As we approach the peak of the election season, it is time to ask why some of the states in India are lagging behind, especially in the realm of women’s health. Fighting this battle in India has become a triple burden: malnutrition, obesity and micronutrient deficiencies such as Vitamin A and zinc.

High malnutrition rates plague states like Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh and Odisha, with 40 to 45 per cent women reporting low body mass index (BMI), according to the National Family Health Survey, 2015-16 (NFHS).

Anemia is still a major epidemic across India, with rates ranging from 70 per cent of women anemic in Jharkhand to 22.5 per cent women anemic in Mizoram.

Lately, obesity is also on the rise with 33-35 per cent women in Delhi, Goa, Andhra Pradesh and Kerala recorded as obese or with BMIs above normal.

It is interesting to note that some states in the Northeast have largely conquered the battle against malnutrition among women. In particular, less than 10 percent of women in Mizoram, Arunachal Pradesh and Manipur have low BMI.

Only 6.4 per cent of Sikkim’s women have low BMI. Even Nagaland and Meghalaya have a lower malnutrition rate among women than most Indian states, with only 12 per cent of its women malnourished.

Surprisingly, many Northeastern states are also tribal, such as Mizoram, Arunachal Pradesh, Nagaland and Meghalaya. Yet, women in most of India’s tribal-dominated states, such as Chhattisgarh, Jharkhand and Odisha, do not have the same levels of nourishment.

So why are these Northeastern, tribal-dominated states so far ahead of the rest of India when it comes to women’s malnutrition?

Our findings rest on two major factors: access to facilities and greater gender equality.

In these Northeastern states, women have more access to improved sanitation facilities at the household level, are better educated and are either self-employed or working (NFHS, 2015-16).

Sikkim and Mizoram have the highest percentages of households using improved sanitation facilities, 88 and 84 per cent, respectively.

In Nagaland, 75 per cent of households have access to improved sanitation facilities. In Mizoram, 93.5 per cent of women are literate, in Sikkim 87 per cent and in Manipur, 85 per cent.

It has been often stated that women are a larger part of the labour force in the Northeast as compared to other states, while it also shows that this is associated with reduced malnutrition among women.

The Northeastern states have also been vigilant in the past decade in increasing access to maternal health services. The coverage of iron and folic acid consumption increased massively from 18 to 54 per cent and the proportion of women receiving at least four antenatal care visits increased from 46 to 62 per cent in Mizoram from 2005 to 2015.

Huge increases can be seen in Meghalaya, where iron and folic acid consumption among pregnant women increased from 6 to 36 per cent of women, and in Manipur from 7 to 39 per cent.

In Meghalaya, ante-natal care coverage (at least four antenatal visits) increased from 42.8 to 50, while in Manipur, antenatal care coverage increased from 54 to 69 per cent.

It may be the case that the practice of eating meat, such as pork, contributes to low malnutrition in the Northeastern region. However, this conclusion seems slightly weak given that in Assam, the malnutrition rate among women is one of the highest in the country, at 25.7 per cent women with low BMI, while 80 per cent of its women report consuming fish, chicken or meat (NFHS-4).

More likely, the afford ability of nutritious fruits, vegetables, pulses, dairy and meat results in improved dietary diversity and therefore improved nutrition. Rises in prices of these goods lead to a decline in dietary diversity.

Our conclusion is clear: if states in India improve women’s access to sanitation, maternal health, education and employment, they will see multiplied positive effects on the nutrition of women.

Women are the backbone of the health of society. Political parties must focus on women’s health and empowerment in their upcoming manifestos, so that they can achieve better health for the entire population and subsequently an improved economy.

Author is with the Public Health Foundation of India. With inputs from Vanya Mehta