From Deprivation to Deficiency: Examining the Nexus Between Multidimensional Poverty and Anemia in India

Anemia in India is shaped by intersecting socio-economic inequalities; however, its relationship with multidimensional deprivation remains insufficiently understood.

This study uses a multidimensional poverty framework, situated within the social determinants of health perspective, to examine the association between overlapping deprivations and anemia in India. It assesses how this association varies across demographic, social, spatial, behavioral, and dietary characteristics and over time.

We analyzed pooled cross-sectional data from NFHS-3 (2005-06), NFHS-4 (2015-16), and NFHS-5 (2019-21), comprising 2 232 138 individuals with hemoglobin information. Multidimensional poverty was measured using the Alkire-Foster approach comprising health, education, and standard-of-living dimensions. Associations with anemia were examined using survey-weighted logistic regression with demographic, socioeconomic, spatial, behavioral, and dietary covariates.

Anemia prevalence increased from 48.18% in 2005-06 to 56.03% in 2019-21, while multidimensional poverty declined from 47.56% to 14.33%. Individuals living in multidimensionally poor households had higher odds of anemia than those in non-poor households (OR = 1.328; marginal effect = 5.7 percentage points, 95% CI: 5.2-6.2). This association remained significant among men (OR = 1.426) and women (OR = 1.269) and varied significantly across survey rounds (adjusted Wald F = 33.61, p < 0.001). Anemia was also patterned by gender, caste, and rural residence.

The findings support a multidimensional perspective on anemia, showing that its distribution is associated with overlapping social and socioeconomic deprivation. A social determinants approach can complement nutritional and biomedical strategies by drawing attention to the broader conditions in which anemia occurs.