Hostname: page-component-848d4c4894-xm8r8 Total loading time: 0 Render date: 2024-06-28T21:43:04.110Z Has data issue: false hasContentIssue false

Who is Anaemic in India? Intersections of class, caste, and gender

Published online by Cambridge University Press:  04 June 2024

Bikash Das*
Affiliation:
Department of Humanities and Social Sciences, Indian Institute of Technology Guwahati, Guwahati, Assam, India
Mihir Adhikary
Affiliation:
Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, Maharashtra, India
Smriti Rekha Singha
Affiliation:
Department of Humanities and Social Sciences, Indian Institute of Technology Guwahati, Guwahati, Assam, India
Daksha Parmar
Affiliation:
Department of Humanities and Social Sciences, Indian Institute of Technology Guwahati, Guwahati, Assam, India
*
Corresponding author: Bikash Das; Email: [email protected], [email protected]

Abstract

Anaemia severely impacts physical and mental abilities, raises health risks, and diminishes the quality of life and work capacity. It is a leading cause of adverse pregnancy outcomes and maternal mortality, especially in developing nations like India, where recent data on anaemia from National Family and Health Survey (NFHS-4) (2015–16) and NFHS-5 (2019–21) indicate a tremendous rise. Anaemia is a marker of poor nutrition and health, and socio-economic factors such as gender norms, race, income, and living conditions influence its impact. As a result, there are disparities in how anaemia affects different segments of society. However, existing research on health inequity and anaemia often employs a single-axis analytical framework of social power. These studies operate under the assumption that gender, economic class, ethnicity, and caste are inherently distinct and mutually exclusive categories and fail to provide a comprehensive understanding of anaemia prevalence. Therefore, the study has adopted the theoretical framework of intersectionality and analysed the NFHS-5 (2019–21) data using bivariate cross-tabulations and binary logistic regression models to understand how gender, class, caste, and place of residence are associated with the prevalence of anaemia. The results suggest that the women of Scheduled Tribes (ST) and Scheduled Castes (SC) share a disproportionate burden of anaemia. This study confirms that economic class and gender, geographical location, level of education, and body mass index significantly determine the prevalence of anaemia. The ST and SC women who are economically marginalised and reside in rural areas with high levels of poverty, exclusion, and poor nutritional status have a higher prevalence of anaemia than other population groups. Thus, the study suggests that intersections of multiple factors such as caste, class, gender, and place of residence significantly determine ‘who is anaemic in India’.

Type
Research Article
Copyright
© The Author(s), 2024. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abalkhail, B and Shawky, S (2002) Prevalence of daily breakfast intake, iron deficiency anaemia and awareness of being anaemic among Saudi school students. International Journal of Food Sciences and Nutrition 53(6), 519528.CrossRefGoogle ScholarPubMed
Abbas, S, Isaac, N, Zia, M, Zakar, R and Fischer, F (2021) Determinants of women’s empowerment in Pakistan: evidence from Demographic and Health Surveys, 2012–13 and 2017–18. BMC Public Health 21(1), 114.CrossRefGoogle ScholarPubMed
Acharya, SS (2022) Persistent Inequalities in Health-Contextualising the Neglect of Ambedkar’s Contribution. In Sanghmitra, Kale RK and Acharya, SS (Eds) Mapping Identity-Induced Marginalisation in India: Inclusion and Access in the Land of Unequal Opportunities. Singapore: Springer Nature Singapore.Google Scholar
Alvarez-Uria, G, Naik, PK, Midde, M, Yalla, PS and Pakam, R (2014) Prevalence and severity of anaemia stratified by age and gender in rural India. Anaemia 2014, 176182.Google ScholarPubMed
Annan, J, Donald, A, Goldstein, M, Martinez, PG and Koolwal, G (2021) Taking power: women’s empowerment and household well-being in Sub-Saharan Africa. World Development 140, 105292.CrossRefGoogle Scholar
Arlappa, N, Balakrishna, N, Laxmaiah, A and Brahmam, GNV (2010) Prevalence of anaemia among rural pre-school children of West Bengal, India. Annals of Human Biology 37(2), 231242.CrossRefGoogle ScholarPubMed
Balarajan, Y, Fawzi, W and Subramanian, S (2013) Changing pattern of social inequalities in anaemia among women in India: cross sectional study using nationally representative data. BMJ Open, 3, e002233 CrossRefGoogle ScholarPubMed
Baru, R, Acharya, A, Acharya, S, Kumar, A and Nagaraj, K (2010) Inequities in access to health services in India: caste, class and region. Economic and Political Weekly 45(38), 4958.Google Scholar
Bharati, P, Shome, S, Chakrabarty, S, Bharati, S and Pal, M (2009) Burden of anemia and its socioeconomic determinants among adolescent girls in India. Food and Nutrition Bulletin 30(3), 217226.CrossRefGoogle ScholarPubMed
Bharati, S, Pal, M and Bharati, P (2020) Prevalence of anaemia among 6- to 59-month-old children in India: the latest picture through the NFHS-4. Journal of Biosocial Science 52(1), 97107.CrossRefGoogle ScholarPubMed
Biradar, R (2022) Anaemia status of preconception young married women in India. Journal of Biosocial Science 54(4), 672681.CrossRefGoogle ScholarPubMed
Borooah, V (2010) Inequality in health outcomes in India: the role of caste and religion. In Thorat, S and Newman, KS (Eds). Blocked by Caste: Economic Discrimination in Modern India. Oxford: Oxford University Press.Google Scholar
Carastathis, A (2014) The concept of intersectionality in feminist theory. Philosophy Compass 9(5), 304314.CrossRefGoogle Scholar
Chakravarti, U (2018) Gendering Caste: Through a Feminist Lens. New Delhi: SAGE Publications Pvt. Limited.CrossRefGoogle Scholar
Cole, ER (2009) Intersectionality and research in psychology. American Psychologist 64(3), 170.CrossRefGoogle ScholarPubMed
Crenshaw, K (1989) Demarginalizing the intersection of race and sex: a black feminist critique of antidiscrimination doctrine, feminist theory, and antiracist politics. Feminist Legal Theory 1989, 5780.Google Scholar
Daru, J (2022) Sustainable development goals for anaemia: 20 years later, where are we now?. The Lancet Global Health 10(5), e586e587.CrossRefGoogle ScholarPubMed
Das, B, Hossain, M and Roy, PB (2022) Caste, social inequalities and maternal healthcare services in India: evidence from the national family and health survey. Contemporary Voice of Dalit OnlineFirst. 128. https://doi.org/10.1177/2455328X2211256 Google Scholar
De, M, Halder, A, Chakraborty, T, Das, U, Paul, S, De, A, Banerjee, J, Chatterjee, T and De, S (2011) Incidence of anaemia and effect of nutritional supplementation on women in rural and tribal populations of eastern and north-eastern India. Hematology 16(3), 190192.CrossRefGoogle Scholar
De la Cruz-Góngora, V, Méndez-Gómez-Humarán, I, Gaona-Pineda, EB, Shamah-Levy, T and Dary, O (2022) Drops of capillary blood are not appropriate for hemoglobin measurement with point-of-care devices: a comparative study using drop capillary, pooled capillary, and venous blood samples. Nutrients 14(24), 5346.CrossRefGoogle Scholar
Didzun, O, De Neve, JW, Awasthi, A, Dubey, M, Theilmann, M, Bärnighausen, T, Vollmer, S and Geldsetzer, P (2019) Anaemia among men in India: a nationally representative cross-sectional study. The Lancet Global Health 7(12), e1685e1694.CrossRefGoogle ScholarPubMed
Dill, BT and Zambrana, RE (2020) Critical thinking about inequality: an emerging lens. In McCann, C, Kim, SK and Ergun, E (Eds) Feminist Theory Reader. New York: Routledge.Google Scholar
Doyal, L (1995) What Makes Women Sick: Gender and the Political Economy of Health. London: Macmillan Press Limited.CrossRefGoogle Scholar
Fiorati, RC, Arcêncio, RA and Souza, LBD (2016) Social inequalities and access to health: challenges for society and the nursing field. Revista Latino-Americana de Enfermagem 24, e2687.CrossRefGoogle ScholarPubMed
Gaiha, R and Kulkarni, V (2005) Anthropometric failure and persistence of poverty in rural India. International Review of Applied Economics 19(2), 179197.CrossRefGoogle Scholar
Garcia-Casal, MN, Dary, O, Jefferds, ME and Pasricha, SR (2023) Diagnosing anemia: challenges selecting methods, addressing underlying causes, and implementing actions at the public health level. Annals of the New York Academy of Sciences 1524(1), 3750.CrossRefGoogle ScholarPubMed
Ghosal, J, Bal, M, Ranjit, M, Das, A, Behera, MR, Satpathy, SK, Dutta, A and Pati, S (2023) To what extent classic socio-economic determinants explain trends of anaemia in tribal and non-tribal women of reproductive age in India? Findings from four National Family Heath Surveys (1998–2021). BMC Public Health 23(1), 856.CrossRefGoogle ScholarPubMed
Ghosh, P (2023) Determinants and transition of anaemia among under-five children from different social groups in India from 2005–06 to 2015–16. Social Science and Medicine 320, 115702.CrossRefGoogle ScholarPubMed
Ghosh, P (2023b) Undernutrition among the children from different social groups in India: prevalence, determinants, and transition over time (2005–2006 to 2019–2021). Journal of Racial and Ethnic Health Disparities. https://doi.org/10.1007/s40615-023-01796-y CrossRefGoogle ScholarPubMed
Ghosh, P, Hossain, M and Sarkar, S (2023) Inequality among social groups in accessing improved drinking water and sanitation in India: a district-level spatial analysis. The Professional Geographer 75(3), 361382.CrossRefGoogle Scholar
Ghosh, S (2009) Exploring socioeconomic vulnerability of anaemia among women in Eastern Indian States. Journal of Biosocial Science 41(6), 763787.CrossRefGoogle ScholarPubMed
Ghosh, S and Vinod, D (2017) What constrains financial inclusion for women? Evidence from Indian micro data. World Development 92, 6081.CrossRefGoogle Scholar
Goswmai, S and Das, KK (2015) Socio-economic and demographic determinants of childhood anemia. Jornal de Pediatria (Versão em Português) 91(5), 471477.CrossRefGoogle ScholarPubMed
Guru, G (1995) Dalit women talk differently. Economic and Political Weekly 30(41/42), 25482550.Google Scholar
Harari, L and Lee, C (2021) Intersectionality in quantitative health disparities research: a systematic review of challenges and limitations in empirical studies. Social Science and Medicine 277, 113876.CrossRefGoogle ScholarPubMed
Iyer, A, Sen, G and Östlin, P (2008) The intersections of gender and class in health status and health care. Global Public Health 3(S1), 1324.CrossRefGoogle ScholarPubMed
Jimenez, K, Kulnigg-Dabsch, S and Gasche, C (2015) Management of iron deficiency anaemia. Gastroenterology and Hepatology 11(4), 241.Google Scholar
John, ME (2015) Intersectionality: rejection or critical dialogue. Economic and Political Weekly 50(33), 7276.Google Scholar
Johnson-Wimbley, TD and Graham, DY (2011) Diagnosis and management of iron deficiency anaemia in the 21st century. Therapeutic Advances in Gastroenterology 4(3), 177184.CrossRefGoogle ScholarPubMed
Jungari, S and Chauhan, BG (2017) Caste, wealth and regional inequalities in health status of women and children in India. Contemporary Voice of Dalit 9(1), 87100.CrossRefGoogle Scholar
Kapilashrami, A, Hill, S and Meer, N (2015) What can health inequalities researchers learn from an intersectionality perspective? Understanding social dynamics with an inter-categorical approach?. Social Theory Health 13, 288307.CrossRefGoogle Scholar
Kassebaum, NJ and GBD 2013 Anaemia Collaborators (2016) The global burden of anaemia. Hematology/oncology Clinics of North America 30(2), 247308.CrossRefGoogle Scholar
Kaur, S, Bains, K and Kaur, H (2018) Anaemia among school-going children in the perspective of socio-economic disparity in Punjab, India. Journal of Applied and Natural Science 10(1), 230235.CrossRefGoogle Scholar
Khamis, M, Prakash, N and Siddique, Z (2012) Consumption and social identity: evidence from India. Journal of Economic Behavior and Organization 83(3), 353371.CrossRefGoogle Scholar
Kotecha, PV (2011) Nutritional anaemia in young children with focus on Asia and India. Indian Journal of Community Medicine: Official Publication of Indian Association of Preventive and Social Medicine 36(1), 816.CrossRefGoogle ScholarPubMed
Kumar, P, Sharma, H and Sinha, D (2021) Socio-economic inequality in anaemia among men in India: a study based on cross-sectional data. BMC Public Health 21, 112.CrossRefGoogle ScholarPubMed
Mahapatro, S, James, K and Mishra, U (2021) Intersection of class, caste, gender and unmet healthcare needs in India: Implications for health policy. Health Policy OPEN 2, 18.CrossRefGoogle ScholarPubMed
Maharatna, A (2011) How can “beautiful” be “backward”? Tribes of India in a long-term demographic perspective. Economic and Political Weekly 46(4), 4252.Google Scholar
Maity, B (2017) Comparing health outcomes across scheduled tribes and castes in India. World Development 96, 163181.CrossRefGoogle Scholar
Menon, N (2015) Is feminism about “women” a critical view on intersectionality from India. Economic and Political Weekly 50(17), 3744.Google Scholar
Milman, N (2011) Anaemia: still a major health problem in many parts of the world. Annals of Hematology 90(4), 369377 CrossRefGoogle Scholar
Mishra, A (2017) Putting the ‘social’ back in: social determinants of health as a methodological lens. In Nambiar, D and Muralidharan, A (Eds.), The Social Determinants of Health in India (pp. 2133). Singapore: Springer.CrossRefGoogle Scholar
Mog, M, Neogi, D, Bharadwz, M, Panda, B and Sil, A (2023) Prevalence and factors associated with anaemia in married women of reproductive age group: evidence from North East India. Journal of Biosocial Science 55(3), 425437.CrossRefGoogle ScholarPubMed
Mukhopadhyay, S (2015) The intersection of gender, caste and class inequalities in child nutrition in rural India. Asian Population Studies 11(1), 1731.CrossRefGoogle Scholar
Nagarajan, R (2023) NFHS-6 not to measure anaemia as experts point out method is faulty. The Times of India. https://timesofindia.indiatimes.com/india/nfhs-6-not-to-measure-anaemia-as-experts-point-out-method-is-faulty/articleshow/100538418.cms?from=mdr Google Scholar
Nair, R and Vollhardt, J R (2020) Intersectionality and relations between oppressed groups: Intergroup implications of beliefs about intersectional differences and commonalities. Journal of Social Issues 76(4), 9931013.CrossRefGoogle Scholar
NFHS (2019–2021) India Fact Sheet: National Family and Health Survey-5. Mumbai: International Institute for Population Sciences.Google Scholar
NFHS (2019) Clinical, Anthropometric and Biochemical (Cab) Manual 2019–2020. Mumbai: International Institute for Population Sciences.Google Scholar
Nguyen, P H, Scott, S, Avula, R, Tran, L M and Menon, P (2018) Trends and drivers of change in the prevalence of anaemia among 1 million women and children in India, 2006–2016. BMJ Global Health 3(5), 112.CrossRefGoogle Scholar
Para-Medina, D and Weber, L (2003) Intersectionality and women’s health: charting a path to eliminating health disparities. In Texler Segal, M, Demos, V and Kronenfeld, J J (Eds.), Gender Perspectives on Health and Medicine. Bingley: Emerald Group Publishing Limited.Google Scholar
Parveen, G (2014) Muslim women in India: problems and prospects. The Indian Journal of Political Science 75(2), 305314.Google Scholar
Patel, P, Das, M and Das, U (2018) The perceptions, health-seeking behaviours an access of scheduled caste women to maternal health services in Bihar, India. Reproductive Health Matters 26(54), 114125.CrossRefGoogle ScholarPubMed
Patnaik, S and Jha, S (2020) Caste, class and gender in determining access to energy: a critical review of LPG adoption in India. Energy Research & Social Science 67, 101530.CrossRefGoogle Scholar
Purdie-Vaughns, V and Eibach, R P (2008) Intersectional invisibility: the distinctive advantages and disadvantages of multiple subordinate-group identities. Sex roles 59(5), 377391.CrossRefGoogle Scholar
Rahman, M M, Abe, S K, Rahman, M S, Kanda, M, Narita, S, Bilano, V, Ota, E, Gilmour, S and Shibuya, K (2016) Maternal anaemia and risk of adverse birth and health outcomes in low-and middle-income countries: systematic review and meta-analysis. The American journal of clinical nutrition 103(2), 495504.CrossRefGoogle ScholarPubMed
Rege, S (1998) Dalit women talk differently: a critique of ‘difference’ and towards a Dalit feminist standpoint position. Economic and Political Weekly 33(44), WS39WS46.Google Scholar
Rohisha, I K, Jose, T T and Chakrabarty, J (2019) Prevalence of anaemia among tribal women. Journal of Family Medicine and Primary Care 8(1), 145.CrossRefGoogle ScholarPubMed
Roy, M, Bhatta, T and Burnette, J D (2020) Intersectional effects of gender, education, and geographic region on functional health disparities among older adults in India. Journal of Aging and Health 32(9), 11881197.CrossRefGoogle ScholarPubMed
Rush, D (2000) Nutrition and maternal mortality in the developing world. The American Journal of Clinical Nutrition 72(1), 212S240S.CrossRefGoogle ScholarPubMed
Sedlander, E, Talegawkar, S, Ganjoo, R, Ladwa, C, DiPietro, L, Aluc, A and Rimal, R N (2021) How gender norms affect anaemia in select villages in rural Odisha, India: a qualitative study. Nutrition 86, 111159.CrossRefGoogle ScholarPubMed
Sekhar, P S (2021) Health and nutrition: malnutrition and anaemia. In Sudhir, G, Bari, M A, Khan, AU and Shaban, A (Eds.), Muslims in Telangana: Dynamics of Asian Development (pp.147169). Singapore: Springer.CrossRefGoogle Scholar
Sen, A (2002) Why health equity? Health Economics 11(8), 659666.CrossRefGoogle ScholarPubMed
Sen, G, Iyer, A and Mukherjee, C (2009) A methodology to analyse the intersections of social inequalities in health. Journal of Human Development and Capabilities 10(3), 397415.CrossRefGoogle Scholar
Shaikh, M, Miraldo, M and Renner, AT (2018) Waiting time at health facilities and social class: evidence from the Indian caste system. Plos one 13(10), e0205641.CrossRefGoogle ScholarPubMed
Sharif, N, Das, B and Alum, A (2023) Prevalence of anaemia among reproductive women in different social group in India: cross sectional study using nationally representative data. Plos one 18(2), e0281015.CrossRefGoogle ScholarPubMed
Sidhu, S, Kumari, K and Uppal, M (2002) Prevalence of anaemia in schedule caste preschool children of Punjab. Indian Journal of Medical Sciences 56(5), 218221.Google ScholarPubMed
Singh, A, Ram, S, Singh, S and Tripathi, P (2022) Prevalence and determinants of anaemia among men in rural India: evidence from a nationally representative survey. Plos Global Public Health 2(12), e0001159.CrossRefGoogle ScholarPubMed
Srinivasan, K and Mohanty, S K (2004) Deprivation of basic amenities by caste and religion: empirical study using NFHS data. Economic and Political Weekly 39(7), 728735.Google Scholar
Subramanian, S V, Ackerson, L K, Subramanyam, M A and Sivaramakrishnan, K (2008) Health inequalities in India: the axes of stratification. The Brown Journal of World Affairs 14(2), 127138.Google Scholar
Sudhagandhi, B, Sundaresan, S, William, W E and Prema, A (2011) Prevalence of anaemia in the school children of Kattankulathur, Tamil Nadu, India. International Journal of Nutrition, Pharmacology, Neurological Diseases 1(2), 184188.Google Scholar
Swaminathan, S, Ghosh, S, Varghese, J S, Sachdev, H S, Kurpad, A V and Thomas, T (2019) Dietary iron intake and anemia are weakly associated, limiting effective iron fortification strategies in India. The Journal of Nutrition 149(5), 831839.CrossRefGoogle ScholarPubMed
Thomas, D, Chandra, J, Sharma, S, Jain, A and Pemde, H K (2015) Determinants of nutritional anemia in adolescents. Indian Pediatrics 52, 867869.CrossRefGoogle ScholarPubMed
Thorat, S (2002) Oppression and denial: Dalit discrimination in the 1990s. Economic and Political Weekly 37(6), 572578.Google Scholar
Thorat, S (2013) Caste, Social Exclusion and Poverty: Concept, Measurement and Empirical Evidences. New Delhi: Critical Quest.Google Scholar
Uddin, J, Acharya, S, Valles, J, Baker, E H and Keith, V M (2020) Caste differences in hypertension among women in India: diminishing health returns to socioeconomic status for lower caste groups. Journal of Racial and Ethnic Health Disparities 7(5), 987995.CrossRefGoogle ScholarPubMed
Vart, P, Jaglan, A and Shafique, K (2015) Caste-based social inequalities and childhood anaemia in India: results from the National Family Health Survey (NFHS) 2005–2006. BMC Public Health 15(1), 18.CrossRefGoogle ScholarPubMed
Vijay, J and Patel, K K (2021) Recommendations to scale up dietary diversity data at household and individual level in India. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 15(6), 102310.CrossRefGoogle ScholarPubMed
Weber, L (2010) Defining contested concepts. In Understanding race, class, gender and sexuality: A conceptual framework. New York: Oxford University Press.Google Scholar
World Health Organization (2001) Iron Deficiency Anaemia: Assessment, Prevention and Control: A Guide for Programme Managers. New York City: United Nations Children’s Fund, United Nations University, and World Health Organization.Google Scholar
World Health Organization (2014) Global Nutrition Targets 2025: Anaemia Policy Brief (WHO/NMH/NHD/14.4). Geneva: World Health Organization.Google Scholar
World Health Organization (2017) Nutritional anaemias: tools for effective prevention and control. Geneva: World Health Organization.Google Scholar
World Health Organization (2020) Global Anaemia Reduction Efforts Among Women of Reproductive Age: Impact, Achievement of Targets and The Way Forward for Optimizing Efforts. Geneva: World Health Organization.Google Scholar
Xaxa, V (2001) Protective discrimination: why scheduled tribes lag behind scheduled castes. Economic and Political Weekly 36(29), 27652772.Google Scholar
Yadav, U K, Ghimire, P, Amatya, A and Lamichhane, A (2021) Factors associated with anaemia among pregnant women of underprivileged ethnic groups attending antenatal care at provincial level hospital of Province 2, Nepal. Anaemia 2021, 8847472.Google ScholarPubMed
Yuval-Davis, N (2006) Intersectionality and feminist politics. European Journal of Women’s Studies 13(3), 193209.CrossRefGoogle Scholar