Why are India’s women underweight? Nobody knows

Poor nutrition has long been a chief concern regarding the Indian population, especially when it comes to children. However, Indian women also suffer from undernourishment. A study published in March 2015 estimates that about 42% of the women in India are underweight before pregnancy. Many women, and young girls, are also anemic, meaning they lack enough iron in their blood. Together these conditions lead to poor birth outcomes. Moreover, there is little understanding of why these conditions prevail in India, which makes it difficult to change.

The study, by Diane Coffey of Princeton University, found that in India the underweight rate among pre-pregnant women is 7% more than the rate among all women 15-49 years old. Pre-pregnant women, meaning women who have never been pregnant, in India would fall into a narrow age range given how many women here have children very young. The underweight rate among pre-pregnant women in India is worse than sub-Saharan Africa, another region with high poverty, but where the underweight rate is about 16% for. Most astonishingly, even after gaining about 7 Kg on average during pregnancy, Indian women end their pregnancy weighing less than African women at the beginning of their pregnancy.

When it comes to anemia, Indian women again fare much worse than those in sub-Saharan Africa. An article on Humanosphere, a Web site that covers global health and development, cites UNICEF estimates that put the rate of anemia at 60% among South Asian women comparted to 40% in Africa. An estimated 83% of pregnant Indian women and an equally alarming 80% of young Indian girls are anemic. Anemia during pregnancy can make the mother feel more tired, cause preterm births and result in less healthy babies.

According to Humansophere, while the thinking in general is that reducing poverty also leads to reducing malnutrition, this correlation does not seem to hold in India. In the case of anemia, such high prevalence rates means that it isn’t just an issue for the poor, even those in the middle class are affected. There are many likely reasons for these lopsided figures in India and so far no single one has been shown to be the primary one.

One reason that has been proposed is that traditionally women eat after everyone else in the family has finished, leaving them without enough, a form of gender discrimination. However, women are also discriminated against in Africa, yet women there don’t have such high rates of being underweight and anemic. Moreover, even among Indian men aged 40-50, who generally hold the head status in households and presumably get priority in nutrition, the underweight prevalence is 25 percent. According to Coffey, “Although certainly important, discrimination against young women is not the only reason why maternal health is so poor.”

Other reasons could be poor diet and a lack of knowledge about nutrition. Yet another could be poor sanitation. A few recent studies have found open defecation to be a factor. Addressing these factors seems to have made a difference in Bangladesh, which has shown consistent progress against malnutrition over the past 20 years. What is needed in India is a comprehensive review of the problem, potential causes and solutions.

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