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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.