Prepregnancy body mass and weight gain during pregnancy in India and sub-Saharan Africa

Abstract

Despite being wealthier, Indian children are significantly shorter and smaller than African children. These differences begin very early in life, suggesting that they may in part reflect differences in maternal health. By applying reweighting estimation strategies to the Demographic and Health Surveys, this paper reports, to my knowledge, the first representative estimates of prepregnancy body mass index and weight gain during pregnancy for India and sub-Saharan Africa. I find that 42.2% of prepregnant women in India are underweight compared with 16.5% of prepregnant women in sub-Saharan Africa. Levels of prepregnancy underweight for India are almost seven percentage points higher than the average fraction underweight among women 15-49 y old. This difference in part reflects a previously unquantified relationship among age, fertility, and underweight; childbearing is concentrated in the narrow age range in which Indian women are most likely to be underweight. Further, because weight gain during pregnancy is low, averaging about 7 kg for a full-term pregnancy in both regions, the average woman in India ends pregnancy weighing less than the average woman in sub-Saharan Africa begins pregnancy. Poor maternal health among Indian women is of global significance because India is home to one fifth of the world's births.

Keywords: India; maternal health; nutrition; sub-Saharan Africa.

Fig. 1.

Underweight by age (among nonpregnant women) and pregnancy by age in India and sub-Saharan Africa. Epanechnikov kernel-weighted local polynomial regressions. Data from India are shown in red; data from sub-Saharan Africa are shown in blue. Underweight women have a BMI < 18.5 kg/m².

Fig. 2.

Estimated CDFs for prepregnant women and empirical CDFs for 3, 6, and 9+ mo of gestation. Estimated CDFs for prepregnant women are shown in black for in India (Left) and sub-Saharan Africa (Right). These are estimated using the extended reweighting function described in Materials and Methods. Red curves represent empirical CDFs for Indian women at 3, 6, and 9+ mo of gestation (left to right). Blue curves present empirical CDFs for African women at 3, 6, and 9+ mo of gestation.