Over half of women and almost a quarter of men in India are anemic.Although pregnant women have the highest prevalence of anemia and are often targeted for anemia reduction interventions, non-pregnant women make up the largest number of individuals with anemia. Anemia affects both work capacity and productivity. Therefore, reducing anemia may also contribute to reducing gender wage gaps and women’s economic livelihood. Achieving gender inequality and empowering women and girls by 2030 is one of the United Nations sustainable development goals (SDGs) set in 2015.

In pregnant women, anemia can also lead to increased risk of premature birth, low birth weight, and maternal mortality.Iron deficiency during pregnancy and early childhood causes permanent reductions in children’s cognitive capacity and socio-emotional functioning that can impact their productive capacity across the life course.

In India, gender inequalities negatively affect women through male-dominated decision-making, economic and educational disparities, and the socialization of women to be “other oriented” at the expense of their own health.Research in low-/middle-income countries suggests that gender inequalities can affect preventive health behaviors, like contraception use, cervical cancer screening, and immunizations. Inequitablegender norms, or expectations around how men and womenare expected to behave, may also affect the intake of iron-rich foods and iron supplements, thus contributing to a higher prevalence of anemia among women.

Some of the ways that gender inequality has been shown to contribute higher rates of anemia is through male power and control over when and if a woman can leave the house. This may affect her ability to go to the health center to obtain iron folic acid supplements. Additionally, cultural norms around eating order, particularly in India, have been shown to affect anemia rates. Women often eat last in the family after the husband, in-laws, and children have eaten. Eating last may mean eating less altogether and specifically less iron-rich food such as meat, fish, and dark leafy vegetables, contributing to higher rates of anemia among women.

It is critical to understand the interconnectedness of anemia and gender inequality. Gender inequities exacerbate high rates of anemia among women and subsequently anemia affects a woman’s earning potential increasing gender inequities even more. Reducing gender inequities may ultimately reduce anemia and vice versa. Gender norms are increasingly globally recognized as critical drivers for overall health.

By Erica Sedlander, Sigur Center Field Research Grant Recipient for Summer 2019. Her work strives to improve women’s health both in the U.S. and globally. She uses mixed methods to examine multi-level factors that affect behavior changes. She serves as a Research Scientist in the Department of Prevention and Community Health and is a Doctoral Candidate in the Milken Institute School of Public Health. Erica’s work on women’s behavioral health can be found here.