Abstract: Despite being wealthier, Indian children are significantly shorter and smaller than African children. These differences begin very early in life, suggesting that they may in part re- flect differences in maternal health. By applying reweighting estimation strategies to the Demographic and Health Surveys, this paper reports the first representative estimates of pre-pregnancy BMI and weight gain during pregnancy for India and sub-Saharan Africa. I find that 42.2% of pre-pregnant women in India are underweight, compared with 16.5% of pre-pregnant women in sub-Saharan Africa. Levels of pre-pregnancy underweight for India are almost 7 percentage points higher than the average fraction underweight among women 15 to 49 years old. This difference in part reflects a previously unquantified relationship among age, fertility and underweight; childbearing is concentrated in the narrow age range in which Indian women are most likely to be underweight. Further, because weight gain during pregnancy is low, averaging about 7 kilograms for a full term pregnancy in both regions, the average woman in India ends pregnancy weighing less than the average woman in sub-Saharan Africa begins pregnancy. Poor maternal health among Indian women is of global significance because India is home to one fifth of the world’s births.
Significance: Because India–home to one fifth of all births–has no monitoring system for maternal health, basic facts about maternal nutrition are unknown. Using statistically adjusted nationally representative survey data, this paper presents the first estimates of pre-pregnancy body mass and weight gain during pregnancy in India and compares them to sub-Saharan Africa. 42.2% of Indian women are underweight when they begin pregnancy, compared to 16.5% of African women. In both regions, women gain little weight during pregnancy, but because of pre-pregnancy deficits Indian women end pregnancy weighing less than African women do at the beginning. Deficits in maternal nutrition could help explain the “Asian enigma,” the puzzle of why Indian children are much smaller than their relative wealth predicts.