Financial decision making power is associated with moderate to severe anemia: A prospective cohort study among pregnant women in rural South India

Karl Krupp, Caitlyn D. Placek, Meredith Wilcox, Kavitha Ravi, Vijaya Srinivas, Anjali Arun, Purnima Madhivanan

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Objective: According to the World Health Organization, about half of all pregnant women in India suffer from some form of anemia. While poor nutrition is the most common cause, social factors, such as gender and religion, also impact anemia status. This study investigates the relationship between anemia and socioeconomic and health-related factors among pregnant women in Mysore, India. Design: Prospective cohort study conducted between January 2009 and 2012 Setting: 144 rural villages ten or more kilometers outside of Mysore City received integrated antenatal care and HIV testing services provided by mobile medical clinic in their communities. Participants: 1675 pregnant women from the villages were screened. All women and their infants were then followed up for up to a year after childbirth. Methods: women who provided informed consent underwent an interviewer-administered questionnaire, physical examination by a doctor, and antenatal laboratory investigations including blood test for anemia. Women were followed through pregnancy and 12 months after childbirth to assess mother-infant health outcomes. Anemia was categorised as normal, mild, moderate, and severe, with moderate/severe anemia defined as a hemoglobin concentration of less than 100 g/l. Measurements and findings: two out of three pregnant women were anemic at baseline (1107/1654; 66.9%). Of those women, 32.7% (362) had mild anemia, 64.0% (708) had moderate anemia, and 3.3% (37) had severe anemia. Anemia was associated with lower education among spouses (p = 0.021) and lower household income (p = 0.022). Women living in a household where others had control over household decision-making had lower odds of moderate/severe anemia (Adjusted Odds Ratio: 0.602; 95% Confidence Interval: 0.37–0.97) as compared to women who shared decision-making power with others in the household. Conclusion: Interventions to reduce anemia should focus on education among men and other household decision makers on the importance of nutrition during pregnancy in India. Implications for practice: To our knowledge, this research is one of the first to examine how control of household resources is related to risk for anemia among pregnant women in India. Our data suggests that interventions aimed at reducing anemia may need to address economic factors beyond nutrition and iron status to reduce the burden of anemia among women in developing countries.

Original languageEnglish (US)
Pages (from-to)15-21
Number of pages7
StatePublished - Jun 2018
Externally publishedYes


  • Anemia
  • Decision making
  • India
  • Pregnant
  • Women

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Maternity and Midwifery


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