Key Determinants of Undernutrition in Women and Girls: From Immediate Causes to Socio-Cultural Factors

Over one billion adolescent girls and women worldwide suffer from undernutrition, micronutrient deficiencies, or anaemia. That’s not just a health statistic – it’s a reflection of deep systemic failures in how societies feed, educate, and empower half their population. Undernutrition in women and girls doesn’t happen in a vacuum. It results from a layered web of causes – some immediate and biological, others rooted in poverty, gender discrimination, and social norms. Understanding these determinants is the first step toward dismantling them.

What is undernutrition and why does it matter for women and girls? 🔗

Undernutrition refers to deficiencies in energy intake and essential nutrients – including vitamins, minerals, and proteins – that the body needs to function, grow, and fight disease. For women and girls, the consequences are severe and far-reaching. According to the World Health Organization (WHO), women, infants, children, and adolescents face the highest risk of malnutrition globally. Poor nutrition during adolescence and the reproductive years doesn’t just affect the individual – it passes across generations. Undernourished mothers are far more likely to give birth to low-birthweight babies, and roughly half of all stunted children under the age of two became stunted during pregnancy or the first six months of life, when they were fully dependent on their mothers for nutrition. In low- and middle-income countries, this creates an intergenerational cycle that is extremely difficult to break.

Immediate causes of undernutrition 🔗

At the most direct level, undernutrition in women and girls stems from two primary factors: inadequate dietary intake and disease burden. These are the triggers that directly deplete the body’s nutritional reserves.

Inadequate dietary intake 🔗

In many low-income countries, women’s diets are chronically poor – not just in quantity, but in quality. This is often driven by low nutrition awareness, irrational food beliefs, and inappropriate feeding habits shaped by social taboos. For instance, certain communities restrict the consumption of eggs, meat, or specific fruits during pregnancy, based on cultural superstitions rather than nutritional science. According to UNICEF India, even before the COVID-19 pandemic, dietary diversity among adolescents in India was alarmingly low. The pandemic only worsened this gap, particularly for women, adolescents, and children. Micronutrient deficiencies – often called “hidden hunger” – are widespread. Deficiencies in iron, folate, vitamin A, iodine, and zinc are among the most common among women of reproductive age in low- and middle-income countries. These deficiencies often coexist in the same individual, indicating that poor-quality diets are a systemic problem rather than an isolated one.

Infectious diseases 🔗

Disease and undernutrition share a dangerous relationship. Infections like malaria, HIV/AIDS, intestinal worms (helminths), and tuberculosis can trigger acute malnutrition and deepen existing nutritional deficits. A sick body demands more nutrients for immune response and recovery, while simultaneously reducing the body’s ability to absorb and utilise those nutrients. For women already consuming inadequate diets, even a single bout of illness can push them into severe undernutrition. As highlighted by research published in The Lancet, inadequate dietary intake and illness together are the principal causes of underweight status among women of reproductive age in low- and middle-income countries.

Intermediate causes: WASH, food insecurity, and living conditions 🔗

Beyond the immediate triggers, a set of intermediate factors creates the conditions under which poor nutrition thrives. These include inadequate water, sanitation, and hygiene (WASH) practices, food insecurity, and overall household living conditions.

The WASH-nutrition connection 🔗

The link between sanitation, hygiene, and nutrition is well established. A study conducted across Bihar, Odisha, and Chhattisgarh in India – three of the country’s most poverty-stricken states – found that poor WASH practices were significantly associated with poor nutritional outcomes in adolescent girls. Specifically, having water facilities located outside the home, using unimproved sanitation, and not using soap after defecation were all linked to higher rates of stunting and thinness among girls. The study, based on data from over 6,300 adolescent girls, found that one-third were stunted and 17% were thin. Poor sanitation increases exposure to infections like diarrhoea and environmental enteropathy – a chronic condition where the gut lining becomes inflamed due to repeated exposure to faecal pathogens – which directly impairs nutrient absorption. Research from the Comprehensive National Nutrition Survey (CNNS) further confirms that about one-sixth of Indian adolescents consider hygiene practices unimportant, making them significantly more vulnerable to undernutrition.

Food insecurity 🔗

Food insecurity – the lack of consistent access to sufficient, safe, and nutritious food – is one of the strongest predictors of undernutrition. It operates at multiple levels: regional, national, household, and individual. In low-income households, food is one of the largest expenditures. Data from several African countries show that close to half of household income is spent on food alone. When incomes drop or food prices rise, women and girls are often the first to cut back on meals. The COVID-19 pandemic amplified this crisis dramatically. The gender gap in food insecurity more than doubled between 2019 and 2021, and in southern and eastern Africa, up to four in five pregnant and breastfeeding women were food insecure during the pandemic. Pregnant women, families with young children, and low-income groups are the most affected by food insecurity, making it a critical intermediate determinant of female undernutrition.

Gender inequality: the deep-rooted determinant 🔗

Of all the factors driving undernutrition in women and girls, gender inequality is perhaps the most pervasive and the hardest to address. It doesn’t just limit food access – it shapes every aspect of a woman’s nutritional journey, from what she eats to whether she can make decisions about her own health.

Discriminatory food practices within households 🔗

In many parts of South Asia, women and girls eat last and eat least. According to the India Human Development Survey (2011), roughly a quarter of Indian households expected women to eat only after men had finished their meals. This practice is not merely symbolic – it has real nutritional consequences. Women who eat last are more likely to be underweight at every level of household income. The practice is also associated with worse mental health outcomes, as it reflects and reinforces a woman’s diminished autonomy within the home.

Research from Oxford University has found that by age 15, a visible gender gap in dietary diversity emerges, with boys consuming a significantly wider variety of foods than girls – even after controlling for factors like puberty, school attendance, and meal frequency. In poor households, sons are often preferred because they are viewed as future income earners, leading to discrimination in food allocation, clothing, education, and medical expenses.

Domestic violence and its nutritional impact 🔗

Gender-based violence is directly linked to poor nutritional status. Data from the National Family Health Survey (NFHS) indicates that over 30% of Indian women have experienced physical, sexual, or emotional abuse from their partners. Domestic violence affects nutrition in multiple ways: it limits women’s decision-making autonomy, restricts their access to food and healthcare, and creates chronic stress that impairs both physical and mental well-being. Studies have also shown a direct correlation between spousal violence and child stunting, underweight, and wasting – meaning the effects cascade across generations. As the Observer Research Foundation notes, improving gender equality could contribute to a substantial decline in stunting rates among children.

Poverty and illiteracy: the vicious cycle 🔗

Poverty is both a cause and a consequence of undernutrition. The relationship between the two creates a self-reinforcing cycle that is extraordinarily difficult to escape.

How poverty fuels undernutrition 🔗

People living in poverty face higher exposure to food insecurity, poor sanitation, inadequate healthcare, and limited access to nutrition education. According to the WHO, poverty amplifies the risk of malnutrition, and malnutrition in turn increases healthcare costs, reduces productivity, and slows economic growth – perpetuating the cycle of poverty and ill-health. In low- and middle-income countries, children from the poorest households are twice as likely to be malnourished as those from wealthier families. For women, poverty means fewer resources to purchase nutritious food, less access to health services, and reduced ability to make autonomous decisions about their own nutrition.

Illiteracy compounds the problem 🔗

Education – particularly women’s education – is one of the strongest protective factors against undernutrition. Uneducated women are more likely to follow irrational food habits driven by social taboos and are less likely to understand the nutritional value of different foods. Research consistently shows that maternal education is a critical determinant of child nutrition outcomes. Mothers with low literacy are less equipped to make informed feeding decisions, less likely to access healthcare, and more vulnerable to harmful traditional practices. Conversely, women with even basic education tend to have better-nourished children, lower child mortality rates, and improved household food security. The connection between illiteracy and malnutrition also has a gender dimension: in many regions, girls are pulled out of school earlier than boys, reducing their future earning potential and reinforcing the poverty-undernutrition cycle.

Family size and its impact on nutrition 🔗

Large family sizes – particularly when pregnancies occur in rapid succession – have a direct and measurable impact on the nutritional status of both mothers and children. In low-income households, more family members mean less food per person. When resources are already scarce, each additional child reduces per capita food availability. UNICEF India notes that the risk of bearing an undernourished child increases when the mother is an adolescent and when the interval between pregnancies is short.

Repeated pregnancies drain a woman’s nutritional reserves. Each pregnancy demands increased intake of calories, iron, folic acid, calcium, and other nutrients. When these demands are unmet – as is frequently the case in low-income settings – mothers develop chronic nutritional deficiencies that worsen with each subsequent pregnancy. This is compounded by family traditions that discourage contraception or by lack of access to family planning services. The result is a household where both the mother and her children are trapped in a state of persistent undernutrition, with diminishing resources to address it.

Breaking the cycle: why multi-sectoral action matters 🔗

The determinants of undernutrition in women and girls are deeply interconnected. Addressing one factor in isolation – say, distributing food supplements – will have limited impact if the underlying issues of gender discrimination, poor sanitation, poverty, and illiteracy remain unaddressed. Effective interventions need to be multi-sectoral, targeting nutrition alongside education, sanitation, women’s empowerment, and poverty alleviation simultaneously. As a review published in Frontiers in Public Health argues, malnutrition and poverty must be tackled in parallel rather than in separate silos. Nutrition-specific interventions (like micronutrient supplementation) need to be combined with nutrition-sensitive approaches (like improving WASH infrastructure, promoting girls’ education, and strengthening women’s economic participation) to create lasting change.

Countries like India, which account for a disproportionate share of the global undernutrition burden, have taken steps through programmes like POSHAN Abhiyaan and Anaemia Mukt Bharat. However, the scale of the problem demands deeper structural reforms – ones that address not just the symptoms of undernutrition, but its root causes in inequality, poverty, and disempowerment.

What do you think? Can undernutrition in women and girls ever be truly eliminated without first achieving gender equality? And in your view, which determinant – poverty, gender discrimination, or lack of education – has the strongest hold on the cycle of female undernutrition?

References

1. https://www.who.int/news-room/fact-sheets/detail/malnutrition
2. https://www.unicef.org/india/what-we-do/womens-nutrition
3. https://pmc.ncbi.nlm.nih.gov/articles/PMC7613170/
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC6612154/
5. https://pmc.ncbi.nlm.nih.gov/articles/PMC10052428/
6. https://pmc.ncbi.nlm.nih.gov/articles/PMC7485412/
7. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0247065
8. https://www.drishtiias.com/daily-updates/daily-news-editorials/women-and-nutrition
9. https://www.orfonline.org/research/the-role-of-gender-equity-in-reducing-malnutrition-the-view-from-south-asia
10. https://pmc.ncbi.nlm.nih.gov/articles/PMC8774664/