A Ready Solution to Tackle Anaemia

UPSC Syllabus: Gs Paper 2- Issues relating to development and management of Social Sector/Services relating to Health And GS Paper 3: Food security

Introduction

Anaemia remains a major public health challenge in India, affecting women, children and adolescents despite sustained health interventions. Iron deficiency is a key contributor, but other micronutrient deficiencies and non-nutritional conditions also play a role. Its consequences include maternal risks, impaired cognition, reduced productivity and intergenerational malnutrition. Effective control requires an integrated approach combining food fortification, supplementation, screening, treatment, dietary diversification and stronger nationwide public health delivery.

Anaemia Burden and Its Underlying Causes

1. High Prevalence: NFHS-5 reports anaemia among 67.1% of children and 59.1% of adolescent girls, reflecting the scale of the challenge.
2. Historical Burden: NFHS-2 (1998) found anaemia among 56% of adolescent girls aged 15–19 years and 69% in tribal communities.
3. Intergenerational Consequences: Anaemia during adolescent pregnancy increases the risks of maternal death, premature delivery and low-birth-weight (LBW) babies.
4. Health and Economic Consequences: Anaemia contributes to maternal mortality, impaired cognition and reduced productivity. Iron deficiency anaemia’s economic burden has been estimated at 4% of GDP.
5. Multiple Nutritional Causes: Besides iron deficiency, deficiencies of vitamin B12, vitamin A, folate and zinc contribute to nutritional problems.
6. Micronutrient Deficiencies: Comprehensive National Nutrition Survey (CNNS) found vitamin B12 deficiency in one-sixth of preschool children and one-third of adolescents, alongside widespread folate deficiency.
7. Poor Hygiene and Sanitation: Inadequate sanitation and poor hygiene can increase exposure to parasitic infections, such as hookworm, which may cause blood loss and contribute to anaemia.
8. 8. Poor Dietary Diversity: Low consumption of fruits, vegetables, milk, pulses, meat and poultry restricts essential nutrient intake.
9. 9. Inadequate Dietary Intake: Only 6% of children aged 6–23 months received a minimum acceptable diet, while 9% consumed iron-rich foods.
10. Affordability of Nutritious Diets: Nearly two-thirds of rural poor cannot afford nutritious diets meeting national guidelines, limiting access to balanced food.

Food Fortification as a Preventive Solution

1. Double-Fortified Salt (DFS): DFS contains iron and iodine and delivers essential micronutrients through routinely consumed salt.
2. Existing Infrastructure: Around 95% of households use iodised salt, providing an established platform for expanding iron fortification.
3. Existing Reach: DFS has reached an estimated 76 million people across four States through government safety-net programmes.
4. Evidence of Effectiveness: A global review found that DFS could reduce anaemia by up to 21%, while Indian trials demonstrated improvements in iron status.
5. Consumer Acceptability: Trials in Bengaluru, Darjeeling and Punjab, alongside implementation in Uttar Pradesh, showed improved iron status and acceptability with validated specifications.
6. Affordability and Returns: DFS costs approximately ₹14–₹20 per person annually, with an estimated 4.2:1 benefit-cost ratio.
7. Rice Fortification: Fortified rice containing iron, folic acid and vitamin B12 provides another preventive delivery channel through a widely consumed staple.
8. Potential Population Coverage: Rice is consumed by 65% of the population, averaging 6.8 kg per person monthly, making it suitable for micronutrient delivery.
9. Economic Benefits: A cited assessment estimated that an annual outlay of ₹2,800 crore could avert 16.6 million disability-adjusted life years (DALYs) annually. Another estimate projected 94.1 million fewer anaemia cases and ₹8,098 crore in savings over five years.

India’s Anaemia Control Strategy

1. Anaemia Mukt Bharat (AMB): Launched in 2018, its revised 7X7X7 framework covers seven beneficiary groups, seven interventions and seven institutional mechanisms.
2. Beneficiary Coverage: Children aged 6 months–19 years, pregnant and lactating women, women of reproductive age (20–49 years) and Low Birth Weight (LBW) babies aged 0–6 months.
3. Key Interventions: Prophylactic iron-folic acid (IFA) supplementation, screening, treatment, deworming, delayed cord clamping, behaviour change communication, dietary diversification and management of non-nutritional causes.
4. Adolescent Programme: India’s universal adolescent anaemia programme targets 116 million adolescents. In Q2 FY 2024–25, 15.4 crore children and adolescents received IFA supplements.
5. Nutrition-Based Interventions: Fortified rice and double-fortified salt complement supplementation and dietary diversification through public welfare delivery systems.
6. Dietary Diversification: India has adopted measures to promote dietary diversity, including millets under nutrition programmes, nutrient-rich crop varieties, POSHAN Vatikas (nutrition gardens) and locally available iron-rich foods to improve nutritional intake and prevent anaemia.
7. Monitoring and Follow-up: India has adopted the T4 approach (Test, Treat, Talk and Track) under the revised Anaemia Mukt Bharat Abhiyaan to strengthen anaemia screening, treatment, counselling and digital monitoring for beneficiary follow-up.

Institutional Framework and Supporting Services

1. Institutional Mechanisms: The revised Anaemia Mukt Bharat (AMB) framework includes intra-ministerial coordination, the National Centre of Excellence and Advanced Research on Anaemia, National AMB Unit, strengthened supply chains, inter-ministerial convergence, AMB portal and digital monitoring.
2. Maternal Healthcare: Surakshit Matritva Aashwasan (SUMAN) ensures respectful maternal care; Janani Shishu Suraksha Karyakram (JSSK) provides free delivery services; Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) offers specialist antenatal care on the 9th of every month, including anaemia screening. Extended PMSMA supports high-risk pregnancies.
3. Community Outreach: Monthly Village Health, Sanitation and Nutrition Days (VHSNDs), Accredited Social Health Activist (ASHA)-supported postnatal referrals, tribal outreach camps and Mother and Child Protection Cards strengthen access and awareness.
4. Healthcare Infrastructure: Functional First Referral Units (FRUs), blood storage facilities, Obstetrics High Dependency Units and Intensive Care Units (ICUs) improve maternal emergency care.
5. Awareness and Research: Solid Body, Smart Mind, Information, Education and Communication (IEC) campaigns and Safe Motherhood Booklets promote preventive practices. The Indian Council of Medical Research (ICMR)‘s National Health Priority Programme supports solution-oriented research and scalable interventions.
6. Quality Assurance: Food Safety and Standards Authority of India (FSSAI) standards, accredited laboratories and manufacturing standardisation support the quality of fortified foods.

Challenges in Scaling Up Fortification and Anaemia Prevention

1. Uneven PDS Integration: DFS integration into the Public Distribution System (PDS) remains uneven, requiring stronger state-level implementation and last-mile delivery.
2. Institutional and Financial Barriers: Wider adoption requires sustained policy commitment, dedicated financing, commercial availability, consumer awareness and dependable distribution.
3. Quality Assurance: Consistent fortification quality requires validated manufacturing specifications, laboratory testing and regulatory monitoring.
4. Multiple Causes of Anaemia: Fortification alone cannot address non-nutritional causes such as malaria, haemoglobinopathies and fluorosis, requiring appropriate screening and treatment.
5. Public Health Safeguards: DFS implementation must complement AMB, align with sodium reduction goals and include screening for thalassaemia and sickle-cell disease.

Way Forward

1. Expand DFS Distribution: Strengthen financing, policy support and PDS integration to improve access through public distribution and safety-net programmes.
2. Strengthen Quality Monitoring: Improve manufacturing standards, laboratory testing, regulatory oversight and supply chains to maintain fortified food quality.
3. Integrate Prevention and Treatment: Combine fortification with IFA supplementation, screening, treatment, deworming and digital tracking under AMB.
4. Promote Dietary Diversification: Encourage millets, nutrient-rich crop varieties, locally available iron-rich foods and POSHAN Vatikas.
5. Improve Diet Affordability: Expand access to nutritious diets and encourage healthier food choices through sustained behaviour change.
6. Strengthen Community Participation: Use Jan Bhagidari and awareness campaigns to improve screening uptake, supplement adherence and public participation.
7. Ensure Institutional Convergence: Coordinate health, education, nutrition and food distribution departments for effective implementation and beneficiary follow-up.
8. Build a Scalable Model: Build on India’s experience with universal salt iodisation to demonstrate an affordable fortification model for other low- and middle-income countries.

Conclusion

Anaemia reduction requires coordinated fortification, supplementation, screening, treatment and dietary diversification. Double-fortified salt and fortified rice can improve micronutrient delivery, but cannot replace comprehensive care. Sustainable progress depends on quality assurance, affordable nutritious diets, institutional coordination, public awareness and reliable last-mile access to prevention and treatment services, especially for vulnerable populations and communities.

Question for practice:

Examine the major causes of anaemia in India and discuss the role of food fortification and government interventions in addressing this public health challenge.

Source: The Hindu; PIB