For women, nutrition is not just about food but a socio-cultural construct

Indian Express

5 days ago

— Rituparna Patgiri
Post-independent India has faced a triple crisis of nutrition – undernutrition, overnutrition and micronutrient deficiencies. As per the Global Hunger Index (2020), India's position is 94 out of 107 countries. The Global Nutrition Report in 2020 also underlined that India is most likely to miss global nutrition targets by 2025.
These findings seem to align with the data released from the National Family Health Survey (NFHS-5) conducted by the Ministry of Health and Family Welfare (2019-21). The survey reported that among children under the age of five, 35.5 per cent are stunted, 19.3 per cent are wasted, and 32.1 per cent are underweight.
Although these figures have improved from the last round of survey conducted in NFHS-4 in 2015-16, nutrition still remains a concern. When it comes to women, nutrition is not just about food, but a socio-cultural construct. Let's explore.
The nutritional burden also has a gendered dimension. According to the NFHS-5 data, as many as 57 per cent of women aged 15-49 were anaemic in 2019-21, compared to 53 per cent in 2015-16. Nutrition is not just about food, but a socio-cultural construct. It is influenced by structural inequalities, gendered roles, household food distribution and cultural factors.
Notably, the prevalence of anaemia (57.2 per cent) was higher in non-pregnant women than in pregnant women (52.2 per cent). It shows that women, especially non-pregnant women, rarely receive special care and nutritious food sources. For instance, anthropological studies – such as Leela Dube's Women and Kinship: Perspectives on Gender in South and South-East Asia (1997) – show that customarily girls are denied milk except in the educated, upper middle-class.
Most are entitled to milk only in special circumstances such as lactation, illness and pregnancy. The neglect of menstrual health further leads to worsening rates of anemia, with 59 per cent of adolescent girls (15-19 years) found to be anemic, which poses increased risks during pregnancy and childbirth.
Apart from anemia, 33.1 per cent of girls under the age of five are stunted. This is a result of several factors, including anemic and malnourished mothers as well as less care after childbirth because of being born as girls. While wasting and underweight figures are similar for girls and boys, girls receive less health care and nutrition during illness.
Moreover, despite being responsible for managing the nutritional needs of their families, women are often the ones who eat less and last. These trends highlight inter-generational nutritional inequality. Children born to thin mothers, whose Body Mass Index (BMI) is less than 18.5 kg/m2 have higher probability of being stunted, wasted, and underweight.
Out of 28 states, the prevalence of anemia rose in 21. West Bengal and Gujarat have the highest rates. Assam, Chhattisgarh and Tripura experienced an increase by 15 percentage points, while Bihar, Karnataka, Madhya Pradesh, Punjab and Telangana recorded a rise of less than 5 percentage points.
Women from Scheduled Tribe (ST) communities face a higher risk of anemia, indicating a lack of access to healthcare. In comparison, women with higher education levels are less likely to be anemic, suggesting that education improves nutrition knowledge and leads to better dietary practices.
It needs to be underlined here that Kerala stands out for its relatively nutritional equity across gender due to high female literacy, late marriage and good reach of the public distribution system. Stunting in children decreases with improvements in mothers' educational and nutritional status. Contrastingly, children born to mothers with no access to schooling and in the lowest wealth percentile are more undernourished.
In this context, Sikkim is another notable state as it has focused on improving women's access to education and healthcare facilities. As such, Sikkim fares second best after Mizoram in the North-East with respect to gender and nutrition as per the NFHS-5 data. These numbers indicate the need for good governance and best practices at the local level to improve nutritional status, particularly of women.
Another emerging nutritional issue among Indian women is overnutrition. For the first time in the country's recorded history, there are more overnourished than undernourished women in the 15-49 year age group. Currently, 41.3 per cent of women are overweight or obese. This trend is more pronounced in urban areas where 33 per cent of women are overnourished compared to 21 per cent in rural areas.
As a result, women face a heightened risk of contracting non-communicable diseases like diabetes and hypertension. Most often, women are the primary caregivers and have limited or no time for self-care, health management, and physical activity.
In addition to this, women also have micronutrient deficiency as their diets often lack diversity, with protein intake missing significantly. The cultural norm of eating less and often eating last further impacts women's nutritional well-being.
The Indian Constitution recognises the Right to Food – access to adequate food and nutrition for every citizen – under the Right to Life as per Article 21. Article 47 of the Directive Principles of State Policy also places a duty on the state to raise the level of nutrition and public health. India has also committed to end hunger as per Goal 2 of the Sustainable Development Goals (SDGs) by 2030.
To address such concerns, the government has launched a number of policies and schemes. These include the Integrated Child Development Services (ICDS) launched in 1975, the National Nutrition Policy (1993), National Health Policy (2017), the Pradhan Mantri Matru Vandana Yojana (PMMVY) (2017) and Poshan 2.0 launched in 2021.
While most of the earlier initiatives focused on children, pregnant and lactating women, Poshan 2.0 expanded the lens to adolescent girls. Nutritional status is not determined only during pregnancy and childbirth. Improving nutrition and health requires a longitudinal approach. Poshan 2.0 also advocates for the use of technology, real-time monitoring using a digital tracking app (Poshan tracker) and behavioural change to improve nutrition.
While India has a significant number of policies and schemes, their implementation and performance vary across states and districts. Grassroot service providers like the Anganwadi workers are underpaid and overworked. Some studies also noted that at times, they also have to provide supplementary food items and take home ration (THR) packets from their own pockets. These factors demotivate them and affect the adequate delivery of childcare and nutritional services.
Nutrition is also connected with issues of social justice and healthcare and requires coordinated actions across multiple sectors and departments. While India has so far focused on undernutrition, there is now an emerging need to address the issue of overnutrition too. Adequately expanding the ambit of policymaking would help combat obesity and non-communicable diseases.
State-led initiatives, such as mid-day meals, THR packets, could incorporate more healthy and diverse diets. Promoting nutrition-sensitive agricultural practices and building private-public partnerships to deliver nutritional services would also help expand the reach and quality of nutritional services. Having a multi-disciplinary approach to nutritional policies by involving economists, sociologists, policy makers and nutritionists, and, more importantly, women representatives would also help them become more socially effective.
Nutrition is not just about food, but a socio-cultural construct. Comment.
The Indian Constitution recognises the Right to Food. How do you see this in the context of the cultural norm of women eating less and often eating last?
How does the nutritional status of women affect intergenerational health outcomes, particularly in children under five?
Do you think that overnutrition among urban women complicates the policy focus on undernutrition? Why and what could be the possible ways to address this?
There are noted variations in state-level performance with regard to women's nutritional status. What does this say about the role of governance and socio-cultural context in improving gendered nutrition outcomes?
(Rituparna Patgiri is an Assistant Professor at the Indian Institute of Technology (IIT), Guwahati.)
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