Poor sanitation can lead to environmental enteropathy, an intestinal disease preventing people from absorbing nutrition in their food, a cause of anaemia.
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‘Education may help women stand up for themselves within their families and ask for better food during pregnancy, which would reduce anaemia.’
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 NFHS-4 data. An anaemic, pregnant woman is more likely to die or deliver a baby lighter than normal, increasing chances of the infant's death. In 2011, 54 percent of pregnant women in India were anaemic, worse than Pakistan (50 percent), Bangladesh (48 percent), Nepal (44 percent), Thailand (30 percent), Iran (26 percent), Sri Lanka (25 percent), and Vietnam (23 percent), according to World Health Organisation (WHO) data. The trends suggest that, in 2015, India was still doing worse than neighbouring countries, even relatively poorer ones.
Mainly caused by blood loss, anaemia results from the lack of healthy, red blood cells or haemoglobin, a protein that binds oxygen. Common symptoms include light-headedness and fatigue.
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The eastern state of Bihar had the largest proportion of pregnant, anaemic women (58 percent); it also had the lowest literacy rate and improvement in sanitation, according to NFHS-4 data. In 2005, five states had a greater proportion of pregnant, anaemic women than Bihar, which has now displaced Assam to occupy the top spot after improvements in other states. The decline in Bihar was two percentage points over the decade to 2015.
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"The government should implement the universal Rs 6,000 cash transfer to pregnant women that was legislated by the 2013 National Food Security Act," Diane Coffey, visiting researcher at the Indian Statistical Institute, Delhi, told IndiaSpend. The money was supposed to allow pregnant women to access an "adequate quantity of quality food", as stated in the Act, hopefully leading to more nutrition in the diet.
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Only 25 percent households feature these improvements in Bihar, a 10 percentage-point increase since they were surveyed in 2005-06, but lowest among all states.
Madhya Pradesh, with 34 percent 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 percent households using improved sanitation facilities.
Poor sanitation can lead to environmental enteropathy, an intestinal disease preventing people from absorbing nutrition in their food, a cause of anaemia, according to this 2014 study. The intestinal disease is caused by exposure to faecal pathogens that result from poor sanitation.
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 percent Indians defecate in the open, according to Census 2011. The open-defecation rate was 35.5 percent in Nepal and 4.6 percent in Bangladesh, poorer developing countries, the same year.
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.
As many as 76 percent of Indian women are now literate, and the 14 states surveyed witnessed a 12 percentage-point average increase in female literacy.
Half of Bihar's women can now read and write, a 13 percentage-point increase over a decade. No more than 59 percent of women are literate in Madhya Pradesh, making it the state with the second-worst female literacy rate. This is in spite of a 15 percentage-point increase in female literacy, the largest increase reported, alongside Haryana.
As many as 89 per cent of women are now literate in Goa, followed by Sikkim (87 percent) and Manipur (85 percent).
On average, the 14 states surveyed saw a 12 percentage-point rise in women studying for at least a decade; 38 per cent women now do so. The largest increase was 19 percentage points in Tamil Nadu, followed by 18 in Sikkim and Karnataka.
Education may help women stand up for themselves within their families and ask for better food during pregnancy, which would reduce anaemia, Coffey suggested.
Source-IANS
