Community-level women's education and undernutrition among Indian adolescents: A multilevel analysis of a national survey

Little research has explored the influence of social context on health of Indian adolescents. We conceptualized community-level women's education (proxy for value placed on women's wellbeing) as exerting contextual influence on adolescent hemoglobin level and body mass index (BMI). We derived our sample of more than 62,000 adolescent aged 15 through 17 years from the Indian National Family Health Survey 2015-16. The sample consisted of a total of 62648 adolescents (54232 girls and 8416 boys) for the hemoglobin, and 62846 adolescents (54383 girls and 8463 boys) for the BMI analysis. We fitted multilevel random intercepts linear regression models to test the association of village- and urban-ward-level-women's education with hemoglobin level and BMI of adolescents, accounting for their own and their mother's education; as well as relevant covariates. Our fully adjusted model estimated that if the 52% of communities with less than 20 percent of women having a tenth-grade education in our sample were to achieve 100 percent tenth-grade completion in women, hemoglobin would be 0·2 g/dl higher (p