Asset-based wealth inequalities in maternal anaemia prevalence across Indian states: A decomposition analysis of nationally representative data.

BACKGROUND: India continues to make a significant contribution to maternal anaemia, globally. Understanding the complex mechanisms of inequalities and how they perpetuate maternal anaemia at the national and state levels is essential. This study estimates the wealth-based inequalities in the prevalence of maternal anaemia and its contributors. METHODS: The fifth National Family Health Survey (NFHS-5) data was used to examine this relationship. To emphasize the inequalities in anaemia prevalence as per wealth, the concentration index was calculated. A decomposition analysis was performed to determine the contributors to these disparities in anaemia prevalence. RESULTS: Nationally, the maternal anaemia prevalence lowered from 63·9% in the poorest quintile to 40·8% in the richest. The highest difference in anaemia prevalence across the wealth index was documented in Andhra Pradesh (-49·0%) followed by Meghalaya (-39·6%) and Chhattisgarh (-37·0%) where anaemia was more prevalent among the poorest. Education status (46·8%), place of residence (30·0%), and number of living children (7·5%), pregnancy duration (7·5%) were among the predominant contributors to asset-based wealth disparities in maternal anaemia prevalence. CONCLUSION: Maternal populations from lower wealth quintiles were disproportionately affected by anaemia, with state-wise variations in India. Reducing anaemia prevalence requires integrated efforts, including improving girls' education, providing family planning services, and promoting timely pregnancies. Determinants like rural residence and caste, while unmodifiable, underscore the need for specially focused interventions to address these disparities. These findings emphasise the significance of focused interventions in mitigating socio-economic divides and enhancing maternal health outcomes in India.