girls.<sup>15</sup> The results of the simulation (table 7) show only minor changes in the aggregate height-for-age z-scores when the mortality rates are increased from 5 – 8 percent (table 1) to 15 percent. The changes are statistically significant for the samples of boys and girls in 1998 and for the sample of boys in 2005, but even in these cases the magnitudes of the changes have not exceeded 3 percent.

# **V. Conclusion**

This paper used data from three rounds of a nationally representative health survey in India to assess the magnitude of the bias in children‘s anthropometrics due to selective mortality. The nutritional status of the child population was simulated under the counterfactual scenario that all children who had died in the first three years of life were alive at the time of measurement. These simulations imputed various values of heightfor-age z-scores to the sample of dead children. The simple simulations, with imputed z- scores that are independent of the child‘s characteristics, show that, at the rates of child mortality prevailing in India in 1992–2005, the selective mortality could have only a moderate impact on overall anthropometric measures. The imputations based on the literature on the association between child mortality and nutrition result in only a 5 percent difference between the counterfactual and the actual height-for-age z-scores.

The simulations based on the hazard model that takes into account differences in mortality and anthropometrics related to child characteristics are consistent with the observation that malnourished children are less likely to survive and thus to contribute to anthropomorphic measurements. However, the results also show that with the current low (and declining) mortality rates by historical standards, improved survival rates have an insignificant impact on overall height-for-age z-scores. The _changes_ in mortality between 1992 and 2005 imply that some malnourished children who would previously have died instead survived and are measured in the 2005 survey. To the degree that selective mortality affects overall malnutrition levels or rates, the reductions in child mortality mask some of the improvement in nutrition. However, the results of this study suggest that progress on the fourth Millennium Development Goal to reduce child mortality only lightly obscures the results for the target for the first Millennium Development Goal to reduce malnutrition and hunger.<sup>16</sup> Similarly, the findings imply that differences in mortality are unlikely to explain gender differences in anthropometrics—or their absence. While the NFHS data do not

> **15** This rate corresponds to the high mortality rate of 14.2 percent observed among boys in Cote d‘Ivoire in 1998.  The rate for Cote D‘Ivoire was the highest mortality rate from 30 DHS of African countries reviewed.

> 16 This target is measured in terms of underweight rather than height for age. Underweight is somewhat easier to measure in a survey covering young children, though height for age is a clearer indicator of cumulative health. While underweight rates and stunting rates often differ, trends in the two tend to move together.

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