The Urgent Need to Address Anemia in Women in India
Anemia incidence in India has escalated in 2020, necessitating mechanisms to control its extraneous impact on not just children and adult health, but also to generational productivity. Population-based studies on anemia in India are routinely conducted through the large-scale, multi-round National Family Health Survey (NFHS). According to the recently published State wise NFHS-5 Phase I (2019), anemia remains a pertinent problem that has seen a drastic rise in particularly women of both rural and urban spheres. Between NFHS-4 (2016-18) and NFHS-5 (2019-20), the number of anemic women in the 15-49 years age group in India has increased to 58.8% from 54% with a corresponding figure of 16.2% in men. Though there is a jump in anemia in men, it is important to note that anemia prevalence in women is approximately double that of in men.
Chronic anemia in women is detrimental not only to the woman but also to fetal and child development; it increases risk of prematurity, low birthweight, perinatal/ neonatal mortality. Anemia in pregnant women physiologically manifests as stress, fatigue and reduction in some cognitive abilities– these factors influence a mother’s ability to lactate, which in turn has a lasting impact on the child’s nutritional intake and development. Iron deficiency anemia contributes close to 6 lakh perinatal deaths and 1.2 lakh maternal deaths globally, creating a clarion call for policy advancement or shift.
Primary reasons for disparity in anemia prevalence in men and women include childbirth and menstruation. Menstrual losses are highly variable, ranging from 10 to 250 mL (4-100 mg of iron) per period. Each healthy pregnancy is said to deplete the mother of approximately 500 mg of iron. NFHS-5 also raises another red flag by reporting the popular adoption of C-Section style deliveries in government hospitals increasing from 23.6% in 2015-16 to 31.5% in 2019-2020– the need for possible transfusion, high amount of blood loss in comparison to a vaginal delivery and delayed postpartum recovery largely contributes to postpartum anemia and potential development of early-onset anemia in the child. NFHS-5 also reports a fall in mothers who consume folic acid tablets for 100 days or more (when pregnant) from 45.2% to 44.7%, with an even graver drop in mothers who consume IFA tablets for 180 days or more (when pregnant) from 32.6% to 26.7%.
In the last two decades the prevalence of anemia among Indian women and children have increased 20% more than world averages. India currently has a multitude of national and state level schemes such as the integrated Child Development Services (ICDS), National Nutritional Anaemia Prophylaxis Programme (NNAPP), Pradhan Mantri Surakshit Matritva Abhiyan, Pradhan Mantri Matru Vandana Yojana and the Anaemia Mukt Bharat (AMB) strategy, Muthapoorna, Ksheera Bhagya, SABLA to address nutritional requirement in women and children. These schemes have had a significant impact on reducing cases of anemia, however their progress has been impeded by low intervention during early childhood, pregnancy, illiteracy, sanitation and socio-cultural misconceptions/ beliefs. Anemia in India cannot be compared to Western nations, where there is access to affordable fortified foods, such as breakfast cereals, supplemental iron and its targeted use for high-risk groups, such as pregnant women, is better coordinated than in India. Furthermore, NFHS-5 has successfully been designed to identify various indicators in national, state and Union Territory data; it still neglects a rural-urban breakdown that has the potential to shed light on the efficacy of schemes on its target beneficiaries.
The increased incidence of anemia must be countered with a multipronged approach targeting more than just its causal relationship with nutrition. While improvement in nutrition and health interventions was the strongest driver of anemia reduction in children, improvements in maternal schooling and socio-economic status (SES) were the key drivers of anemia reduction in pregnant women. The clinical term “anaemia” in most states is seen to be redefined by words colloquially used for general health ailments. An example of this, the clinical term for “anemia” in Karnataka is ‘susthu, thalaisuthu, raktha heenathenot’ translating to ‘tiredness, dizziness and blood loss’. The lack of awareness is diluting the severity and magnitude of generational implications of anemia. The existence of anemia is directly linked to socio-cultural values and beliefs in various states. Furthermore, a large
proportion of women in India still follow patriarchal lifestyles such as eating last and eating less and addressing traditional beliefs would be prudent to ameliorate health outcomes. The potential negligence in acknowledging dietary preferences and traditional beliefs is a reason that schemes haven’t reached full potential and its target beneficiaries. While positive changes were observed in several states, others showed lack of improvement due to state specific urban expansion, influx of migrant labor, increased vegetarianism and shifting dietary landscape. The commencement of schemes need to be partially decentralised in order to reckon with dietary preferences, geographical conditions and develop alternative foods.
Previous attempts to supply food supplements and diversify ration kits have proven to be time-consuming, costly and cumbersome due to inefficient supply chains. The prudent approach requires R&D investment into biofortification. Biofortification offers economically remunerative options to cultivators and eliminates highly compound distributive chains.
Finally, a key determinant in the adoption of IFA supplements will be public engagement –the government has to take a lead role in distributing IFA sources across all age groups of women and encourage their consumption.
Addressing anemia in women is critical both for our current generation and for the health of future generations. Breaking traditional beliefs, expanding nutritional delivery programmes and extensive public engagement will be important to tackle this continued driver of poor health in women.
