# Do disempowered bodies risk anaemia? Evidence from married women in Assam’s Sixth Schedule areas of Northeast India

## TL;DR

This study shows that anaemia in married women from Assam is linked to their lack of autonomy and social empowerment, not just diet or health factors.

## Contribution

The study reveals that structural disempowerment, not just individual behaviors, drives anaemia risk in married women in Assam’s Sixth Schedule areas.

## Key findings

- Anaemia rates varied widely, with women in Udalguri nearly five times more likely to be anaemic than those in Kokrajhar.
- Low decision-making power and limited social independence significantly increased the risk of anaemia.
- Women with medium levels of tolerance for wife-beating had lower anaemia risk, suggesting complex social dynamics at play.

## Abstract

Anaemia remains widespread among Indian women and reflects persistent structural and gendered inequities.

This study examines how socio-demographic-economic, autonomy, and empowerment indicators interact to influence anaemia risk among married women in the Sixth Schedule districts of Assam, Northeast India.

This study analysed 5245 married women aged 18–49 years from Assam’s seven Sixth Schedule districts using the NFHS–5 (2019–2021) data. Anaemia was modelled against sociodemographic-economic, autonomy, and empowerment indicators derived from contextually adapted indices (WAI-M and SWPER-M) using logistic regression to estimate unadjusted and adjusted odds ratios.

Anaemia affected 66.0% of women, ranging from 58.0% in Kokrajhar to 83.7% in Udalguri; women in Udalguri remained nearly five times more likely to be anaemic than those in Kokrajhar (AOR = 4.76; 95% CI = 2.46–9.24). Low decision-making power (AOR = 2.24; 95% CI = 1.28–3.94) and limited social independence (AOR = 3.09; 95% CI = 1.70–5.60) were significant predictors of anaemia. Counterintuitively, women with medium-high (AOR = 0.56; 95% CI = 0.32–1.00) and medium-low (AOR = 0.48; 95% CI = 0.26–0.86) tolerance of wife-beating were less likely to be anaemic than those categorised as highly empowered.

Anaemia is not solely a biomedical condition but a manifestation of constrained autonomy, limited social independence, and unequal decision-making power. High-burden districts such as Udalguri and Baksa require structural interventions. Effective anaemia reduction necessitates a structural shift toward empowerment-centred interventions that integrate gender-transformative health and nutrition strategies.

Main findings: Anaemia among married women in Assam’s Sixth Schedule areas is rooted in structural disempowerment, manifested through limited autonomy, restricted decision-making, and constrained social independence.Added knowledge: Women’s agency mediates how structural hierarchies influence embodied health inequalities, with empowerment operating through thresholds and gradients, where limited autonomy increases anaemia risk but full assertion of agency may trigger social backlash in patriarchal contexts.Global health impact for policy and action: Reducing anaemia requires gender-transformative, empowerment-centred approaches addressing structural disempowerment, beyond behavioural or dietary interventions, supporting Sustainable Development Goals 2, 3, and 5.

Main findings: Anaemia among married women in Assam’s Sixth Schedule areas is rooted in structural disempowerment, manifested through limited autonomy, restricted decision-making, and constrained social independence.

Added knowledge: Women’s agency mediates how structural hierarchies influence embodied health inequalities, with empowerment operating through thresholds and gradients, where limited autonomy increases anaemia risk but full assertion of agency may trigger social backlash in patriarchal contexts.

Global health impact for policy and action: Reducing anaemia requires gender-transformative, empowerment-centred approaches addressing structural disempowerment, beyond behavioural or dietary interventions, supporting Sustainable Development Goals 2, 3, and 5.