Voices from the margins: a scoping review of Dalit women’s nutrition and food security in rural India Free

Rural India’s nutritional landscape is characterized by a complex interplay of persistence and change: the stubborn persistence of undernutrition, particularly among marginalized groups, and the rapid change of dietary patterns influenced by market forces and cultural shifts (Dreze and Khera, 2017; Pingali et al., 2019). Within this landscape, the experiences of Dalit women, formerly “untouchables” remain disproportionately dire and critically underexplored. Positioned at the violent crossroads of caste hierarchy, gender subordination, and economic deprivation, Dalit women embody what feminist scholar Kimberlé Crenshaw termed “intersectionality,” where multiple forms of discrimination converge to create a unique and intensified experience of oppression (Crenshaw, 1989). For nutrition, this means their access to food is not merely a function of poverty but is fundamentally structured by caste-based untouchability and patriarchal control over resources (Guru, 2012; Thorat and Sabharwal, 2011).

This review focuses on rural India, where the majority of Dalits reside and where caste-based social relations and agrarian economies render nutritional inequities particularly acute. The rural context, defined sociologically by agrarian livelihoods, community-based social structures and distinct patterns of resource access, is the primary site where caste hierarchies are spatially enforced through segregated hamlets (bastis) and control over commons. While urban contexts present different dynamics of caste discrimination, the rural setting is fundamental to understanding the place-based, structural mechanisms of nutritional deprivation analyzed here.

Conventional public health analyses and interventions have largely treated caste as a demographic variable, a risk marker rather than a constitutive, relational system of power that actively produces health disparities (Ambedkar, 1936; Mosse, 2018). Similarly, gender is often reduced to a binary category without analyzing how caste-specific patriarchies shape intra-household dynamics (Rege, 1998). This has resulted in nutrition policies that are “caste-blind” and only superficially “gender-sensitive,” failing to address the core mechanisms of exclusion that dictate Dalit women’s nutritional realities. For instance, while the link between poverty and stunting is well-established, the specific pathway by which the humiliation of untouchability at a water source translates into reduced dietary diversity for Dalit women remains obscured in conventional analyses.

This article, therefore, calls for a theoretical and methodological recentering of Dalit women lived experiences. To do this, we propose an integrated theoretical framework visualized in Figure 1, drawing from three critical strands of thought: (1) Dalit Feminist Theory, which insists on the specificity of the Dalit woman’s experience (Guru, 2012; Paik, 2021); (2) Political Economy of Caste, which analyzes caste as an economic system that regulates labor, property and class relations (Thorat and Newman, 2010) and (3) Symbolic Anthropology of Food, which examines how food taboos and practices are central to maintaining caste boundaries (Dube, 2001; Chakravarti, 2003). This interdisciplinary framework allows us to analyze how symbolic violence (anthropology), structural violence (political economy) and intimate control (feminist theory) coalesce to shape nutritional outcomes.

This article presents a scoping review of interdisciplinary literature to map the evidence on the nutritional status and food security of Dalit women in rural India. The objective is to synthesize existing knowledge, identify critical explanatory gaps and propose a more robust, intersectional and ethically grounded agenda for research and intervention. A scoping review is particularly suited to this objective, as it allows for the mapping of a heterogeneous and interdisciplinary body of literature, the identification of key concepts and theoretical gaps, and the synthesis of evidence across diverse methodological traditions from epidemiological surveys to ethnographic case studies.

The nutritional plight of Dalit women cannot be understood by adding caste disadvantage to gender disadvantage. It is a synergistic phenomenon where each axis of identity intensifies the other. National data, while often inadequately disaggregated, paints a stark picture. According to NFHS-5 (2020–21), the anemia prevalence among Scheduled Caste (SC) women (59.8%) is significantly higher than among women from non-SC/ST groups (53.2%) (Thorat et al., 2021). However, these statistics are merely the surface manifestation of deeper structural pathologies.

Caste operates through both exclusionary and hierarchical mechanisms. Exclusionary practices include the denial of access to water sources, common grazing lands and even public food distribution spaces (Human Rights Watch, 2007; Navsarjan Trust, 2010). For Dalit women, who are often the primary fetchers of water and fuel, these restrictions increase their physical burden and time poverty, leaving less time for childcare and food preparation (Kabeer, 2012). Hierarchical mechanisms are embedded in the ideology of purity and pollution, which positions Dalits at the bottom of a social order, justifying their economic exploitation (as a class of landless laborers and precarious workers) and legitimizing discriminatory practices in everyday life, including food sharing and service delivery.

Within the household, Dalit women face a “patriarchy of a different kind,” one shaped by the specific histories of Dalit marginalization and the household’s pervasive economic insecurity (Rege, 1998). While all women in patriarchal settings face food discrimination, for Dalit women, this is compounded by the fact that the entire household is food-insecure due to caste-based economic deprivation. Her “sacrifice” is thus often a necessity for the collective survival of the family, normalizing her chronic hunger (Panda, 2020).

The Indian state has established one of the world’s largest social protection architectures to address food insecurity, notably the Targeted Public Distribution System (TPDS or PDS), the ICDS and the Mid-Day Meal Scheme (MDMS). However, these very systems often become sites where caste and gender discrimination are reproduced (Dreze and Khera, 2017; Thorat and Lee, 2005).

Studies have documented how Dalit families are served last at PDS shops, are given inferior quality grain or are subjected to verbal abuse by the often upper-caste shopkeepers (Khera, 2011). In the ICDS, Anganwadi workers have been shown to exhibit caste bias, sometimes refusing to serve cooked food to Dalit children or discriminating against Dalit mothers during nutrition counseling (Nambissan, 2010).

For Dalit women, accessing these benefits requires navigating this gauntlet of humiliation. The fear of discrimination, rooted in social stigma and the psychological burden of anticipated shame, can deter them from claiming their entitled rations or services, effectively rendering them “policy non-subjects” (Panda, 2020). This highlights a fundamental flaw in program design: the assumption of a neutral, caste-less citizen.

This scoping review was conducted to systematically map and synthesize the body of interdisciplinary research examining the distinct factors shaping the nutrition and food security of Dalit women in rural India. The primary objective was to explore how the intersection of caste, gender and class structures their dietary intake, nutritional status and engagement with public food safety nets. The review was designed to bridge public health evidence with critical insights from sociology, anthropology and Dalit studies, each contributing unique insights: public health provides epidemiological patterns, sociology and Dalit studies analyze power structures, and anthropology decodes cultural meanings of food.

A comprehensive search strategy was developed in consultation with a subject librarian. Searches were executed across four interdisciplinary databases: PubMed, Scopus, Academic Search Ultimate and Sociological Abstracts. The search combined keywords and controlled vocabulary terms related to three core concepts:

1. Population: (“Dalit” OR “Scheduled Caste” OR “untouchable” OR “SC”) AND (“women” OR “female” OR “mother” OR “wife”)

2. Concept: (“nutrition” OR “diet” OR “food security” OR “malnutrition” OR “anemia” OR “dietary practice*”)

3. Context: (“rural India” OR “villages” OR “village”) AND India

Searches were limited to studies published in English between January 2000 and December 2024 to capture the contemporary policy landscape, including significant policy shifts like the Government of India (2013). The eligibility criteria were structured using the PCC (Population-Concept-Context) framework:

1. Population: The study must focus on or include a specific sub-analysis of Dalit (Scheduled Caste) women in rural India.

2. Concept: The study must examine aspects of food consumption, dietary practices, nutritional status or access to food-related government schemes, with an explicit or implicit analysis of how caste and gender intersect to shape these outcomes.

3. Context: Rural Indian settings. Studies were excluded if they focused exclusively on urban populations, did not disaggregate findings for Dalit women, were purely biomedical without socio-cultural analysis, were not peer-reviewed or were unavailable in full text.

The screening process adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines. All identified records were imported into Covidence software. After duplicate removal, titles and abstracts were screened independently by two reviewers (MS and SM). The full texts of potentially relevant studies were then assessed against the eligibility criteria. Any disagreements were resolved through consensus discussion. This process, detailed in Figure 2, resulted in a final sample of 28 studies for inclusion.

A standardized data extraction form was used to collate information from each included study. Extracted data included: author(s), year and location of study; study design and methodology; primary population characteristics; key themes related to caste, gender and food; main findings on nutritional outcomes or food access; and discussions of public policy (ICDS, PDS, MDMS). Thematic analysis was employed to synthesize the findings. The coding process was conducted manually. Initial descriptive codes (e.g. “water access denial,” “eating last”) were generated inductively from the data. These were subsequently grouped and refined into the four analytical themes presented in the results. The final thematic structure (1) caste-based exclusion, (2) intra-household dynamics, (3) public food programs and (4) nutrition transition, thus emerged directly from the iterative coding process, rather than being imposed a priori. The data supporting this synthesis are presented in Table 1 (Summary of Included Studies).

The synthesis of the 28 included studies reveals a consistent and grim picture of the nutritional vulnerabilities faced by Dalit women, shaped by a triad of caste oppression, patriarchal norms and economic deprivation. The findings are organized below into four interconnected thematic areas.

The literature unequivocally identifies caste-based untouchability not merely as a background factor, but as an active, daily mechanism that directly restricts dietary diversity and quality for Dalit communities, with disproportionate impacts on women who are primarily responsible for food provisioning. Studies by Desai and Thorat (2019) and the Navsarjan Trust (2010) provided granular, ethnographic evidence of the systematic denial of access to common water sources, village markets, and even grazing lands for Dalits. This forces families to rely on distant, often contaminated water sources, which has a dual impact: it drastically increases the physical labor and time burden on women (Kabeer, 2012) while simultaneously threatening food safety and limiting water available for cooking and kitchen gardening, thereby constraining dietary diversity.

Food itself is a potent marker of caste identity and hierarchy. Gupta (2015) and Chakraborty and Sahoo (2018) found that upper-caste ideologies of vegetarianism and notions of “purity” are routinely weaponized to denigrate Dalit food habits, which have historically included the consumption of certain meats and resilient but stigmatized grains like millets. This symbolic devaluation translates into material deprivation; Dalits are frequently excluded from community feasts or, when included, are served separately with food of inferior quality and quantity.

The cumulative impact of this caste-based exclusion is starkly evident in quantitative dietary data. Subramanian and Deaton (2013) and Pandey and Rao (2019), analyzing national survey data, demonstrated that even after controlling for income and education, Dalit households have significantly lower dietary diversity scores compared to upper-caste households. Their diets are heavily reliant on subsidized cereals from the PDS (primarily rice and wheat), with minimal consumption of fruits, vegetables, dairy and protein-rich foods like pulses, eggs and meat – a pattern directly linked to the higher rates of stunting, wasting and micronutrient deficiencies documented in this population.

Within Dalit households, patriarchal norms enforce a rigid pattern of food distribution that systematically disadvantages women and girls, a dynamic intensified by the community’s overarching food insecurity. Multiple studies, including Bhattacharya and Desai (2017) and Harris-Fry et al. (2017), confirmed a consistent pattern: Dalit women are typically the last to eat in the household, consuming the leftover and often less nutritious portions after male members and children have been fed. This practice, while rooted in a cultural valorization of female sacrifice, is, in the Dalit context, intensified by the pervasive food scarcity of the household itself. As Panda (2020) argues in her ethnographic work, the Dalit woman’s hunger is not a passive state but an active, “silent adjustment” or strategic “shock absorber” to the family’s overall scarcity, a sacrifice meant to buffer male earners and the next generation.

This gendered disparity has particularly dire consequences for maternal health. Studies by Mishra et al. (2018) in Bihar and Kumar and Singh (2019) in Uttar Pradesh highlighted that culturally enforced food taboos during pregnancy are prevalent among Dalit communities. These include the avoidance of eggs, meat and certain green leafy vegetables due to beliefs about them causing complications, “heat” or spiritual harm to the fetus. These restrictions, layered on top of a general caloric deficit, contribute significantly to high rates of Low Birth Weight (LBW) and severe maternal anemia. NFHS-5 data, as analyzed by Thorat et al. (2021), shows that anemia prevalence among Dalit women is among the highest of any social group in India – a direct result of chronic iron deficiency exacerbated by repeated pregnancies, heavy physical labor and dietary exclusion.

Government nutrition schemes, designed as universal safety nets, were consistently found to fail Dalit women due to a combination of fundamental design flaws and on-the-ground discrimination, thereby reproducing the very inequalities they are meant to alleviate. The Public Distribution System (PDS), while a critical source of calories and a buffer against starvation, was widely criticized for its lack of dietary diversity. More critically, studies by Khera (2011) and Desai and Thorat (2019) documented rampant discriminatory practices at PDS shops, where Dalit customers, especially women, are routinely harassed, served last, forced to use separate sacks or given rotten and inferior-quality grain, turning a right-based entitlement into a humiliating ordeal.

The Integrated Child Development Services (ICDS), which specifically targets women and children, also falls profoundly short. Nambissan (2010) and Saxena (2018) reported that Anganwadi centers located in Dalit-majority hamlets are often poorly resourced, geographically peripheral and suffer from lower worker attendance. The Anganwadi workers, who are supposed to provide crucial nutritional counseling and support, sometimes act upon deep-seated caste biases, offering less time, care and respect to Dalit mothers and children.

The nutrition transition, the shift from traditional diets to those high in processed fats, sugars and refined grains, is underway in rural India, and Dalit communities are not immune. However, their engagement with it is uniquely shaped by their economic and social location. Studies by Reddy and Gupta (2018) and Yadav and Sharma (2019) noted an increasing desire for and limited consumption of commercially produced processed foods such as biscuits, noodles and sugary drinks among Dalit households. These items carry potent symbolic value as markers of modernity, urbanity and an escape from the stigmatized “backward” and “rustic” Dalit identity associated with traditional foods.

However, chronic poverty and economic precarity severely constrain their ability to regularly purchase these goods. Consequently, the transition is often partial and perverse: traditional, nutrient-dense and climate-resilient foods like millets and wild greens are abandoned as symbols of poverty and historical oppression, but they are not replaced by a diverse, high-quality market-based diet. Instead, as Dasgupta and Sengupta (2016) note, the diet becomes increasingly dominated by two poles: PDS cereals on one end, and cheap, nutrient-poor and often harmful processed snacks on the other. This creates the devastating paradox noted earlier: healthy traditional foods are stigmatized, while accessible aspirational foods are unhealthy. This creates a perfect storm for the double burden of malnutrition, where the historical scourge of undernutrition and micronutrient deficiencies coexists with the emerging risks of obesity, diabetes and hypertension.

The findings of this scoping review present an unequivocal case: the malnutrition of Dalit women in rural India is not a mere outcome of individual behavior or caloric scarcity but a direct manifestation of a social order engineered to devalue their life and labor. Interpreting these results through our integrated framework of Dalit feminist theory, political economy of caste and symbolic anthropology allows us to move beyond description to explain the causal architecture of this nutritional inequity. The synthesized evidence is conceptualized in Figure 3, “The Cycle of Nutritional Marginalization,” which illustrates the self-reinforcing nature of this inequity and points toward strategic interventions to break the chain.

Through a Dalit feminist lens, the consistent findings of intra-household food discrimination are revealed not as a universal patriarchy but as a “Brahmanical patriarchy” that is uniquely inflected by caste (Chakravarti, 2003; Rege, 1998). The Dalit woman’s body becomes a site of multiple, intersecting controls: controlled by upper castes through the threat of sexual violence and economic exploitation, and controlled within her own community by patriarchal norms that designate her as the primary shock-absorber of family scarcity. Public health interventions that simply advise families to “feed women better” are naively apolitical; they fail to engage with the deep structure of gendered caste power that fundamentally dictates resource allocation, wherein a woman’s nutritional sacrifice is often a strategic, painful negotiation for collective survival.

The political economy of caste elucidates how untouchability is not an archaic ritual but an active economic mechanism that enforces material deprivation and shapes class position. The documented denial of access to water sources, markets, and common lands (Desai and Thorat, 2019; Navsarjan Trust, 2010) is a form of “institutionalized humiliation” that directly constrains the quantity, quality and safety of food available to Dalit households. The discrimination at the Fair Price Shop or the neglect by the Anganwadi worker is not a programmatic glitch; as our analysis suggests, it represents the state’s local apparatus reflecting and reproducing societal biases (Khera, 2011; Nambissan, 2010).

A symbolic anthropological perspective helps decode the deeper meanings behind dietary choices, explaining why educational messages often fail. The abandonment of nutrient-dense traditional foods like millets is not merely a rational choice based on taste or convenience. Evidence suggests it is an aspirational act – a conscious or subconscious rejection of foods that are symbolically coded as “Dalit,” “backward,” and “rural” (Gupta, 2015). This creates the devastating paradox: the foods that are culturally valorized and economically accessible (PDS rice, cheap processed goods) are nutritionally inferior, while the foods that are nutritionally superior (millets, leafy greens, animal protein) are either stigmatized or economically out of reach.

The persistent failure of mainstream nutrition policy demands a structural reorientation from standardized, top-down supplementation to context-aware, politically engaged and co-designed strategies. Our synthesis, visualized through the intervention levers in Figure 3, points to the following actionable recommendations. These levers operationalize intersectionality by simultaneously targeting caste-based exclusion, gendered norms, and economic (class) disempowerment.

• Lever A: Transform Public Food Systems with an Anti-Caste Lens: The PDS food basket must be diversified to include locally-sourced, nutrient-dense foods like millets, pulses and fortified oils. Critically, stringent anti-discrimination guidelines must be instituted with transparent, independent grievance redressal mechanisms. Actively recruiting Dalit women as Fair Price Shop dealers, a strategy successfully piloted in Kerala and Tamil Nadu, can transform them from passive beneficiaries to active agents. While this lever faces challenges from entrenched local power structures and the political economy of grain procurement, state-level precedents demonstrate its feasibility with sustained political commitment.

• Lever B: Implement Culturally-Sensitive Food Systems: Supplementary nutrition programs under ICDS must be reformed to incorporate locally acceptable, traditional foods. Public campaigns, developed in partnership with Dalit organizations, should reframe traditional foods as “smart,” “climate-resilient,” and “modern” choices, deliberately divorcing them from caste stigma. This requires overcoming bureaucratic inertia within the Ministry of Women and Child Development, but can be piloted through district-level innovations.

• Lever C: Revamp Gender-Plus Health Services: The training curriculum for ASHAs and Anganwadi workers must include mandatory modules on intersectionality and nondiscriminatory communication. A policy of preferential recruitment of Dalit women as frontline workers in Dalit-majority areas can build trust and improve service delivery. Implementation challenges include resistance from existing workers and the need for significant investment in training infrastructure.

• Lever D: Foster Economic Empowerment and Collective Agency: Linking nutrition programs explicitly with initiatives that secure land rights for Dalit women and ensuring their meaningful participation in collectives is critical. Investing in Dalit women’s Self-Help Groups (SHGs) can enable collective bargaining for better wages and political representation, thereby enhancing their intra-household bargaining power. This cross-ministerial approach (Rural Development, Women and Child Development) faces coordination challenges but is essential for addressing root economic drivers.

This scoping review has several limitations. The reliance on English-language peer-reviewed literature may have excluded valuable insights from grey literature; such as reports from Dalit rights organizations, state-level evaluation studies and community health worker documentation and publications in Indian languages. Given the sensitive and politically charged nature of caste discrimination, much of the most granular evidence of everyday exclusion is documented in these non-peer-reviewed, vernacular sources. Their omission suggests our findings likely represent a conservative estimate of the problem. Furthermore, the thematic synthesis involves interpretive judgment, and while we used a systematic approach, other researchers might foreground different thematic emphases. Finally, as a scoping review, our primary aim was to map the extent and nature of the evidence rather than to critically appraise the methodological quality of each individual study.

This scoping review has systematically charted the evidence demonstrating that the nutritional insecurity of Dalit women in rural India is a profound and distinct crisis, born from the intersection of caste, gender and class oppressions. Their malnutrition is not a simple lack of food but a complex outcome of social exclusion, economic dispossession and patriarchal control.

Government food security programs, while providing a critical caloric safety net, are frequently rendered ineffective by discriminatory implementation and a fundamental failure to address the structural roots of Dalit hunger. The ongoing nutrition transition introduces new risks, as traditional food knowledge is lost and replaced by an aspirational but often unattainable and unhealthy market-based diet.

Addressing this crisis requires a paradigm shift. Policymakers must move beyond caste-blind, technocratic solutions and adopt an explicit, intersectional framework. As illustrated by the intervention levers in our cyclical model, concrete, evidence-informed actions must include the structural reform of public food systems, the explicit linking of nutrition programs with economic empowerment, and the mandatory integration of caste- and gender-sensitivity training.

Future research must prioritize community-based participatory action research, co-designed and led by Dalit women and their organizations. There is an urgent need for more qualitative, ethnographic work to deeply understand the lived experiences of food and hunger from a Dalit feminist standpoint. Only by centering the voices from the margins can we hope to forge a path toward genuine nutritional justice in rural India.

(ASHA)

Accredited Social Health Activist

(AWC)

Anganwadi Centre

(ANM)

Auxiliary Nurse Midwife

(BMI)

Body Mass Index

(FGD)

Focus Group Discussion

(HH)

Household

(ICDS)

Integrated Child Development Services

(LBW)

Low Birth Weight

(MP)

Madhya Pradesh

(MDMS)

Mid-Day Meal Scheme

(NFHS)

National Family Health Survey

(NSSO)

National Sample Survey Office

(PCC)

Population-Concept-Context

(PRISMA-ScR)

Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews

(PDS)

Public Distribution System

(SC)

Scheduled Caste

(ST)

Scheduled Tribe

(SHG)

Self-Help Group

(TPDS)

Targeted Public Distribution System

(UP)

Uttar Pradesh