, cookstoves that use cleaner fuel can ease meal preparation and reduce cooking times).

Nearly 85 percent of children under-5 years of age in the Philippines reside in moderately or severely food insecure households that do not regularly consume protein-rich foods (as measured by consumption of ASFs at least once in the past week) (Tables 9 and 10). These children have 1.35 times the risk of stunting compared to children with a more favorable food security and diversity profile, controlling for socio-economic factors and other prenatal and postnatal stunting determinants (Tables 9 and 10). Around 23 percent of cases of stunting among children under-5 are attributable to inadequate household food security and diversity (Tables 9 and 10). Without measures of the actual frequency, quantity and quality of children’s diets in the NNS data it is unclear to what degree food security and diversity at the household level translates to child-level food consumption, but it is plausible that this relationship in part reflects the benefits of a higher quality diet enabled by food security and access to ASFs high in protein content. More research would help shed light on both the supply-side (such as the availability and price of ASFs in markets) and demand-side (such as knowledge, traditions and preferences) constraints to diversity in children’s diets.

Energy intake from milk - but not breastmilk - by children between 6 and 24 months of age is associated with a reduction in stunting risk even after controlling for income and mother’s education (use of breastmilk substitutes is strongly associated with family income and mother’s education, reflecting a preference among mothers with more financial resources and education not to breastfeed). More research and data are needed to untangle the behaviors and factors associated with milk feeding that might help explain why it is associated with better nutrition.

There is some evidence that factors associated with children’s postnatal health reduce stunting risk. Among infants, access to improved drinking water is associated with a reduction in the risk of stunting. This effect possibly links with the low prevalence of exclusive breastfeeding in the Philippines and the potential prevention of illness among infants whose formula is prepared with clean water. Assistance during birth by a skilled practitioner is negatively associated with stunting for children between the ages of 2 and 5 years. Given that other measures of child health care utilization are not available in the NNS data for children in this age group, this predictor may be capturing the benefits of health seeking behaviors more broadly (for example, mothers who delivered in hospital may be more likely to vaccinate their children or seek professional health care in other situations, such as when their child is ill).

Two socio-economic factors also emerge as important independent drivers of child nutrition in this analysis. Infants under the age of 6 months in single-mother households have an elevated stunting risk relative to children in two-parent households, possibly reflecting the greater burden of caretaking and housework that single mothers face. Children over the age of 2 with university educated mothers have a lower risk of stunting, possibly reflecting the role of formal education in facilitating the acquisition of knowledge - either directly or through expanded social networks - for more effective meal selection and feeding practices.

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