Undernutrition among girls and women is one of the most pressing yet underreported public health challenges of our time. Despite decades of development programmes and policy interventions, more than one billion adolescent girls and women worldwide continue to suffer from undernutrition, micronutrient deficiencies, and anaemia. In India, the problem carries additional layers of complexity – shaped by deep regional disparities, socio-economic inequality, and persistent gender norms. This post breaks down the current status of undernutrition in girls and women, both globally and within India, to help you understand where we stand and what the numbers really mean.
Table of Contents
- Malnutrition vs. undernutrition: what’s the difference?
- The four forms of undernutrition
- Stunting (low height-for-age)
- Wasting (low weight-for-height)
- Underweight (low weight-for-age)
- Micronutrient deficiencies
- Global undernutrition: the numbers that matter
- Why girls and women are disproportionately affected
- India’s undernutrition challenge
- What NFHS-5 tells us about women’s nutritional status
- BMI as an indicator of nutritional status
- Regional disparities in India
- States with the highest burden
- States showing improvement
- The intergenerational cycle of undernutrition
- What is being done – and what more is needed
- Key takeaways
Malnutrition vs. undernutrition: what’s the difference?
These two terms are often used interchangeably, but they are not the same. Malnutrition is a broad umbrella term that covers both undernutrition and overnutrition. It refers to deficiencies, excesses, or imbalances in a person’s intake of energy and nutrients. According to the World Health Organization (WHO), malnutrition in all its forms includes undernutrition (wasting, stunting, underweight), inadequate vitamins or minerals, overweight, obesity, and diet-related non-communicable diseases.
Undernutrition, on the other hand, refers specifically to the insufficient intake of energy and nutrients needed to maintain good health. It is the deficit side of the malnutrition spectrum. A person who is undernourished is not consuming enough calories or nutrients for their body to function properly over a sustained period.
Why does this distinction matter? Because a country can face rising obesity rates and persistent undernutrition at the same time – a phenomenon known as the double burden of malnutrition. India is a classic example, where overweight and obesity among adults are increasing even as millions remain underweight and nutrient-deficient.
The four forms of undernutrition
The WHO classifies undernutrition into four broad sub-forms. Each has distinct causes, consequences, and indicators.
Stunting (low height-for-age)
Stunting means a child is too short for their age. It results from chronic or recurrent undernutrition – often linked to poverty, poor maternal health, frequent illness, and inadequate feeding practices during early life. Stunted children may never reach their full physical or cognitive potential. Globally, an estimated 149 million children under five were stunted in 2022.
Wasting (low weight-for-height)
Wasting means a person is too thin for their height. It typically signals recent and severe weight loss, often due to acute food shortages or illness. Wasting in children significantly raises the risk of death if left untreated. In 2022, approximately 45 million children under five were affected by wasting worldwide.
Underweight (low weight-for-age)
Underweight is a composite measure – a child who is underweight could be stunted, wasted, or both. It is commonly used as a general indicator of undernutrition in population-level surveys. In 2022, approximately 390 million adults globally were classified as underweight.
Micronutrient deficiencies
Micronutrient deficiencies refer to the lack of essential vitamins and minerals – such as iron, iodine, vitamin A, zinc, and folate – that the body needs to produce enzymes, hormones, and other substances critical for growth and development. This form of undernutrition is sometimes called “hidden hunger” because it may not be immediately visible but causes serious long-term health consequences. Iron deficiency alone affects hundreds of millions of women of reproductive age worldwide.
Global undernutrition: the numbers that matter
The scale of undernutrition worldwide remains staggering, despite improvements in some regions. According to the FAO’s latest estimates, around 673 million people – roughly 8.2% of the global population – faced hunger in 2024. While this represents a decline from previous years, the numbers remain far above pre-pandemic levels.
About one-third of the world’s population suffers from some form of malnutrition. On one end, approximately 2.5 billion adults are overweight or obese. On the other, roughly 390 million adults remain underweight. Nearly half of all deaths among children under five are linked to undernutrition, and these deaths disproportionately occur in low- and middle-income countries.
Why girls and women are disproportionately affected
Gender plays a decisive role in nutrition outcomes. According to a landmark UNICEF report, more than a billion adolescent girls and women suffer from undernutrition, micronutrient deficiencies, or anaemia globally. Two out of three underweight adolescent girls and women live in South Asia and Sub-Saharan Africa, and these regions also house 60% of women and girls with anaemia.
The reasons are both biological and social. Pregnancy and breastfeeding significantly increase a woman’s nutritional needs. When those needs are unmet, the consequences ripple across generations – undernourished mothers are more likely to give birth to low birthweight babies, who in turn face higher risks of illness, stunted growth, and death. Around half of the 51 million stunted children under age two became stunted during pregnancy or in the first six months of life, when they depend entirely on maternal nutrition.
Social norms compound the problem. In many communities, women and girls eat last, eat the least, and consume the least nutritious foods. Poverty, conflict, and climate shocks hit women harder, and the gender gap in food insecurity more than doubled between 2019 and 2021.
The economic cost is enormous. A 2024 World Vision report estimated that malnutrition’s toll on women and girls costs the global economy over $1.6 trillion annually in lost productivity and potential.
India’s undernutrition challenge
India accounts for a disproportionate share of the world’s undernutrition burden. According to the State of Food Security and Nutrition in the World 2022 report, around 224.3 million people in India were undernourished during 2019-21. This was a decline from 247.8 million in 2004-06, but India still has the highest absolute number of undernourished people of any country.
More recent FAO estimates suggest further improvement, with India’s undernourished population dropping to about 194.6 million by the 2021-23 period. Still, the prevalence of undernutrition at 16.3% is higher than the South Asian average, and more than half of India’s population cannot afford a healthy diet.
What NFHS-5 tells us about women’s nutritional status
The National Family Health Survey (NFHS-5), conducted during 2019-21, provides the most comprehensive snapshot of women’s nutritional status across India. According to this survey, the percentage of women aged 15-49 with a below-normal BMI (less than 18.5 kg/m²) declined from 22.9% in NFHS-4 to 18.7% in NFHS-5. This is encouraging progress – but it still means that nearly one in five Indian women of reproductive age is underweight.
At the same time, obesity and overweight among women have risen sharply. This dual trend reflects the double burden of malnutrition that India is increasingly grappling with – undernutrition persists in some population groups and regions, while overnutrition grows in others.
Anaemia remains a severe concern. The percentage of women aged 15-49 who are anaemic actually increased in NFHS-5, with the proportion of all women aged 15-19 who are anaemic rising from 54.1% to 59.1%. Anaemia raises the risk of premature birth, low birthweight, and maternal mortality – making it a critical public health concern for women and girls.
BMI as an indicator of nutritional status
Body Mass Index (BMI) is one of the most widely used screening tools for assessing nutritional status at the population level. It is calculated by dividing a person’s weight in kilograms by the square of their height in metres (kg/m²).
The WHO classifies BMI into the following categories: underweight (below 18.5), normal weight (18.5-24.9), overweight (25.0-29.9), and obese (30.0 and above). For the Asia-Pacific region, some guidelines use lower thresholds for overweight and obesity, given the higher health risks observed at lower BMI levels among Asian populations.
A BMI below 18.5 kg/m² is used by the WHO as the international threshold for underweight status and is considered indicative of undernutrition. According to research published in Scientific Reports, this threshold is used in national surveys like the NFHS to classify women’s nutritional status and track trends over time. While BMI does not distinguish between fat and lean mass or capture micronutrient status, it remains a practical and widely accepted measure for large-scale surveys.
Regional disparities in India
National averages can hide enormous variation. Some Indian states face undernutrition rates far above the national figure, while others have made significant progress.
States with the highest burden
According to NFHS-5 data, Jharkhand has the highest percentage of women with below-normal BMI at approximately 26%, significantly above the national average of 18.7%. Other states with alarmingly high rates include Bihar (around 25.6%), Gujarat, Chhattisgarh, Madhya Pradesh, Maharashtra, and Odisha – all reporting figures well above 20%.
According to an analysis by the Observer Research Foundation, a prevalence rate of over 20% of women with low BMI signals a serious public health problem that requires targeted intervention. Several Indian states cross this threshold.
States showing improvement
The overall trend across most states is a decline in the percentage of thin women (BMI below 18.5) between NFHS-4 and NFHS-5. However, a few states like Kerala and Dadra and Nagar Haveli bucked this trend, showing a slight increase. The states with the lowest rates of underweight women include Ladakh, Sikkim, and parts of northeastern India.
These regional differences are shaped by factors such as poverty levels, women’s education and autonomy, access to healthcare, dietary patterns, and the effectiveness of nutrition programmes like the Integrated Child Development Services (ICDS) and the Mid-Day Meal scheme.
The intergenerational cycle of undernutrition
Undernutrition in women is not just a health issue for the individual – it perpetuates a cycle that affects the next generation. When a girl grows up malnourished, she is more likely to become a malnourished mother. Her children are at greater risk of being born with low birthweight, developing stunting, and suffering from weakened immunity. This intergenerational transmission of malnutrition is one of the most difficult cycles to break.
NFHS-5 data shows that early marriage and teenage pregnancy remain significant contributors to this cycle. Adolescent mothers are more likely to be underweight themselves and more likely to deliver malnourished babies. Investment in girls’ education, delayed marriage, and improved access to maternal nutrition services are recognized as some of the most effective ways to interrupt this cycle.
What is being done – and what more is needed
India has several large-scale nutrition programmes in place, including the Poshan Abhiyaan (National Nutrition Mission), ICDS, the Mid-Day Meal programme, and supplementary nutrition through public distribution systems. These have contributed to the gradual decline in undernutrition indicators over the past two decades.
However, progress remains uneven and slow. Key gaps include poor implementation in tribal and remote areas, insufficient focus on adolescent girls’ nutrition, limited dietary diversity in supplementary feeding programmes, and weak integration of nutrition with healthcare delivery. The rise in anaemia despite improvements in other indicators highlights the need for targeted micronutrient supplementation, particularly iron and folic acid, for women and girls.
Globally, UNICEF has called for transforming food, health, and social protection systems to better serve adolescent girls and women – including ensuring access to nutritious diets, expanding large-scale food fortification, and providing free access to essential nutrition services during pregnancy and breastfeeding.
Key takeaways
Malnutrition includes both undernutrition and overnutrition; undernutrition specifically refers to inadequate intake of energy and nutrients. It manifests in four forms: stunting, wasting, underweight, and micronutrient deficiencies. Globally, over a billion women and girls are affected, with South Asia and Sub-Saharan Africa bearing the greatest burden. In India, while NFHS-5 shows progress – women with below-normal BMI declining from 22.9% to 18.7% – significant regional disparities persist, and anaemia rates are actually rising. Breaking the intergenerational cycle of undernutrition requires investment in girls’ education, delayed marriage, better maternal nutrition services, and stronger implementation of existing programmes.
What do you think? Given that India’s nutrition programmes have been in place for decades, what do you believe is the biggest barrier to closing the undernutrition gap among women and girls – is it policy design, on-ground implementation, or deep-rooted social norms around gender and food?
References
- https://www.unicef.org/press-releases/malnutrition-mothers-soars-25-cent-crisis-hit-countries-putting-women-and-newborn
- https://www.who.int/news-room/fact-sheets/detail/malnutrition
- https://www.who.int/health-topics/malnutrition
- https://openknowledge.fao.org/server/api/core/bitstreams/de95e011-1af9-4b28-9a07-d8ce61f8aa6c/content/state-food-security-and-nutrition-2025/ending-hunger-food-security.html
- https://www.unicefusa.org/stories/undernourished-and-overlooked-new-report-reveals-global-nutrition-crisis-women-and-girls
- https://www.worldvision.org/about-us/media-center/malnutrition-disproportionately-impacts-women-and-girls-costs-global-economy-over-1-6-trillion-annually-says-new-world-vision-report
- https://www.theweek.in/news/health/2022/07/07/number-of-undernourished-people-in-india-declines-to-224-3-milli.html
- https://pmc.ncbi.nlm.nih.gov/articles/PMC10991083/
- https://science.thewire.in/health/nfhs-5-nutrition-data-underweight-stunting-bmi-nutrient-deficiencies/
- https://www.nature.com/articles/s41598-025-08368-6
- https://www.orfonline.org/research/the-5th-national-family-health-survey-of-india-a-sub-national-analysis-of-child-nutrition
- https://www.orfonline.org/expert-speak/nfhs5-data-reiterates-challenge-breaking-intergenerational-cycle-undernutrition
- https://www.unicef.org/reports/undernourished-overlooked-nutrition-crisis
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