Anaemia, a condition marked by a deficiency of healthy red blood cells or haemoglobin, has emerged as a silent epidemic in India. Despite numerous interventions, it remains a significant public health challenge, affecting millions and undermining the nation’s productivity and development. India has the highest number of anaemic individuals globally, and its prevalence continues to rise, with women, children, and rural populations being the most vulnerable. This article delves into the alarming state of anaemia in India, its causes, consequences, and the interventions required to combat it effectively.

Prevalence of Anaemia in India

The National Family Health Survey (NFHS-5) 2019-2021 reveals concerning statistics:

• 57% of women and 67.1% of children are anaemic in India.
• The prevalence is particularly acute among women of reproductive age, children under five, and rural populations.
• Rural areas exhibit a higher prevalence (68.3%) compared to urban areas (64.2%), highlighting disparities in access to healthcare and nutrition.
• The prevalence has risen from 53% to 57% in women between 2015–16 and 2019–21, underscoring the systemic challenges in addressing anaemia.

Adolescent girls, who constitute about 17% of the female population, are especially susceptible due to the physiological demands of growth, menstruation, and inadequate dietary intake during this crucial phase of life.

Symptoms and Impact of Anaemia

Anaemia manifests through symptoms such as:

• Weakness and exhaustion
• Pale complexion
• Cold extremities
• Shortness of breath
• Light-headedness
• Difficulty concentrating
• Rapid heartbeat

These symptoms result in reduced productivity, impaired cognitive function, and diminished quality of life. Among women, anaemia increases the risks of maternal mortality, low birth weight, and infant mortality. In children, it leads to intellectual impairment, stunted growth, and poor academic performance, affecting their long-term potential.

Key Causes of Anaemia

·        Nutritional Deficiencies: The primary cause of anaemia in India is the inadequate intake of iron, folate, and vitamin B12. Many Indian diets are deficient in these essential nutrients due to limited food diversity and restricted access to fortified foods. Cultural practices often discourage women from consuming nutrient-rich diets during pregnancy and postpartum, exacerbating the issue.

·        Socioeconomic Factors: Anaemia is disproportionately prevalent among marginalized groups with low income, poor educational levels, and limited healthcare access. Poverty and social inequality restrict access to nutritious food and essential healthcare services, perpetuating the cycle of malnutrition.

·        Chronic Diseases and Infections: Conditions such as HIV, malaria, tuberculosis, and parasitic infections significantly elevate anaemia risk. These diseases interfere with the body's ability to absorb and utilize nutrients effectively, further worsening the condition.

·        COVID-19 Pandemic: The pandemic disrupted nutritional programs and healthcare services, limiting access to dietary supplements and medical care. Studies during this period revealed that 80% of women hospitalized for COVID-19 were anaemic. Lower haemoglobin levels were associated with severe disease outcomes and higher mortality rates.

Consequences of Anaemia

Health Impacts

Anaemia significantly affects physical and mental health, especially in vulnerable populations:

• In women, it leads to complications during pregnancy, increasing the risk of maternal mortality and adverse birth outcomes.
• Children born to anaemic mothers are more likely to suffer from anaemia, perpetuating intergenerational health challenges.
• Anaemic children experience stunted growth, weakened immunity, and cognitive delays, reducing their potential to excel academically and socially.

Economic and Social Consequences

Anaemia undermines productivity, leading to economic losses at individual and national levels. The condition affects adults’ ability to work, particularly in labor-intensive sectors, reducing household income. It also limits children’s educational attainment, further perpetuating poverty and inequality.

Government Initiatives to Address Anaemia

Anaemia Mukt Bharat (AMB) Strategy

Launched in 2018, the Anaemia Mukt Bharat (AMB) strategy aims to reduce anaemia prevalence in women, children, and adolescents. Its 6x6x6 approach includes:

·         Six interventions: Enhancing iron and folic acid supplementation, deworming, food fortification, improving dietary diversity, behaviour change communication, and screening for anaemia.

·         Six beneficiary categories: Pregnant women, lactating mothers, adolescent girls, children, school-aged boys, and non-pregnant women.

·         Six institutional frameworks: Strengthening supply chains, demand generation, and robust monitoring systems.

Mission POSHAN 2.0

Aligned with AMB, this initiative focuses on addressing malnutrition by promoting:

• Food fortification: Adding essential nutrients to staples such as rice, wheat, and milk.
• Diet diversity: Encouraging the consumption of locally available, nutritious foods.
• Millets: Promoting these nutrient-rich grains to bridge dietary gaps.

Food Fortification Programs

These programs aim to improve nutritional outcomes by fortifying staples with iron and other micronutrients. The fortified foods are distributed through Public Distribution Systems (PDS) and Integrated Child Development Services (ICDS), ensuring they reach the most vulnerable populations.

Challenges in Combating Anaemia

Despite these initiatives, significant barriers persist:

• Inadequate Implementation: Delays in program rollouts and gaps in monitoring hinder progress.
• Cultural Practices: Dietary restrictions based on cultural beliefs limit nutrient intake, especially among pregnant and postpartum women.
• Healthcare Access: Rural populations face significant challenges in accessing quality healthcare services, exacerbating the condition.
• Economic Inequalities: Poverty restricts access to nutritious food and dietary supplements, perpetuating anaemia.

Recommendations and Interventions

1. Enhancing Dietary Intake

• Promote the consumption of iron-rich foods like leafy greens, legumes, nuts, and fortified cereals.
• Increase awareness about dietary diversity through community-based nutrition education programs.

2. Strengthening Supplementation Programs

• Improve the distribution and adherence to Iron and Folic Acid (IFA) supplements.
• Address side effects of supplementation through counselling and health education.

3. Improving Screening and Diagnosis

• Use accurate diagnostic tools, such as venous blood samples, for reliable anaemia detection.
• Train healthcare workers to identify anaemia early and ensure timely intervention.

4. Empowering Community Health Workers

• Equip health workers to provide counselling on anaemia prevention and management.
• Facilitate parental counselling to address anaemia in children and adolescents effectively.

5. Focused Regional Interventions

• Implement region-specific strategies targeting high-risk areas like Jharkhand and Bihar, where anaemia prevalence is highest.

The Way Forward: A Holistic Approach

Combating anaemia in India requires a multifaceted and holistic approach. Addressing the root causes—nutritional, social, economic, and healthcare-related—will be crucial for long-term success. Effective policies must integrate:

• Nutritional Interventions: Enhancing food security and promoting dietary diversity.
• Health Services: Strengthening healthcare infrastructure and ensuring accessibility for marginalized populations.
• Community Engagement: Educating communities about the importance of nutrition and addressing cultural barriers.

India’s fight against anaemia is critical for improving the quality of life, boosting economic productivity, and fostering inclusive development. By prioritizing the health of its women and children, India can lay the foundation for a healthier, more prosperous future.