Poor women in urban areas were shorter, thinner and more anaemic as compared to those from higher wealth categories, according to a new study which calls for policy initiatives to focus on urban poor women to curb malnutrition.
The research aims at determining the levels and trends of different forms of malnutrition among urban poor women and look beyond mere averages for the entire urban population, which paints a rosier picture. It has also resulted in a skewed focus on rural areas because averages show that urban estimates of nutritional status are better than rural. It analyses data from two rounds of the Demographic Health Survey conducted during 2005-2006 (DHS-3) and 2015-16 (DHS -4). The study comes at a time the government’s policy think-tank, NITI Aayog, is working on a paper to improve nutrition services in urban areas as part of the National Nutrition Mission.
It is co-authored by Vani Sethi, Arjan de Wagt, Arti Bhanot and seven others and was published recently in peer-reviewed journal, Maternal and Child Nutrition .
The analysis includes women who delivered between two to less than five years and for whom anthropometric and biochemical data were available resulting in a sample of 5,458 and 20,876 urban mothers for DHS‐3 and DHS‐4. These were divided into four equal groups of population on the basis of wealth index or a household’s relative economic status. Among this sample of 5,458 urban women in DHS‐3 and 20,876 urban women in DHS‐4, 25% (1,387) and 30% (6,321) were in the lowest quartile by wealth index or poor.
The findings show that as per DHS-4, 12.8% of urban poor mothers were short, 20.6% thin, 13.7% overweight, 21.1% obese, 57.4% anaemic and 32.4% had moderate to severe anaemia. Prevalence of short stature was 4.4 percentage points higher among poor mothers compared with all urban mothers, thinness was 8.5 percentage points higher and moderate to severe anaemia was 4 percentage points higher. In contrast, prevalence of obesity was higher among all urban mothers compared with urban poor mothers by 11 percentage points. The prevalence of double burden of thinness and anaemia and thinness and short stature was also the highest among poor mothers. Poor indicators of different forms of malnutrition among mothers have implications for the growth of the foetus and are known to result in low birth weight.
The study also examines the socio-economic characteristics of urban poor mothers and finds that 49.3% of them were married before the age of 18 years as compared to 31.2% of all urban mothers, a quarter or more of the mothers among the urban poor were from the Scheduled Castes households as compared to 17% to 18% among all urban mothers and less than 40% of them in DHS-4 had a BPL card. Only 45% of urban poor mothers had secondary or higher education, while the urban average was at 53% in DHS‐4. Urban mothers were largely unemployed and a lower proportion of urban poor mothers had access to money, bank accounts and information on microcredit scheme.
The study proposes a greater focus on urban poor women while extending nutrition services as well as screening for anaemia. It also calls for a need to evolve new methods to ensure improved coverage of government schemes in urban areas as frontline health workers (ASHAS and Anganwadi workers) active in rural areas are unable to deliver results in cities because of various reasons, including higher population density. The study also harps on the need to ensure access to nutritious foods and counselling services and criticises the government for failing to address challenges of overweight and obesity in its National Nutrition Mission as the urban population and especially the poor are at a greater risk.
