Multilevel Determinants of Childhood Undernutrition among Low-Income Urban and Rural Households in the Philippines

Poverty plays a large role in childhood undernutrition; however, the interplay between context-specific economic, environmental, and social factors and food decisions of Philippine low-income households has yet to be fully explored, especially given wide variation between the characteristics of the country’s rural and urban areas. This paper aimed to identify and compare pathways of childhood undernutrition among 308 rural and 310 urban children from low-income households in the Philippines. Multidisciplinary analyses based on 24-hour dietary recalls, household surveys, focus-group discussions, field data, and secondary literature revealed that while the poor are more vulnerable to undernutrition, poor urban and rural children faced unique constraints that accounted for differing nutritional outcomes. Urban families utilized cheap processed-foods that shaped children’s dietary preferences towards sugars and fats, leading to vegetable avoidance and poor micronutrient adequacy. Rural households generally relied on home food production. However, rather than mitigate threats to undernutrition, agriculture heightened rural households’ risk to food insecurity, as the Philippines is vulnerable to crop-destroying tropical storms. Geographically-isolated rural communities were particularly disadvantaged because members had limited livelihood opportunities and could not access most social protection programs. Our findings suggest the need to strengthen local governance institutions to implement context-specific multisectoral interventions.