Unexpected Gender Story Behind India’s Changing Alcohol Use After Lockdown

A new study has found that alcohol use in parts of India followed different post-lockdown patterns for women and men, with the clearest increase appearing among women facing social and economic disadvantages. The original study, titled 'Past-month alcohol use in relation to the COVID-19 lockdown in 13 Indian states and union territories: gender, socioeconomic status, and state alcohol policy differences,' was published in the journal Frontiers in Public Health.

Researchers Md Zubab Ibne Moid, Abhishek Ghosh, Shinjini Choudhury and Jeremy Bray examined whether alcohol use after the national lockdown was higher or lower than expected from trends already visible before the disruption.

Survey Data Revealed a Gender Divide Hidden Behind the Overall Numbers

The analysis combined National Family Health Survey data from NFHS-4, conducted in 2015–2016, with NFHS-5 information gathered during 2019–2021. Only 13 states and union territories with NFHS-5 interviews both before and after the lockdown were included: Arunachal Pradesh, Chhattisgarh, Delhi, Haryana, Jharkhand, Madhya Pradesh, Odisha, Puducherry, Punjab, Rajasthan, Tamil Nadu, Uttar Pradesh and Uttarakhand.

India's national lockdown began on March 25, 2020, and continued through May 31 in several phases. Interviews completed on or before March 24 were treated as pre-lockdown observations, while those conducted after June 1 were placed in the post-lockdown group. Responses collected during the strict lockdown were excluded.

The final sample contained 461,552 NFHS-4 respondents, 179,316 people interviewed before the NFHS-5 interruption and 258,812 interviewed after fieldwork resumed. Women were aged 15-49, and men were aged 15-54, reflecting the NFHS sampling structure.

Overall past-month alcohol use fell from 6.3% in NFHS-4 to 4.6% before the lockdown, then rose to 5.1% after it. Men still reported drinking far more frequently than women: male prevalence moved from 32.6% to 26.3% and then 26.7%, while the corresponding figures for women were 2.3%, 1.6% and 2.0%. These raw percentages alone could not show whether the post-lockdown figures represented an unexpected break from the existing downward pattern, which is why the researchers used an adjusted model.

Women Recorded a Much Stronger Post-Lockdown Association Than Men

Alcohol use was defined as any drinking during the month before an interview, combining daily, weekly and less-than-weekly consumption into one category. This approach made the results easier to interpret and reduced statistical problems caused by the small number of women reporting alcohol use.

Bayesian binomial logistic regression models were calculated separately for women and men. The models considered age, rural or urban residence, education, household wealth, marital status, religious norms around alcohol, Scheduled Tribe status and state alcohol-policy category, while also accounting for baseline differences between states.

Once the earlier time trend and respondent characteristics were considered, women had 83% higher odds of past-month alcohol use than expected during the post-lockdown survey period. The adjusted odds ratio was 1.83, with a 95% credible interval of 1.42–2.20, and virtually every model estimate pointed toward a positive association.

Men showed a far smaller change, recording 9% higher odds than expected. Their odds ratio was 1.09, with a 95% credible interval of 1.01–1.16. This gender contrast matters because women may experience serious alcohol-related health consequences at lower consumption levels, while stigma can keep their drinking less visible and make support harder to seek.

Rural, Older and Less-Advantaged Women Showed the Clearest Increases

Women aged 15–24 showed little clear change, while the odds ratio reached 1.88 among women aged 25–34, 1.93 among those aged 35–44 and 2.23 among women aged 45–49. Rural women recorded an odds ratio of 1.88, compared with a smaller and less certain estimate of 1.50 among urban women.

Education revealed a similar social divide: Women with no schooling had more than twice the expected odds of drinking after lockdown, with an odds ratio of 2.06. Estimates became progressively smaller among women with primary, secondary and higher education. Women in the poorest household group recorded an odds ratio of 1.93, while the result for the richest group was weaker and uncertain.

Marital circumstances shaped the findings: Odds were higher among married women and highest among divorced, separated or widowed women, whose odds ratio reached 2.24. No clear increase appeared among women who had never been in a union.

Patterns among men were more mixed: Higher odds were concentrated among men aged 35 and above, rural residents, men with primary education, poorer and middle-income groups, married or previously married men and Scheduled Tribe men. Young men aged 15–24 had lower odds than expected, while results among urban men and those with higher education showed little evidence of an increase.

Alcohol Rules Alone Cannot Explain What Happened After Lockdown

The researchers grouped states according to whether alcohol sales faced temporary prohibition, restricted access or relatively relaxed policies. Women in restricted-sales states recorded the largest increase, with an odds ratio of 2.38, followed by women in relaxed-policy states at 1.45. Women in temporary-prohibition states showed lower post-lockdown odds, with an estimate of 0.55. Men experienced modest increases in restricted-sales and relaxed-policy states, while their results in temporary-prohibition areas remained uncertain.

These categories reflect formal rules rather than what people could obtain in practice. Restricted shop hours sometimes existed alongside online ordering or home delivery, while illicit production, informal sellers, smuggling, uneven enforcement and local reopening decisions could all change real access. Economic insecurity, isolation, household pressure, caregiving demands, emotional distress and interrupted addiction services may also have influenced drinking among disadvantaged women.

The results cannot prove that lockdown measures caused alcohol use to change. NFHS records drinking during the month before each interview, meaning post-lockdown responses do not describe consumption during the strict shutdown itself. Calendar timing, seasonal differences, infection levels, economic recovery and changes in the people surveyed may have contributed to the patterns. The cross-sectional study covered only 13 states and union territories, used unweighted counts without the NFHS sampling design, and measured any alcohol use without recording quantity, heavy drinking, alcohol dependence, treatment seeking or related harm.

The findings still raise an important public health concern that broad national averages can hide meaningful changes among women whose drinking receives less attention. Gender-sensitive monitoring, accessible screening, brief interventions and dependable referral services in primary and community care could help identify emerging problems after major social disruptions, especially among rural women and households with fewer economic resources.