Anaemia among Women of Reproductive Age (15-49 years) in the EAG States and Assam, India: Inter-District Variation and Socio-Demographic Correlates

Abstract

Background: Anaemia remains a major public health concern in India, particularly among women of reproductive age. Despite ongoing nutritional and health interventions, its prevalence remains high, with considerable differences across geographical areas and population groups. Objective: This study examines anaemia prevalence, inter-district variation, and associated sociodemographic correlates among women aged 15–49 years across the eight Empowered Action Group (EAG) states and Assam. Methods: The study uses data from the National Family Health Survey-5 (NFHS-5), conducted during 2019–2021. Descriptive statistics were used to examine district-level anaemia prevalence and its distribution across states. Inter-district variation was assessed using measures of central tendency and dispersion, including the mean, range, standard deviation, interquartile range, and coefficient of variation. Multivariable binary logistic regression was employed to examine the association between anaemia and selected sociodemographic characteristics. Results: The pooled prevalence of anaemia across the study regions was 56.7%. The mean district-level prevalence was highest in Jharkhand (66.3%), followed by Assam (65.7%), Bihar (64.7%), Odisha (64.3%), and Chhattisgarh (63.0%), while Uttarakhand recorded the lowest mean (40.2%). Substantial inter-district variation was observed, with the widest prevalence range in Chhattisgarh (36.1 percentage points), followed by Uttarakhand (35.4 percentage points). Regression results indicated higher adjusted odds of anaemia among Scheduled Tribe women than Scheduled Caste women (AOR: 1.35). Higher educational attainment, membership in the richest wealth quintile, employment, and older age were associated with lower odds of anaemia. Widowed women had higher odds than never-married women (AOR: 1.16). Conclusion: Anaemia remains widespread among women of reproductive age across the EAG states and Assam, with substantial geographical variation and sociodemographic inequalities. The findings highlight the importance of geographically targeted and socially inclusive strategies to address anaemia, alongside continued district-level monitoring and context-specific interventions.