Two fifths of pregnant women in India are underweight

More women in India are underweight at the start of pregnancy than those in sub-Saharan Africa, a study has found.

India has no national monitoring system for health in pregnancy. Diane Coffey, from Princeton University in the United States and a visiting researcher at the Centre for Development Economics of the Delhi School of Economics, used data from the Demographic and Health Survey in 2005 to estimate the body mass index of women in India and sub-Saharan Africa before they became pregnant and how much weight they gained during pregnancy.

The survey found that 35.5% of women aged 15 to 49 were underweight. However, this figure was probably an underestimate. To get a more accurate figure Coffey used reweighted techniques to adjust for the age at which women are most likely to be pregnant in India, which is between 18 and 25, and other characteristics including education, rural or urban residence, and number of living children.

Reporting in the Proceedings of the National Academy of Sciences, Coffey found that 42.2% of women in India were underweight when they began pregnancy, compared with 16.5% of women in sub-Saharan Africa.1 Before pregnancy, women in India had an average BMI of 19.1 compared with 21.5 among women in Africa.

Coffey also found that women in both regions gained only about 7 kg during pregnancy, which is approximately 60% of the weight gain recommended by medical guidelines. At the end of their pregnancies women in India weighed less than sub-Saharan women did at the start of their pregnancies.

The findings showed that maternal nutrition in India was deficient and was likely to be an important cause of poor nutritional outcomes for children, Coffey concluded. She told The BMJ, “When women are underweight before pregnancy, and do not gain adequate weight during pregnancy, their babies are more likely to be born at low birth weights. Low birth weight babies are more likely to die in infancy. Those that survive are more likely to be stunted, both physically and cognitively.

“Because of links between maternal nutrition, child stunting, and a child’s future economic productivity, poor health during pregnancy has severe repercussions for both the health of the Indian population and for the Indian economy.”

The Indian government could be doing much more to address maternal malnutrition, she said. “The government should immediately implement a national monitoring system to get real time measurements of health in pregnancy. In terms of programmes, the 2013 National Food Security Act has a provision for universal maternity benefits of Rs6000 (£63; €87; $97), which would likely have been very helpful for pregnant women. It is shocking and disappointing that [the] budget [announced on 28 February] did not allocate funds to implement this programme, despite the fact that it is actually written into the law.”