How Sanitation, Literacy Rate Affect Anaemic, Pregnant Women In India

The decline in anaemia among pregnant women (15 to 49 years) is correlated with improved sanitation and female education. says study.
  • In last decade, India saw a decline in proportion of anaemic pregnant women
  • Sikkim, with highest literacy rate, sanitation improvement, saw maximum dip
  • Bihar, on the other hand, still has 58% pregnant women with anaemia

By Charlie Moloney

In the last decade, India has seen a decline in the number of anaemic women. However, it still is home to more anaemic, pregnant women than any other country.

All the 14 states surveyed for the latest National Family Health Survey 2015-16 showed the proportion of anaemic, pregnant women has seen a drop to 45 per cent from 57 per cent a decade ago.

The decline in anaemia among pregnant women (15 to 49 years) is correlated with improved sanitation and female education, according to an IndiaSpend analysis of the survey data.

An anaemic, pregnant woman is more likely to die or deliver a baby lighter than normal, increasing chances of the infant’s death.

Where India stands in comparison with other countries

In 2011, 54 per cent of pregnant women in India were anaemic, worse than Pakistan (50 per cent), Bangladesh (48 per cent), Nepal (44 per cent), Thailand (30 per cent), Iran (26 per cent), Sri Lanka (25 per cent), and Vietnam (23 per cent), according to World Health Organisation  data.

The trends suggest that in 2015, India was still doing worse than neighbouring countries.

Sikkim shows highest decline in pregnant, anaemic women

From the 14 states surveyed, the largest decline was reported in Sikkim. 24 per cent of pregnant women are now anaemic in Sikkim.

The state not only improved its sanitation but also saw the second-largest increase in female literacy over 10 years from 2005-06 to 2014-15.

Sikkim is followed by Manipur (26 per cent) and Goa (27 per cent).

Bihar, on the hand, had the largest proportion of pregnant, anaemic women (58 per cent); it also had the lowest literacy rate and improvement in sanitation, according to National Family Health Survey 2015-16 data.

Bihar is followed by Madhya Pradesh and Haryana, both with 55 per cent of pregnant, anaemic women.

How can government intervene

“The government should implement the universal Rs 6,000 cash transfer to pregnant women that was legislated by the 2013 National Food Security Act,” said Diane Coffey, visiting researcher at the Indian Statistical Institute, Delhi.

The money was supposed to allow pregnant women to access an adequate quantity of quality food, as stated in the Act.

How better sanitation led to decline in pregnant, anaemic women

Poor sanitation can lead to environmental enteropathy, an intestinal disease preventing people from absorbing nutrition in their food, a cause of anaemia, according to a study.

Up to 88 per cent of households now use improved sanitation in Sikkim. Haryana saw the largest increase (39 percentage points) of households with improved sanitation.

Despite the increased usage of improved sanitation facilities, open defecation is still relatively high. As many as 54 per cent Indians defecate in the open, according to Census 2011.

Open defecation, argued Coffey, can lead to both environmental enteropathy and worms, closely linked to anaemia.

“The government should invest in teaching rural people about how affordable latrines work, and convincing people to use them, rather than simply building the kinds of latrines that rural people don’t want because they are concerned about pit emptying, a task they believe only untouchables can do,” Coffey said.

Better sanitation leads to lesser anaemic pregnant women

Sanitation improvement includes toilets connected to a sewer system, septic tank, pit latrine, ventilated improved pit/biogas latrine, pit latrine with slab, or twin pit/composting toilet not shared with other households.

Only 25 per cent households have sanitation improvements in Bihar.

Madhya Pradesh, with 34 per cent households using improved facilities, is the next worst state for sanitation improvements, as it is with anaemia.

Assam is the third worst, with only 48 per cent households using improved sanitation facilities.

How literacy rate affects anaemic rates amongst pregnant women

As many as 76 per cent of Indian women are now literate and the 14 states surveyed witnessed a 12 percentage-point average increase in female literacy.

50 per cent of women in Bihar are illiterate, followed by Madhya Pradesh where 41 per cent women cannot read and write.

On the hand, as many as 89 per cent women are now literate in Goa, followed by Sikkim (87 per cent) and Manipur (85 per cent).

Education may help women stand up for themselves within their families and ask for better food during pregnancy, which would reduce anaemia, Coffey.

(In arrangement with, a data-driven, non-profit, public interest journalism platform. Charlie Moloney is a multimedia journalist and has a BA (Hons) degree from the University of Birmingham, UK. The views expressed are those of IndiaSpend. Feedback at Read the report on IndiaSpend:


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