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In countries like India, common public concerns regarding nutrition are low birth weight. The types and patterns of food consumption vary among Hindus and Muslims. Therefore, the objectives of the present study are in the Indian context based on two religious groups, Hindu and Muslim. To know how the nutritional status of women is associated with different socio-economic, demographic, and spatial determinants. To find out how birth weight is related to the nutritional status of mothers.
Methods
The study was based on data from 15 to 49 years of currently married women from NFHS-5. The chi-square test and ordered logistics regression have been used to find out how low birth weight, normal birth weight, and Heavy birth weight are affected by BMI.
Results
Hindu (14.87%) women have a higher prevalence of being underweight than Muslim (9.82%). Normal weight is higher among Muslims (60.35%) than Hindus (59.49%). Being overweight is higher among Muslims (22.45%) than among Hindus (19.29%). In addition, obesity is higher among Muslims (7.39%) than among Hindus (6.34%). The study found little differences in LBW among Hindus (21.44%) and Muslims (21.15%) underweight. Normal, overweight, and obese are all significantly associated with birth weight.
Conclusion
Despite the religious variation of nutritional status (BMI) and birth weight, we can conclude that government needs to take particular interventions in the mother's socioeconomic status, health awareness programs, and provide different healthcare services. In addition, we need to take care of ourselves. Those cumulative effects will help to prevent problems associated with being underweight, overweight, obese, low birth weight, and heavy birth weight.
Nutritional problems and low birth weight are global, national, and local health issues for both mother and child. Article 25(1) of the Universal Declaration of Human Rights (UDHR), 1948, declares that ‘every person has the right to a maintain a standard health and well-being of himself and his family including three basic needs like - food, clothing, and housing … ’.
Supreme Court has described that the right to food and other necessities includes the fundamental right ‘right to life’ in Article 21 of the Indian constitution.
After the green revolution in India, the food grain supplies increased and self-sufficiency; but the lack of nutrition level has continuously increased among women, men and children; and become a nutritional problem, especially in Rural India.
In countries like India, common public concerns regarding nutrition are low birth weight, high mortality and morbidity rate of women, maternal undernutrition,
However, hunger and undernutrition prevailed simultaneously from the second round of the National Family Health Survey (NFHS-2); underweight decreased by 9.2%, but both overweight and obesity increased by 6.7% and 3.4%, respectively.
In 2014 India became the global hotspot of maternal and child undernutrition, accounting for the first and fifth rank in terms of the number of overweight and obese people in the world.
The infant's weight at birth is a powerful predictor of infant growth and survival and is dependent on maternal health and nutrition during pregnancy. Low birth weight is defined as weighing less than 2500 g at birth. The prevalence of low birth weight is higher in Asia, mainly of the undernutrition of the mother prior to and during pregnancy. There are qualitative differences in dietary requirements during early and late pregnancy - micronutrients and proteins required in early pregnancy, and calories and other nutrients later. Nearly half the pregnant women still suffer from varying degrees of anaemia, with the highest prevalence in India and the highest number of maternal deaths in the Asian region. Studies worldwide have examined the effect of socio-economic status indicators, including maternal education, on birth weight.
Maternal illiteracy and low socio-economic status are major risk factors for low birth weight. In the developing world, lacking proper health systems and resources, maternal education may be of prime importance in determining the health outcomes of mothers and their infants and children.
Religion influences the rituals, norms and culture in society. It impacts moral, ideological, and decision-making issues that sometimes affect everyone.
The majority population in this country is Hindu and Muslim. The social, cultural and customs of the people of these two religions are very different. The food pattern, diet, rituals, norms, and culture create differences in nutritional status and birth weight.
Many researchers on nutritional status and low birth weight conducted many studies. Sharma and Mishra investigated the effect of maternal health on birth weight based on an interview of 80 mother-infant pairs delivered in a sub-district hospital in Lucknow.
Kader and Perera explain the socio-economic and nutritional determinants of LBW in India based on the NFHS-3 database. Jungari and Chauhan explain the effect of caste, income, and regional inequalities on the health of women and children in India based on NFHS-3 data.
Subramanian, Perkins, and Khan examine whether underweight and overweight prevail among lower socio-economic groups in India based on NFHS-2 and NFHS-3 databases.
Dubey and Nath investigate the effect of a mother's nutritional status (BMI, Anemia, and antenatal care during pregnancy) on low birth weight at the national and state level in India based on the NFHS-3 database.
Body mass and nutritional status have different effects. Studies by Ferraro and Feinstein et al. show that a high risk of obesity is associated with religious involvement. However, Gillum, Hill et al. show no relationship between religious involvement and body mass.
According to Yaya and Ghose, Religion is an essential factor that contributes to overnutrition other than Hinduism; because of dietary or nutritional practices and opinion of nutritional status or body weight.
Cline and Ferraro explain that household food and beverage consumption varies according to religious activities, which may affect caloric content and weight gain.
Burdette et al. say that religious attendance is defensive against low birth weight. The odds of low birth weight are reduced by 15% because of the increasing frequency of religious attendance.
So, from the literature, it is observed that mothers' nutritional status effect birth weight. As the mother's nutritional status varies according to religion, the birth weight will also vary by religion. Therefore, religious involvement affects both nutritional status and birth weight altogether.
However, more information is needed about religion-specific analysis of the determinant of nutritional level and its impact on birth weight in agrarian countries like India. The present study tries to answer the questions in the Indian context based on two religious groups, Hindu and Muslim – 1. How does the Nutritional status of women vary by socio-economic and demographic determinants among Hindus and Muslims? 2. How is birth weight affected by the Nutritional level of the mother among Hindus and Muslims? 3. It also examines whether or not previous determinants of nutritional status and birth weight are significant.
1.3 Rational of the study
As mentioned above, lack of nutritional level has a different adverse effect on the child and mother's health. So it is important to study before taking action, planning, and policies. The study is confined to two religious groups, Hindus and Muslims, because they contribute a larger population, 93.04% of India's total population, as per the 2011 census.
The Religious base study is essential due to the different types and patterns of food consumption among Hindus and Muslims.
1.4 Objectives of the study
The study focused on the following objectives: I. to find out nutritional level by the different socio-economic, demographic determinants, and spatial determinants. II. To investigate the relationship between socio-economic, demographic, and spatial determinants with nutritional level. III. To know the variation of birth weight by the nutritional level of mothers. IV. To investigate the association between nutritional status and Birth weight.
2. Data and methods
2.1 Data
The study was based on secondary data. Data was collected from the fifth round of the National Family Health Survey 2019-21 (NFHS-5). NFHS surveys have been conducted under the Government of India's Ministry of Health and Family Welfare (MoHFW). International Institute for Population Sciences (IIPS), Mumbai, is the nodal agency for all the rounds of NFHS. The current study was based on information related to only currently married women in the reproductive age group. The cultural norm of birth in India happened after marriage. Birth weight data were collected for the women who had given birth to one child in the last five years; out of total birth, the maximum birth was confined to one child. BMI data were collected for Women aged 15–49 who are not pregnant and have not had a birth in the two months before the survey.
Our study is restricted to two religious groups, Hindu and Muslim, because according to NFHS-5, they contain 81.36% and 13.48% sample size, respectively, and the remaining 5.16% sample size is from other religions.
2.2 Methods
BMI was used as an Indicator of the Nutritional status of women. Because of the following reasons, a Mother's BMI as an indicator of nutritional status has a more persistent effect on birth weight than other indicators and factors.
It is an authenticated indicator of measurement of nutritional status, overweight, and obesity derived by the ratio of weight in kilograms divided by height in meters squared (kg/m^2).
Several works of literature reviews suggested that the nutritional status of mothers is the outcome of different variables such as age group, marital status, religion, place of residence, education, wealth index, parity, family size, and region,
And the birth weight was affected by the following factors such as sex of the child, wealth status, caste/tribe, age, education, stature, anemia level, parity, Inter-pregnancy interval, and Living place,
health abusive behaviour (mother smokes, mother chews tobacco and mother consumes alcohol), empowerment indicator (women decides for health care), empowered for child-rearing, biological factor (sex of the child), pregnancy-associated biological and programmatic factors (used oral contraceptive pills, received vaccination at pregnancy, received health check-ups, received food supplementations, received health and nutrition related education, type of delivery, place of delivery, received antenatal care, skipped follow-ups at pregnancy, and pregnancy complications),
We have used a few significant variables in the previous study related to NFHS-2, 3, 4, & 5 rounds. In this study, we reinforce the selected variable to investigate its effect on nutritional status (BMI). Moreover, whether those variables are significant for Hindu and Muslim women. We also examine only the effect of BMI on birth weight separately for Hindu and Muslim women.
Different bivariate and multivariate approaches were utilized in order to get a result. Firstly, Pearson's Chi-square test was used to understand the association among bivariate variables. The variables whose confidence level was greater than 95% were used for further analysis. Percentage distribution and cross-tabulation were utilized to find the distribution of BMI and birth weight by the determinant. A logistic regression was used to assess the association between socioeconomic, demographic, and spatial determinants and BMI. Because variables were categorical and arranged in an orderly manner, as both birth weight and BMI were distributed in an orderly manner, the ordered logistic regression method was utilized to investigate the relationship between BMI and birth weight. All the statistical analyses were performed by using Stata/MP 14.1 software.
3. Result
3.1 BMI among Hindu-Muslim by different determinants
The Most powerful predictor of nutritional status is BMI. Table 1 represent how underweight, normal weight, overweight and obese varies between Hindus and Muslims by different determinant among currently married women.
Table 1Religion-specific nutritional status of currently married women (percentage) by different socio-economic, demographic and spatial characteristics in India, NFHS-5 (2019–21).
Religion and BMI: Hindus (14.87%) have a higher prevalence of being underweight than Muslims (9.82%). Normal weight is higher among Muslims (60.35%) than Hindus (59.49%). Being overweight is higher among Muslims (22.45%) than among Hindus (19.29%). In addition, obesity is higher among Muslims (7.39%) than among Hindus (6.34%).
Age and BMI: Being underweight is more prevalent in all age groups among Hindus than Muslims. It is higher in the age group 15–24 (24.76%) among Hindus and 18.63% among Muslims. Normal weight, overweight and obese has a higher prevalence among Muslim than Hindu in all age groups. Normal weight has a higher prevalence in the 15–24 years and a lower prevalence in the 35–49 age group for both religions. Overweight and obese have a higher prevalence in the 35–49 years and lower prevalence in the 15–24 age group.
Family size and BMI: Among Hindus and Muslims, a higher prevalence of being underweight and normal weight have been found in large families (more than seven persons); overweight and obese have a higher prevalence in small family sizes (less than four persons).
Parity and BMI: Among Hindus and Muslims, a higher prevalence of underweight and normal weight have been found among women having no child; overweight and obese have a higher prevalence among women having two children and three children, respectively.
Region and BMI: Among Hindus and Muslims, a higher prevalence of underweight in the eastern region, normal weight in the north-eastern region, and overweight and obese in the southern region of India have been found.
Ethnicity and BMI: Among Hindus, a higher prevalence of underweight (20.97%) and normal weight (65.35%) have found among tribes; overweight 22.49% among women who have no caste/tribe, and obese 6.72% among women belonging from caste. In addition, in Muslims, a higher prevalence of underweight (10.63%) and normal weight (65.67%) have been found among those having no caste/tribe, overweight 25.27% among tribal women, and obese 8.19% among women belonging from caste.
Education level and BMI: Among Hindus, a higher prevalence of underweight (18.37%) and normal weight (62.84%) have been found among uneducated women. Overweight (26.11%), and obese (9.67%) found among higher educated women. In addition, among Muslims, a higher prevalence of underweight (10.97%) among primary educated women, normal weight (62.02%) among uneducated women, overweight (27.41%), and obese (8.74%) among higher educated women have been found.
Place of residence and BMI: Among Hindus and Muslims, a higher prevalence of underweight and normal weight have been among rural women, and overweight and obese have been among urban women.
Wealth index and BMI: Underweight and normal weight have a higher prevalence among the poorest family, and overweight and obese have a higher prevalence among the richest family for both religions.
Watching television and BMI: Among both religions, a higher prevalence of being underweight and normal weight has been found among women who have not watched television at all, and overweight and obese have among women who have watched television at least once a week.
Reading newspapers or magazines and BMI: A higher prevalence of being underweight and normal weight has been among women who have not watched television at all, and overweight and obese have been among women who have watched television at least once a week.
3.2 Birth weight among Hindu-Muslim by different determinants
Birth weight is significant because it affects mortality, morbidity, and the growth and development of the child. Table 2 represents how birth weight differs by different socio-economic, demographic, spatial, and health characteristics between Hindu and Muslim currently married women. Birth weight has three categories- Low birth weight (LBW), Normal birth weight (NBW), and Heavy birth weight (HBW).
Table 2Birth weight and nutritional status in India, NFHS-5 (2019–2021).
Determinant/background characteristics
Subdivision of characteristics
Birth weight, Hindu
Birth weight, Muslim
low birth weight (LBW)
Normal birth weight (NBW)
Heavey birth weight (HBW)
Sample size
Pearson's Chi-square tests, (P-value)
low birth weight (LBW)
Normal birth weight (NBW)
Heavey birth weight (HBW)
Sample size
Pearson's Chi-square tests, (P-value)
Religion
17.74
79.58
2.69
1,15,567
0.000
15.80
80.76
3.44
21,274
0.000
BMI
Underweight
21.44
76.75
1.81
22,994
0.000
21.15
76.62
2.24
2724
0.000
Normal
17.38
80.14
2.48
71,256
15.74
81.26
3.00
13,531
Overweight
14.73
81.18
4.08
16,574
13.29
81.59
5.12
3905
Obese
15.67
79.15
5.19
4743
12.30
81.87
5.83
1114
Total
17.74
79.58
2.69
1,15,567
15.80
80.76
3.44
21,274
Sample Size
20497
91963
3107
115567
3362
17180
732
21274
Association between BMI and Birth weight
Data source: NFHS-5
Birth weight
Odd Ratio
[95% Confidence interval]
Odd Ratio
[95% Confidence interval]
Hindu
Muslim
BMI
Underweight®
1
1
Normal
1.30***
[1.26,1.35]
1.45***
[1.33,1.59]
Overweight
1.61***
[1.53,1.68]
1.78***
[1.59,1.99]
Obese
1.61***
[1.50,1.73]
2.08***
[1.77,2.45]
Note: Significant at * p < 0.05; **p < 0.01; ***p < 0.001; ® represent reference category. The result from ordered logistics regression.
Religion and Birth weight: LBW is more prevalent among Hindus (17.74%) than Muslims (15.80%). NBW and HBW have a higher prevalence among Muslims (80.76%, 3.44%) than Hindus (79.58%, 2.69%).
BMI and Birth weight: LBW has little difference among Hindu and Muslim women. The prevalence of LBW among underweight Hindus is 21.44%, and among underweight Muslims is 21.15%. The sample size proportion is not equal among Hindus, and Muslims is one of the obvious reasons. LBW has a lower prevalence among 14.73% of overweight Hindus and 12.30% of overweight Muslims. HBW has a higher prevalence among of obese (5.19%) Hindu women. And HBW has a lower prevalence among underweight (1.81%) Hindu women's.
3.3 Association between determinants and BMI among currently married women belonging to Hindu-Muslim
Table 3 explains how different determinants (age, family size, parity, region, ethnicity, educational level, wealth index, watching television, and reading newspapers or magazines) are associated with nutritional status (BMI) among currently married women for Hindu and Muslim. Determinants have been used as independent variables, and BMI has been used as the dependent variable. Odd ratios of ordered logistic regression have been used to explain the relationship between dependent and independent variables.
Table 3Religion-specific coefficient value showing the association between socio-economic, demographic and spatial variables with nutrition status (BMI) among currently married women in India, NFHS-5(2019–2021).
BMI
Hindu
Muslim
Background characteristics
Odds Ratio
[95% Confidence interval]
Odds Ratio
[95% Confidence interval]
Age
15-24®
1.00
1.00
25–34
1.82***
[1.78,1.85]
1.92***
[1.82,2.01]
35–49
2.99***
[2.92,3.06]
3.12***
[2.95,3.31]
Family size
<4®
1.00
1.00
4–7
0.87***
[0.86,0.89]
0.82***
[0.78,0.86]
7+
0.82***
[0.80,0.84]
0.72***
[0.68,0.76]
Parity
0®
1.00
1.00
1
1.02
[0.99,1.05]
0.90**
[0.84,0.96]
2
1.09***
[1.07,1.12]
1.03
[0.97,1.10]
3
1.09***
[1.06,1.12]
1.06
[0.99,1.14]
4
1.07***
[1.04,1.11]
1.05
[0.97,1.13]
4+
1.03
[1.00,1.07]
1.04
[0.96,1.13]
Region
North®
1.00
1.00
Central
1.10***
[1.08,1.12]
1.09**
[1.03,1.16]
East
1.07***
[1.05,1.09]
1.10***
[1.04,1.17]
Northeast
1.06**
[1.02,1.11]
0.75***
[0.69,0.81]
West
0.73***
[0.72,0.75]
1.05
[0.99,1.12]
South
1.36***
[1.33,1.39]
1.58***
[1.49,1.68]
Ethnicity
Caste®
1.00
1.00
Tribe
0.78***
[0.76,0.80]
1.00
[0.88,1.14]
No caste/tribe
0.95**
[0.91,0.98]
1.20***
[1.15,1.26]
Place of residence
Urban®
1.00
1.00
Rural
0.80***
[0.79,0.81]
0.89***
[0.85,0.92]
Educational level
No education®
1.00
1.00
Primary
1.21***
[1.19,1.24]
1.22***
[1.16,1.28]
Secondary
1.29***
[1.27,1.32]
1.30***
[1.24,1.35]
Higher
1.29***
[1.25,1.32]
1.25***
[1.16,1.35]
Wealth index
Poorest®
1.00
1.00
Poorer
1.41***
[1.38,1.44]
1.48***
[1.41,1.56]
Middle
1.94***
[1.90,1.99]
1.92***
[1.81,2.03]
Richer
2.63***
[2.57,2.70]
2.49***
[2.34,2.65]
Richest
3.75***
[3.65,3.86]
3.02***
[2.81,3.24]
Watching television
Not at all®
1.00
1.00
less than once a week
1.07***
[1.05,1.09]
0.98
[0.93,1.02]
At least once a week
1.17***
[1.15,1.19]
1.10***
[1.06,1.15]
Reading newspaper or magazine
Not at all®
1.00
1.00
less than once a week
1.04***
[1.02,1.06]
0.99
[0.95,1.04]
At least once a week
1.04***
[1.02,1.07]
0.99
[0.93,1.05]
Note: Significant at * p < 0.05; **p < 0.01; ***p < 0.001; ® represent reference category. Result from ordered logistics regression.
Age and BMI: Among Hindus, the 25 to 34 and 35 to 49 years age group has 1.82 and 2.99 times greater prevalence in combined normal weight, overweight and obese versus underweight 15 to 24 years age women. In addition, this effect is 1.92 and 3.12 times greater among Muslims. Both age groups, 25 to 34 and 35 to 49, are significant for both religions in the prevalence of BMI.
Family size and BMI: Among Hindus, medium families (4 to 7) and large families (7+) are 13% and 18% less prevalent in combined normal weight, overweight and obese versus underweight small families (less than four persons). In addition, this effect is 18% and 28% lesser among Muslims. Both medium and larger families are significant for both religions.
Parity and BMI: Among Hindus, 2nd, 3rd, and 4th parity are significant, but in the case of Muslim women, only 1st parity is significant. Among Hindu women, 2nd, 3rd, and 4th parity are 9%, 9%, and 7% greater prevalence in combined normal weight, overweight and obese versus underweight zero parity. In addition, among Muslim women, 1st parity is 10% lesser prevalent in combined normal weight, overweight, and obese versus underweight zero parity.
Region and BMI: All regions are significant among Hindu women, but except for the west, all other regions are significant among Muslim women. Among Hindus, the central, eastern, north-eastern, and southern regions have 1.10, 1.07, 1.06, and 1.36 times greater prevalence than the north; the western regions have 0.27 times lesser prevalence in combined normal weight, overweight and obese than the underweight women in northern region. Among Muslims, the central, eastern, and southern regions have 1.09, 1.10, and 1.58 times greater prevalence than the north; the northeast region has 0.25 times lesser prevalence in combined normal weight, overweight and obese versus underweight women in the northern region.
Ethnicity and BMI: Tribal women and women who have no caste/tribe; are both significant for Hindus, but only women who have no caste/tribe are significant for Muslims. Among Hindus, tribe and no caste/tribe has 22% and 5% less prevalence in combined normal weight, overweight and obese versus underweight women belong to caste. Among Muslims, with no caste/tribe have a 20% greater prevalence than women's belong to caste and tribe.
Place of residence and BMI: Rural residence Hindus 20% and Muslims 11% lesser prevalence in combined normal weight, overweight and obese versus underweight urban residents women.
Education level and BMI: Among Hindus, primary, secondary, and higher educated women have 1.21, 1.29, and 1.29 times greater prevalence in combined normal weight, overweight and obese versus underweight uneducated women. Among Muslim women, it is 1.22, 1.30, and 1.25 times.
Wealth index and BMI: Among Hindus, poorer, middle, richer, and richest women have 1.41, 1.94, 2.63, and 3.75 times greater prevalence in combined normal weight, overweight and obese than underweight poorest women. It is 1.48, 1.92, 2.49, and 3.02 times among Muslims.
Watching television and BMI: Among Hindus, women who have watched television less than once a week and at least once a week have 1.07 and 1.17 times greater prevalence in combined normal weight, overweight and obese versus underweight women who have not watched television at all. Among Muslims, women who have watched television at least once a week have 1.17 times greater influence.
Reading newspapers or magazines and BMI: Among Hindus, women who have watched television less than once a week and at least once a week have 1.04 and 1.04 times greater prevalence in combined normal weight, overweight and obese versus underweight women who have not watched television at all.
3.4 Association between BMI and birth weight among currently married women belonging to Hindu-Muslim
Table 2 explains the relationship between BMI and birth weight. To understand how the nutritional status of women (BMI) affects birth weight, ordered logistic regression has been run separately for both Hindus and Muslims. BMI was used as the independent variable, and birth weight as the dependent variable. Model estimation for Hindus is 0.3% and for Muslims 0.5%. Among Hindus, normal, overweight, and obese have 1.30, 1.61, and 1.61 times greater prevalence in combined NBW and HBW than LBW underweight women. It is 1.45, 1.78, and 2.08 times greater among Muslim women.
4. Discussion
The study has been based on the NFHS-5 data set. We have analyzed 3,79,959 Hindu and 58,774 Muslim women for analysis of BMI; in addition, 1,15,576 Hindu and 21,274 Muslim women for analysis of Birth weight. Due to the availability of data related to our objectives. In India, women's Health and nutritional status are badly affected by culture and traditional practices.
Under-nutrient and over-nutrients are associated with two factors: family income level, which is also related to food availability and standard of living; second, manual and agricultural work. Manual and agricultural workers have a higher level of underweight and a lower level of overweight. High obesity in women is related to social and cultural norms.
Religious variations in nutrition status may be because of variations in food consumption. Although it is less proven. As per NFHS-5 data, India has a large variety of food habits among religions. Among Hindu women have food habits like milk or curd (73%), pulses or beans (93%), dark green, leafy vegetables (91%), fruits (48%), eggs (41%), fish (32%), chicken or meat (32%), fish, chicken or meat (40.7%), fried foods (42%), aerated drinks (15%). Among Muslim women, milk or curd (68%), pulses or beans (91%), dark green, leafy vegetables (89%), fruits (51%), eggs (65%), fish (54%), chicken or meat (58%), fish, chicken or meat (70%), fried foods (50%) and aerated drinks (18%).
It is evident that higher BMI is associated with higher consumption of a group of food consumption fruit or vegetable or fish or poultry and ‘low calorie’.
The most significant factors in determining BMI were age, and others were wealth status, watching television, parity, and place of Residence. The Most significant factors determining BMI related to current pregnancy and non-pregnant women were age and wealth status, respectively. The Previous study shows that overweight and obesity were more likely to occur among higher parity, indicating practical consequences of motherhood against underweight. Education and nutrition levels positively indicate the beneficial effect of education on economic well-being. With increasing wealth status, underweight decreases but overweight and obesity increase. Educational level and health status are related to lifestyles where the permanent type of work is associated with spending more time seated. Wealthy families contributed to more intake of energy-dense food. It has a significant occurrence of obesity in developing countries. Variations of dietary or nutritional practices and insight into nutritional status among religions have essential contributions to nutritional status. Watching television at least once a week has a higher proportion of overweight and obesity. It was also found in previous. It indicates a sedentary lifestyle of Over nutrition.
The tribal population lacks education, isolation from the social mainstream, a traditional agricultural system, and a lower level of government facilities. Those factors resulted in hunger and food security. The Low education level of the tribal population leads to poor health awareness and lower utilization of healthcare facilities.
A nourished mother, through adequate intake of nutrients, can accomplish a Healthy baby related to a well-developed foetus during her pregnancy, and a nourished mother has fewer chances of having an LBW baby.
The adverse effect of lower BMI on birth size may be reduced by increased micronutrient-rich food consumption before pregnancy. It increased birth size. Low BMI is related to a low level of micronutrient consumption. Low nutrient levels in pregnant women may affect fetal growth.
A study by Ramana and others stated that 30%–50% protein intake in the entire diet would reduce the probability of low birth weight. Mother's low BMI effect in increased low birth weight and neonatal mortality.
The literature proposes that among the different ethnic groups, birth weight has been associated with increasing BMI and gestational weight gain in mothers.
According to United Nations Children's Fund and World Health Organization, 96% of LBW births occur because of poor socio-economic conditions, poor diet, infection, and physical work during pregnancy.
In the NFHS-5, it is observed that there is a significant variation in food consumption or dietary pattern among Hindus and Muslims. These may affect the variation of Nutritional status among the religious group. Literature suggests that birth weight is affected by mothers' nutritional status. From the above discussion, we can say that variations in food consumption or dietary pattern among Hindus and Muslims may affect BMI and Birth weight. However, it needs to be further explored that variation in BMI and Birth weight among different religions is because of variations in dietary patterns.
5. Conclusion
From the above discussion, it is that overweight and obese have a dangerously adverse effect on the health of mothers. Those have higher occurrence for both Hindu and Muslim, among the higher age group, small and medium family size, higher parity, tribal women, having no case or tribe, higher education level, urban area, higher economic class, and exposure to media. However, the underweight has a higher concentration among the lower age group, women having no education, lower economic class, and not exposed to media. Low birth weight is significant because it has higher morbidity and mortality. It has a higher concentration for underweight women. Underweight, overweight, and obese were related to the type and pattern of nutrient consumption and nutritional status of mothers, which were further associated with the development of children.
The government of India has taken some initiatives to reduce malnutrition for women and children. ICDS and POSHAN Abhiyaan are important national schemes. Several state governments also take some vital state schemes, such as the Mathrushree scheme (Government of Karnataka) and Dr Muthulakshmi Maternity Benefit Scheme (Government of Tamil Nadu), which provides direct incentives to pregnant women in BPL families. As per the Mathrushree scheme, pregnant women will get a total allowance of Rs. 6000, where Rs.1000 per month is directly transferred to the Aadhaar-linked bank account of pregnant women of BPL families for three months prior to the delivery and three months after the delivery. Dr Muthulakshmi Maternity Benefit Scheme aims to provide financial assistance of Rs. 18000 to poor pregnant mothers for their first two deliveries; these also provide Amma Maternity Nutrition Kit to provide iron tonic and nutritional supplements to pregnant women. The study suggests the need for direct monetary benefit schemes all over India, specifically for BPL families, that help reduce low birth weight and malnutrition. Moreover, ICDS and POSHAN Abhiyaan need to continue with some modifications (Increase the per head monetary value for each pregnant woman, Give healthy food, continuous health checkups etc.). Despite the religious variation of nutritional status (BMI) and birth weight, we can conclude that government needs to take particular intervention in the mother's socio-economic status, health awareness programs and provide different healthcare services. In addition, we need to take care of ourselves. Those cumulative effects will help to prevent problems associated with being underweight, overweight, obese, low birth weight, and heavy birth weight.
Sources of funding
This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.
Author's contribution
Authors have an equal contribution.
Declaration of competing interest
The Authors, declare the study has no conflicts of interest.
Acknowledgement
The authors are thankful to the DHS website for giving permission to download dataset, IIPS for conducting NFHS-5 and creating data available for the study, Google scholar for searching and downloading literature.
List of abbreviations
DHS
Demographic and Health survey
IIPS
International Institute for Population Sciences
NFHS
National Family Health Survey
BMI
Body Mass Index
UDHR
Universal Declaration of Human Rights
WHO
World health organization
LBW
Low birth weight
NBW
Normal birth weight
HBW
Heavy birth weight
BPL
Below Poverty Level
References
Dev S.M.
Right to Food in India.
Centre for Economic and Social Studies Hyderabad,
2003
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