Gender inequality and the Asian enigma of malnutrition
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With nearly one in three children in the country under-nourished, India is widely recognized to be a nutritional basket case. What is less widely known is the high level of malnutrition among pregnant Indian women, and how that adds to India’s malnutrition burden. A significant proportion of Indian women are known to be underweight. But the proportion of pregnant women who are underweight is significantly higher than the average proportion of underweight women in India, according to new research by the health economist Diane Coffey published in the Proceedings of the National Academy of Sciences (PNAS) journal.
Two factors combine to create an unfavourable situation for Indians. First, the average proportion of underweight women in India is higher than the average proportion of underweight women in sub-Saharan Africa. And as the chart below shows, the difference between the proportions of underweight women in the two regions is highest among young women.
Secondly, a greater proportion of young women become pregnant in India compared to sub-Saharan Africa. As the second chart shows, the distribution of pregnant women is heavily skewed in the country, with most women giving birth at an early age.
Given the lower age at which they give birth and the higher risk of being under-nourished then, the average pregnant woman in India is significantly worse off than her sub-Saharan counterpart. Coffey estimates that 42.2% of Indian women are underweight when they begin pregnancy compared with 16.5% of African women.
“In both regions, women gain little weight during pregnancy, but because of prepregnancy deficits, Indian women end pregnancy weighing less than African women do at the beginning,” writes Coffey.
Greater under-nutrition among pregnant women in turn raises the risks of low birth weight babies, who start life with a nutritional disadvantage right at birth. The proportion of low birth weight babies as well as the proportion of under-nourished children in India is higher than even poorer sub-Saharan countries.
To be sure, low birth weight explains only about half of India’s malnutrition burden. Many children with normal birth weights falter in growth owing to illnesses such as diarrhoea that diminish their ability to absorb nutrients. But while the absence of proper hygiene and sanitation which drive such diseases is increasingly being recognized as a major child-killer, the role of under-nourished women in perpetuating India’s malnutrition burden across generations gets less attention than it deserves.
Coffey’s research relies on data from demographic and health surveys, which were last conducted nearly a decade ago in India. According to a 2013 nutrition survey conducted by the ministry of women and child development, the proportion of underweight children has fallen 12.8 percentage points since 2005 to 30.7%. Given the lack of detailed data on the recent survey, it is impossible to conclude whether the findings are comparable to past demographic surveys, or to ascertain the precise change in the nutritional status of women in the country. But even if the progress in the fight against malnutrition in the country is real, India’s malnutrition burden is still higher than most other countries in the world. And it is unlikely that Indian women have been able to completely eliminate their nutritional disadvantage vis-à-vis African women over the past few years.
Coffey is of course not the first to write about the nutritional disadvantage faced by Indian women, although her work quantifies the disadvantage much more precisely as compared to earlier research. One of the first scholars to identify gender inequality, which led to lower food intake by women in South Asia, as a key driver of malnutrition in the region was the former director of the All India Institute of Medical Sciences (AIIMS) in New Delhi, Vulimiri Ramalingaswami.
In a widely cited 1996 article, Ramalingaswami and his co-authors drew attention to the sharp difference in malnutrition rates between children in South Asia and sub-Saharan Africa. Despite greater progress in the battle against poverty, South Asia faces a greater malnutrition burden than sub-Saharan Africa. One answer to the ‘Asian enigma’ of high malnutrition could lie in the low social status of women in the region, Ramalingaswami and his co-authors wrote.
The low social status of women in South Asia not only skews the distribution of food within the household against women but also leads to a disproportionately higher work load for them, adversely affecting child care. The low social status of women in South Asia is in turn tied to other unfavourable gender outcomes, such as the limited participation of women in South Asian economies, and their limited autonomy, as an earlier Mint essay argued.
Government interventions can help address these issues but such interventions may not be adequate given the deep roots of patriarchy in our society. Correcting gender inequality is not merely a public policy challenge but also a civilizational one.