Changing Landscape of Undernutrition in Reproductive-age Indian Women: Analysis of the Nationally Representative Data, 1998–2021

Aim: This study investigates the national and regional distribution and trend of undernutrition among nonpregnant 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/m 2 . Association between undernutrition and sociodemographic variables including caste, place of residence (rural and urban as reported in NFHS), marital status, educational level, and wealth index was examined using multiple logistic regression with multilevel modeling (MLM) and reported adjusted odds ratio (aOR). Results: A total of 461,093 women’s records were 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 the highest and lowest prevalence district >20%) were noted across the country. NFHS-5 data show that women who belong to the poorest wealth index (aOR 1.68; 1.6, 1.76), those 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 nonpregnant women has remained high in India. Interstate and intrastate disparities and inequalities among the various social groups visibly exist for this ignored health issue.