Gender Differences in Body Mass Index in Rural India Are Determined by Socio-Economic Factors and Lifestyle1
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The Journal of Nutrition Nutritional Epidemiology Gender Differences in Body Mass Index in Rural India Are Determined by Socio-Economic Factors and Lifestyle1 Mary Barker,2* Ginny Chorghade,2 Sarah Crozier,2 Sam Leary,3 and Caroline Fall2 2MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK and 3Avon Longitudinal Study of Parents and Children (ALSPAC), Bristol BS8 1TQ, UK Downloaded from https://academic.oup.com/jn/article/136/12/3062/4664006 by guest on 24 September 2021 Abstract A survey of the nutritional status of women in 6 villages of the Pune district of Maharashtra, India, found young women to have a significantly lower BMI than their male peers. The purpose of this study was to identify social and economic factors associated with this difference in thinness and to explore the behavior in men and women that might underlie these associations. We compared men and women in 90 families in this part of Maharashtra by taking measurements of the height and weight of the married couple of child-bearing age in each family and assessing their social and economic details, fasting practices, and oil consumption. In this agricultural community, women were thinner in joint land-owning families, where the main occupation was farming, than those in nonfarming families. This was not true of men in this type of family. Men in ‘‘cash-rich’’ families had higher BMI than men in families without this characteristic. There was no corresponding difference in women’s BMI. We then examined the lifestyles of men and women in a subset of 45 of these families. Women were more likely to work full time in farming than men, to carry the burden of all household chores, to have less sleep, and to eat less food away from home than men. Women fasted more frequently and more strictly than men. Despite identifying significant differences in behavior between men and women in the same household, we did not find a direct link between behavior and BMI. We conclude that being married into a farming family is an important factor in determining the thinness of a woman in rural Maharashtra. J. Nutr. 136: 3062–3068, 2006. Introduction the extent of these inequalities. For example, fewer girls are Indian women are thinner and shorter than women in other immunized in rural than urban areas and in the north rather than parts of Asia (1). This has consequences for their own health and the south of India (12). that of their children. India has one of the highest incidences of As they pass into adulthood, Indian girls adopt a social role that low birth weight in the world (2). This is not simply because may limit their access to education, health care, and food (13). India is economically poor; it has a higher gross national product Traditionally,they marry young and enter the groom’s family at the than many other developing countries and has shown remark- bottom of the hierarchy. They are given the most menial work and able economic growth in recent years. Gender inequality, deeply are expected to prove themselves by working hard and bearing a entrenched in Indian society, may be a factor (3). child within a year of marriage, preferably a boy. Between 1994 and 1996, a study of women living in villages Although it seems likely that this role affects women’s near Pune city in western India was conducted to examine the nutritional status, there is little direct evidence to link the two. relation of maternal nutrition to fetal growth (4–6). The study Villagers in rural Maharashtra believed their women were thin showed that thinner women had thinner babies, and also that because of the combined demands of early motherhood and work they were significantly thinner than their husbands (7); 65% of (7). This article attempts to identify the social and economic women had BMIs below 18.5 kg/m2, an indicator of chronic correlates of thinness among young women in this population energy deficiency, compared with 39% of their husbands. (survey 1), and to explore how women’s daily activities might Gender inequalities in health and nutritional status in India contribute to this phenomenon (survey 2). are the subject of an extensive literature. Females have higher mortality rates in utero due to sex-selective abortion (8), and a higher mortality in infancy and childhood (9). Girl children are Methods and Procedures more likely to be undernourished than boys (10) and often have less access to health care (11). There are regional variations in Socio-economic status: survey 1. We surveyed 101 families currently living in Pabal village. Pabal is 51 km from Pune City and comprises a 1 This study was funded by Hope (Wessex Medical Research Charity, UK). central village area surrounded by 27 hamlets. In 1991, the village had an * To whom correspondence should be addressed. E-mail: [email protected]. adult population of 8300. Most families earn a living farming cash crops, ac.uk. and women work on the farms as well as perform domestic work such as 3062 0022-3166/06 $8.00 ª 2006 American Society for Nutrition. Manuscript received 4 May 2006. Initial review completed 7 July 2006. Revision accepted 3 October 2006. washing clothes and carrying water and firewood (14). Few are educated asked closed questions about the frequency of working on their own or beyond primary school level. The majority of families in the survey another’s farm, or in other jobs; how often they carried out specific belonged to agricultural castes. The King Edward Memorial Hospital household chores; whether they went to bed last in the household and Ethics Committee in Pune, India, granted permission for studies 1 and 2. got up first; how often they watched television, spent time with their Families were selected, from a survey of all married women in the friends, or had a siesta. Women were asked whether their workload village (5), to contain a husband and wife pair of child-bearing age with at increased, decreased, or remained the same after marriage. Men and least 1 son and 1 daughter in the age range of 3 to 8 y (n ¼ 101). A total of women’s eating patterns were established by asking how often they 93 men and 98 women took part in the study, producing 90 couples whose missed meals, ate outside the home, ate first or last at meal times, ate nutritional status could be compared in the 2nd half of the analysis. nonvegetarian foods, eggs, milk, fruit, and green vegetables. They were Families were visited by a researcher (G. Chlorghade), a midwife to asked whether they fasted and why, when they began to fast, how often make anthropometric measurements, and a community worker who was they fasted, and how many meals they consumed on a fasting day. known to the families. The height and weight of the father and mother in Respondents were asked about frequency of seeking medical treatment, each family were recorded. A questionnaire was completed for each how much money they spent, and why they needed treatment. We asked family by a member of the research team (G. Chlorghade), covering social, men and women about whether they worried, and what they worried economic and nutritional factors. Educational status of the target pair was about, because worrying had also been mentioned in the focus group recorded in 5 categories from illiterate to graduate. A record was made of discussions as a factor contributing to women’s thinness. whether they lived in a traditional extended family unit or a nuclear Most questions were related to activities during the past month. Downloaded from https://academic.oup.com/jn/article/136/12/3062/4664006 by guest on 24 September 2021 family. Their houses were categorized as a 1-room hut, a ‘‘kutcha’’ (more Questions about medical treatment were related to the past 3 mo. than 1 room, with mud walls and a thatched roof), ‘‘mixed pucca’’ (stone Questions about habitual practices such as fasting referred to the and cement walls, mud plaster,and a tiled roof), ‘‘pucca’’ (entirely stone or respondent’s current lifestyle. bricks and cement with a tiled roof), or rented house. Distance from Pabal The questionnaire was administered in the local language (Marathi) main village was estimated from the jeep’s mileometer. Men’s and by 1 member of the GPC research team and piloted in a neighboring women’s occupations were recorded as farm laborer on other’s land, farm village. Interviews were conducted throughout the winter of 1998 and laborer on their own and other’s land, petty employee or artisan, business the spring of 1999. person or trader, land-owning farmer, worker in service industries, or (for women) housewife. Analysis. A summary and descriptive statistics were produced to Participants estimated the acreage of irrigated and nonirrigated land compare the workload, eating habits, and fasting practices of men and owned by the household. Irrigated land was considered to be 4 times as women. Answers to questions regarding work outside the home, house- productive as nonirrigated land. A total productive acreage was created hold chores, leisure time, sleep, eating habits, fasting, and worrying were by multiplying irrigated land acreage by 4 and adding the acreage of aggregated and recoded where necessary to produce information on nonirrigated land. The interviewer recorded whether the household frequency per week. We also carried out a principal-components analysis owned the following: an iron, bicycle, tape player or radio, moped, car of the relations among these activities using data from the 42 households or jeep, or bullock cart; and these were summed to create a material with complete information from both the man and the woman.