“Changing Landscape of Undernutrition in Reproductive-Age Indian Women: Analysis of the nationally representative data, 1998-2021”

Abstract Aim: This study investigates the national and regional distribution and trend of undernutrition among non-pregnant reproductive age-group (15-44 years) women in India based on the National Family Health Survey (NFHS) data round 2 (1998-99) to round 5 (2019-21). Subject and Methods: Undernutrition was defined as a body mass index (BMI) <18.5 kg/m². Association between undernutrition and socio-demographic variables including caste, place of residence (Rural and urban as reported in NFHS), marital status, educational level, and wealth index were examined using multiple logistic regression with multi-level modelling (MLM) and reported adjusted odds ratio (aOR). Results: A total of 461,093 women’s record was analyzed. The prevalence of undernutrition among women in the country reduced from 32.8% (n=22,890) in NFHS-2 to 27.1% (n=42,401) in NFHS-5 (average decadal reduction 2.7%). High intrastate variations (difference between highest and lowest prevalence district >20%) were noted across the country. NFHS-5 data shows that women belong to the poorest wealth index (aOR 1.68; 1.6, 1.76), up to preschool education (aOR 1.29; 1.23, 1.36), and unmarried women (aOR 1.54; 1.49, 1.59) are at risk of having undernutrition. Conclusion: Undernutrition among non-pregnant women has remained high in India. Inter-state and intra-state disparities and inequalities among the various social groups visibly exist for this ignored health issue.