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

BACKGROUND: Anaemia remains widespread among Indian women and reflects persistent structural and gendered inequities. OBJECTIVE: 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. METHODS: 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. RESULTS: 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 = 95% CI = 0.56; 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. CONCLUSIONS: 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.