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    Underweight: A Persistent Negligence

    ChildrenChild mortalityUnderweight: A Persistent Negligence
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    Underweight: A Persistent Negligence

    The gendered distribution of food within families continues to socialize girls to eat last and less, often surviving on leftovers after male family members had eaten. The practices persist as the girls are socially taught self-denial.

    By Rashmi Sinha

    One winter night in 2007, Rambha, a 14-year-old student at a Kasturba Gandhi Balika Awasiya Vidyalaya (KGBV), is rushed to a Medical College Hospital in Uttar Pradesh, India’s largest state. She has been complaining of a severe headache, body cramps, and fever. The diagnosis is acute anemia, with her hemoglobin (Hb) level critically low at 3.6 g/dL, compared to the normal range of 12-14 g/dL for her age. A blood transfusion saves her life, and with proper medical care, her health improves over the following months.

    Shabnam, a 15-year-old in the seventh grade, has her recurring headaches dismissed by her parents as excuses to avoid household chores. After joining KGBV, her schoolteacher takes her to a doctor, where her Hb level is found to be dangerously low at 3.8 g/dL. Targeted treatment and a nutritious diet eventually raised her hemoglobin to 8.6 g/dL, restoring her health.

    Mani, a 14-year-old from Bahraich (Uttar Pradesh), experiences frequent fainting spells that her family ignores. But at KGBV, she is diagnosed with tuberculosis. After treatment, her condition slowly improves.

    These are just a few of the many cases of adolescent girls suffering from severe anemia and malnutrition. For many of these girls, it was the proactive action of their school’s administration and regular health checkups that led to their diagnoses, most often for the first time. 

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    Parental neglect is manufactured by their financial inability and social attitudes toward a girl child. For many families, daughters are seen as less deserving of resources, and when faced with the cost of medical care, abandoning them becomes the unfortunate path of least resistance. This abandonment reflects not only financial hardship but also deeply ingrained gender biases that perpetuate a cycle of neglect and malnutrition for girls. 

    Prevalence of anemia

    Much like their parents, the state too tends to assign only minimalistic and ritualistic attention without any functional accountability for results. Possibly, a reason, why despite so many programmes of the govt to end anemia and child protection, it persists and shows a significantly increasing trend (NFHS-5 2019-21).

    Routine medical check-ups in KGBV schools revealed that most girls who joined were severely underweight, anemic, with alarmingly low hemoglobin levels—a clear sign of chronic malnutrition. The prevalence of anemia led to various health issues: fatigue, weakness, breathlessness, palpitations, and an inability to concentrate in class. Menstruation, in many cases, exacerbated these symptoms, further weakening the girls.

    The gendered distribution of food within families continues to socialize girls to eat last and less, often surviving on leftovers after male family members had eaten. The practices persist as the girls are socially taught self-denial. As a result, malnutrition remains rampant among adolescent girls across all classes, castes, and ages, putting them at risk of severe health complications. 

    When a girl is diagnosed with a medical condition, the likelihood of her family seeking treatment is low. Local health centers and families often fail to recognize the severity of the problem, dismissing malnutrition as something that doesn’t warrant immediate medical intervention. 

    Mothers relying solely on outward physical appearance, are unable to understand and tackle the signs of severe anemia or malnutrition in their daughters. Accredited Social Health Activists (ASHA), Auxiliary Nurses & Midwives (ANM), Anganwadi workers (village-level child-mother caregivers), and Primary Health Centres are technically equipped to identify early signs of malnourishment and anemia. 

    But severe gender bias is failing girls completely on this. 

    Positive interventions

    The KGBV, initiated as part of the Government of India’s program to tackle bringing back dropped-out girls from most disadvantaged communities to formal education, was implemented in about thirty-three schools by Mahila Samkhya in Uttar Pradesh. As part of its residential school curriculum, it implemented structured health, and hygiene care interventions for girls, including a planned nutritional diet and outdoor sports. Within just three months, noticeable improvements were observed: the girls gained weight, their skin and hair became healthier, and their participation in school activities increased. The incidence of debilitating conditions decreased, and the girls’ overall well-being improved. This transformation was visible in their rapid outgrowing of clothes and shoes, perceptible signs of growth.

    Despite positive interventions like the above, the larger picture of gender-based malnutrition in India remains grim. Gendered starvation—where girls receive less food and nutrition than their male counterparts—is preventable, yet it persists. It requires gender-sensitive policies, targeted interventions, and adequate financial provisioning for sustainable change. 

    The National Family Health Survey-5 (2019-21), estimates that anemia prevalence among Indian adolescents aged between 15 and 19 years has slightly increased (girls: 55.8% to 59.1%, boys: 30.2% to 31.1%) from 2005-06.   It is 25.0 percent in men (15-49 years) and 57.0 percent in women (15-49 years). The stark difference between males and females shows the high levels of gender-based discrimination in intra-family food distribution.

    The Mahila Samakhya Uttar Pradesh experience demonstrates that targeted interventions, better resource allocation, education, and community awareness can save lives and empower girls to pursue their education and, ultimately, their potential.

    State must step in

    The journey is far from over, despite extensive government schemes aimed at providing free wheat and rice to 800 million people, the nutritional front remains weak. Large-scale food distribution programs do not necessarily translate into adequate nourishment for vulnerable groups, particularly adolescent girls.

    Addressing this ongoing crisis requires more than just food distribution—it demands gender-sensitive approaches across all programmes, holistic health and school-based interventions, and, above all, a commitment to ending the gendered deprivation of food and nutrition. Until these fundamental changes occur, the cycle of malnutrition will continue to endanger the lives of countless girls. We also, need to implement the programme of Anemia Mukta Bharat of GOI launched in 2018 with the highest precision and reach to all with the most rooted solutions.

    When a social and economic structure of society fails a family unit to fulfill all its basic responsibilities towards child care, the state must step in proactively and effectively to safeguard the child’s right to adequate health care and education with more stringent accountability for govt. programmes.  

    I had the opportunity of spending a few years of my professional journey with girls like Rambha, Shabnam, and Manju, as the Program Director of Mahila Samakhya Uttar Pradesh. It’s been more than 15 years since those critical interventions, and now, these girls must be approaching 30 years of age. I often wonder how their lives have unfolded—how the education and healthcare they received shaped their futures and, perhaps, how they are now passing it on to their children. Have they been able to break free from the cycles of deprivation that once threatened their life? 

    The thought of their underweight and the petiteness of their feeble bodies presses on me.

    To rephrase Gabriel Mistral,‘…many of the things we need can wait. The child cannot…her bones are being formed today, her blood is being made today. To her we can not answer tomorrow, her name is today.’

    Rashmi Sinha is Director at the Centre for Rural Policies and Studies, VillageNama. Formerly, she was Programme Director, Mahila Samakhya Uttar Pradesh and also a former UN Women India Consultant    l    Contact: [email protected]

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