Anaemia, burden of contraception, high BMI: How the average Indian woman fares

A data-driven look at how the average woman in India is doing based on statistics from the last three National Family Health Survey (NFHS).
A woman in a pink kurta and red dupatta squatting beside a wood fire stove and cooking
A woman in a pink kurta and red dupatta squatting beside a wood fire stove and cooking
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International Women’s Day was celebrated worldwide last month. Amidst inspirational stories, messages and initiatives, we took a data-driven look at how the average woman in India is doing. Over 88% women are literate today. Women in India are on par with men in educational performance and participation at the higher education level. However, their labour force participation remains abysmally poor. At 17.6%, it is among the lowest globally. Women’s access to education has improved significantly, but not their employment.

Similarly, women’s access to healthcare has improved but not their health, unfortunately. Women’s health forms a cornerstone of overall public health, having a cyclical influence on newborn and child health. We turn to data from the National Family Health Survey (NFHS), a large-scale, multi-round survey conducted in a representative sample of households throughout India, from 2006 (NFHS 3), 2016 (NFHS 4) and 2020 (NFHS 5) to get a glimpse.

We must keep in mind that the latest iteration of NFHS was conducted prior to the COVID-19 pandemic and the nation-wide lockdown. The extent of the influence of the pandemic on health services and women’s health remains to be seen. We look at 22 states/UTs for which data is currently available.

Among the many systemic factors that influence a woman’s health, her access to money and knowledge, and the agency to make decisions are important factors in her ability to take care of her health. This survey looks at the autonomy of women through four major lenses – education, financial inclusion, digital literacy and participation in household decisions. Over the years, we see a good improvement in all parameters.

General health & nutrition

Has this positive change led to improvement in women’s health overall though? Here are some indicators:

Just about 60% of women fall in the normal weight (BMI) category, 40% are either overweight or underweight. A staggering number of women – above 50% – are anaemic.

The proportion of women who are overweight surpasses those who are underweight in all the surveyed states, except Bihar, Assam and Gujarat. In addition to BMI, the latest NFHS also looked at a new indicator – high risk waist-to-hip ratio (WHR), a determinant of heart disease along with BMI – and found that close to 62% of women fall under the high-risk category. Along with an overall increase in BMI, we also see an increase in blood pressure and blood sugar levels.

Overall, urban women have higher BMI, WHR, blood pressure and blood sugar than women in rural areas. This is even more pronounced in the southern states. Further, one in two women in the surveyed states is anaemic, with an upward trend over the last 5 years. Rural women have higher rates of anaemia and higher rates of low BMI than urban. There seems to be a decline in overall wellness based on general health indicators, and the urban and rural areas pose very different challenges.

Sexual & reproductive health

The good news here is that good menstrual hygiene among women has seen a rise, with rural areas showing a steeper increase. Teenage pregnancies are on the decline overall, but rural areas need to improve further.

Among the contraceptives used, female sterilisation ranks the highest, contributing to over half the contraception methods used in India, while male sterilisation ranks the lowest. The Male to Female Sterilisation ratio stands at a staggering 1:60. While 30% of women in the reproductive age are sterilised, only 0.5% of men are. The burden of contraception falls disproportionately on women, though the male sterilisation process is a lot less invasive as a medical procedure.

Maternal health

Total Fertility Rate (number of children per woman) has declined from 2.7 in 2006 to 1.8 in 2020. At the national level, the Maternal Mortality Rate (MMR) has seen a welcome decrease from 20.07 in 2007 to 8.17 in 2018 (source: Sample Registration System, released annually by the Census Board). Yet much more needs to be achieved when it comes to healthier pregnancies and thus healthier offspring.

While folic acid consumption has increased over the years, anaemia in pregnant women continues to go up. Anaemia is known to significantly raise the risk of death during pregnancy, and poor motor and mental growth in children. Anaemia in non-pregnant women is actually higher than in those pregnant, underlining the need for sustained supplementation and better nutrition for women longer term and not just during pregnancy.

Malnutrition has been a widespread and chronic problem in India. Particularly in the case of women, it creates a vicious ‘malnutrition trap’ with cycles of malnourished mothers and malnourished babies over generations. Government schemes focus on providing supplementary nutrition through Anganwadis to pregnant and lactating mothers. But that’s a short-term measure. Large scale prevalence of chronic malnutrition and anaemia is partly also due to over-emphasis on growing starchy grains (rice and wheat) due to incentivisation through policies such as MSP, and the public distribution system that feeds more than 80 crore Indians by distributing only these grains. Food security is not the same as balanced nutrition.

Women’s good health is a combination of many factors, including right nutrition, good healthcare, menstrual hygiene, good sexual and reproductive health, sanitation facilities and more. Today with half the women in India being anaemic, increasing numbers outside of the normal weight category, and the rising incidence of elevated blood pressure and sugar – we certainly need a wider focus on women’s health, beyond maternal care alone. That would be an apt action and celebration for Women’s Day.

Authored by Team, India Data Insights, Sattva Consulting.

Views expressed are the author’s own.

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