Poor nutrition causes a massive burden of death and disability in the world, with nutritional deficiencies responsible for 252,000 deaths and 50 million years of life lost due to sickness, disability and death, and obesity a risk factor in five million deaths, according to the Global Burden of Disease (GBD). One in three people on the planet is malnourished, and every country is now struggling with malnutrition in some form, ranging from underweight to obesity.
The costs of this burden of malnutrition are enormous, impeding not only population health improvements but also economic growth and development. Failing to act on malnutrition is costing low-, middle-, and high-income countries billions of dollars in healthcare costs and lost worker productivity, every year. On the other side, investing in nutrition can deliver big benefits. For example, every $US1 invested in reducing child malnutrition can save up to $US166, according to the Copenhagen Consensus.
Malnutrition in all of its forms – underweight, obesity, and micronutrient deficiencies – disproportionately impacts women. An estimated 244 million women in the world are underweight compared to 216 million men, and 375 million women are obese compared to 266 million men, according to the NCD Risk Factor Collaboration. Further, an estimated 524 million women suffer from iron-deficiency anemia, including 56 million pregnant women, compared to 260 million men. 42% of all women and 38% of pregnant women are anemic, according to the World Health Organization (WHO).
As a result, death and disability from malnutrition are concentrated among women. Nutritional deficiencies kill more women (138,000) than men (136,000), and high body mass index (BMI) contributes to more deaths among women (2.54 million) than men (2.48 million). Nutritional deficiencies among females are responsible for an estimated 28.4 million lost years of life due to early death, sickness, and disability compared to 21.3 million among males, according to the GBD.
Malnutrition among women aged 15 to 49 is particularly concerning because of its impact on women’s and children’s health, as well as on labor force and on educational performance. Women who are malnourished (underweight or obese, and/or micronutrient deficient) are more likely to experience birth complications, including babies born preterm, with low birth weight, and/or with congenital defects, and are at an increased risk of maternal death. The health impacts of malnutrition restrict women’s capacity to work and earn incomes and invest time and resources in their children’s health and education. Child growth failure is an underlying factor in the majority of child deaths. In 2019, there were 144 million children who were stunted, 47 million who were wasted, and 20 million born with low birth weight.
Malnutrition among younger women is concentrated in specific countries. More than half of undernutrition-related deaths among women aged 15 to 49 occur in just five countries, including India, Pakistan, Bangladesh, Indonesia, and Madagascar. Similarly, more than half of all obesity-related deaths among young women occur in a handful of countries, including India, Indonesia, China, Pakistan, and Brazil. Note India, Pakistan, and Indonesia appear on both lists, because they are struggling with “double burdens” of malnutrition.
For example, in India an estimated 1,937 young women aged 15 to 49 die from nutritional deficiencies, while 35,200 die from obesity-related causes. In Pakistan, an estimated 1,585 young women die from undernutrition, while 10,198 die from obesity-related causes. And in Indonesia, an estimated 495 young women die from undernutrition, while 21,151 die from obesity-related causes. As deaths from undernutrition fall in most countries, deaths from obesity are rising, often precipitously.
In addition to reducing deaths among young women from undernutrition and obesity, the world needs an all-out assault on micronutrient deficiencies among women, with a special focus on anemia. For example, in India, one-half of all women aged 15 to 49 (195 million) are anemic and almost half of all women enter pregnancy underweight, according to research by Diane Coffey. Many western and central African countries are also struggling with anemia prevalence rates of above 50%.
Iron deficiency is a risk factor in 42,000 deaths among women aged 15 to 49, with most deaths in India, Nigeria, Pakistan, the Democratic Republic of Congo, and Ethiopia. In many of these countries, anemia deaths among young women have plateaued, including in India, Nigeria, Pakistan, and Ethiopia, according to the GBD. As a result, no country is on track to meet the World Health Assembly target of halving the number of women of reproductive age who are anemic by 2025. In fact, of all the nutrition targets, reducing anemia is the most off-track, according to the Global Nutrition Report.
At the other end of the spectrum is obesity, which now affects 375 million women, and contributes to the high and rising burden of death and disability from non-communicable diseases in most countries. New strategies are urgently needed to reduce obesity among women of reproductive age. Governments need to set targets for reducing obesity among young women in the context of achieving the one-third reduction in early deaths from non-communicable diseases required by the Sustainable Development Goals (SDGs), and implement new strategies.
As the major providers of nutritious food for their children and families, women of reproductive age also exert a profound influence on the nutritional status of future generations, especially in countries where women are wholly responsible for family food preparation. In recognition of women’s leadership role in family nutrition, efforts to improve mothers’ agency to provide nutritious foods and to create a healthy home environment, in a way that doesn’t impede female labor force participation, should be at the center of nutrition policies and programs. In this context, the ability of women to breastfeed and to cook meals that do not contribute to the dangerously high levels of household air pollution should be part of a maternal nutrition agenda. There needs to be wider recognition that reducing current levels of malnutrition, and arresting its intergenerational cycle, depends on the level of support provided to improve the daily lives of women of reproductive age.