Why Indian Children are much Shorter and Smaller than African Children

Kenya’s Mandera County is the most dangerous place in the world to give birth. It’s 135 times more dangerous to be pregnant in Mandera County than in the United States – according to the United Nations, about 38 mothers die in childbirth in Mandera County for every 1,000 live births, that’s two to three women a day.

However, according to a study published by Princeton University’s Woodrow Wilson School of Public and International Affairs, average maternal health in India – the world’s fastest-growing economy – is worse than in sub-Saharan Africa. 42.2% of Indian mothers are underweight when they begin pregnancy. The figure for sub-Saharan Africa is 16.5%. The average BMI (body mass index) of pre-pregnant women in India is 19.5%. The average pre-pregnancy BMI in sub-Saharan Africa is 21.5%.

Lead author Diane Coffey remarked:

“These findings should be a wake-up call about maternal nutrition in India. The health of children is one of the most important measures of the well-being of society and that starts during pregnancy. Infants whose mothers do not weigh enough when they are born are more likely to die in the first month of life. Infants born to undernourished mothers are also more likely to have low birth weight, which is associated with height and health in childhood and adulthood, as well as cognition and economic productivity.

“India must invest more in its most important resource: human capital formed at the very beginning of life. These findings point to the need for a national health monitoring system. That way we wouldn’t need to rely on outdated cross-sectional surveys to estimate these important indicators of maternal health.”

The study also found that a child raised in India is far more likely to be malnourished, than one from the Democratic Republic of Congo, Zimbabwe or Somalia – the world’s poorest countries. Coffey told The New York Times:

“In India, people are richer, better educated, and have fewer children than those in sub-Saharan Africa, so it’s really surprising that Indian children are shorter and smaller than those in sub-Saharan Africa. But when you step back and look at the state of Indian mothers, it’s not such a surprise after all.”

Sex differences in education, employment outside the home, and infant mortality are all greater in India than in sub-Saharan Africa – a primary rationale behind women’s pathetic maternal nutrition records in the Asian country. Coffey says there are two big reasons that explain big differences in maternal health in India and sub-Saharan Africa.

“The first is the status of women in Indian society. In India, young women who become mothers are severely discriminated against – they have to work hard, and are expected to be self-sacrificing, even to the extent of not eating enough in pregnancy. The status of young women in sub-Saharan Africa is much better.

“The second is diseases. Diseases caused by open defecation (parasites, cholera, diarrhoeal diseases, typhoid) affect adults as well as kids. Adults who are sick with intestinal diseases are skinnier than they would be if they were not sick – women in India would almost certainly weigh more during pregnancy if we could reduce open defecation. Open defecation in rural Africa is far less than in rural India, and population density is much lower.”

Since Indian women are often last in the family to eat, Coffey says, they tend to eat less, which results in low energy and low body mass [more than 90% of adolescent Indian girls are anemic]. Further, she attributes the pre-pregnancy underweight problem and women’s overall weak health in India to waterborne diseases and intestinal infections, while living in exceptionally poor disease environments [around 70% of rural Indian households defecate in the open].

“Throughout India, pregnant women and their babies suffer the consequences of living in a deeply patriarchal society. Young, newly married women, who are the most likely to become pregnant, are often expected to keep quiet, work hard and eat little.”

The US Institute of Medicine recommends that women who begin pregnancy underweight, must gain between 12.5 and 18 kg during pregnancy, and women who begin pregnancy at a normal weight, must gain between 11.5 and 16 kg. Coffey’s research found that on average, women in both regions gain only about 7 kg. However, since Indian women begin their pregnancy underweight, they end their pregnancy underweight, and increase their risk of complications during childbirth, which leads to high death tolls, as well as post birth, which results in malnutrition and stunting.

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