Anaemia cases have been on the rise since the COVID-19 pandemic, and India needs a holistic public health approach to tackle this problem
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India has the highest number of anaemic individuals globally, with anaemia often described as a silent epidemic in the country. Despite efforts to address it, anaemia remains a significant public health challenge, and its prevalence has continued to rise in recent decades. Anaemia manifests through symptoms such as weakness, exhaustion, shortness of breath, pale complexion, cold extremities, light-headedness, fast heartbeat, and difficulty concentrating. A vicious cycle is created where weakness reduces productivity and well-being, posing a risk of maternal mortality, infant mortality, and low birth weight. Anaemia has far-reaching social and economic consequences, significantly impairing both physical and cognitive development.
According to the National Family Health Survey (NFHS-5) 2019-2021 data, 57 percent of women and 67.1 percent of children are anaemic in India (figure below). The prevalence is higher in women of reproductive age, young children, and rural populations. The increase in anaemia rates highlights systemic issues in India's public health system that need to be addressed urgently.
Source: IIPS
Over the past two decades, India's anaemia prevalence has decreased between the NFHS-3 and NFHS-4 and an improvement in other important anaemia-related indicators, including maternal health services due to increased antenatal care coverage, institutional deliveries, and access to healthcare for pregnant women has been witnessed. Additionally, child health indicators have improved, with children under five years old having better nutrition and greater vaccination rates. However, the prevalence of anaemia increased again in the NFHS-5 for all categories. The frequency of anaemia in women rose from 53 to 57 percent between 2015–16 and 2019–21. In all of the female groupings, the overall prevalence of anaemia is continuously high, exceeding 50 percent. Anaemia was more prevalent in children living in rural areas (68.3 percent) than in urban areas (64.2 percent), which is directly related to mothers’ low educational levels and low-income households. Children of anaemic mothers are more likely to have anaemia than children of non-anaemic mothers, and this prevalence rises with the number of children born. Adolescent women, who make up roughly 17 percent of all Indian women, are especially vulnerable to anaemia because of the distinctive physical and physiological changes that take place during this phase of life, along with low iron intake and loss during menstruation. They may also be at risk for other dietary deficiencies, such as folate and vitamin B12, which are critical for synthesising red blood cells.
Children of anaemic mothers are more likely to have anaemia than children of non-anaemic mothers, and this prevalence rises with the number of children born.
Anaemia in children and women of reproductive age has risen as a result of COVID-19, attributable to lockdown-related disruptions in nutritional programs and health services, which made it more difficult to obtain essential medical treatment and dietary supplements. Anaemia was found to be present in 80 percent of women hospitalised for COVID-19 in a cross-sectional research carried out in a tertiary care hospital in eastern India. The study found that lower haemoglobin levels were linked to greater fatality rates and more severe COVID-19, suggesting that pre-existing anaemia had a major influence on patient outcomes during the pandemic. According to data from the Health Management Information System, all benefit groups saw an improvement in the coverage of Iron and Folic Acid (IFA) supplementation between 2017–18 and 2019–20. Nevertheless, post-COVID-19 pandemic evaluations reveal that, although some progress was achieved, the prevalence of anaemia did not considerably decline over this time.
The majority of Indians eat diets that are "barely sufficient" or "frankly inadequate" in terms of meeting their daily needs for iron, folate, and vitamin B12. Restrictive diets during pregnancy or the postpartum period might originate from cultural beliefs and behaviours, which can cause dietary deficits that prevent women from getting enough nutrients, leading to anaemia. Anaemia prevalence is often influenced by socioeconomic factors, such as marginalised status, low income, restricted access to healthcare, a lack of financial autonomy, limited decision-making authority and illiteracy. Chronic diseases such as HIV (human immunodeficiency virus), malaria, TB (tuberculosis), and parasitic infections further elevate the risk. A higher prevalence of anaemia has been observed in the states of Jharkhand and Bihar, associated with high levels of poverty and restricted access to nutrition and medical treatment. Anaemia in children and adolescents results in intellectual impairment, poor academic performance, and stunted growth, all of which can have long-term consequences on educational attainment and economic productivity. Progress has been slow despite several government attempts to reduce anaemia, and current data shows that incidence is rising among susceptible populations.
Anaemia in children and adolescents results in intellectual impairment, poor academic performance, and stunted growth, all of which can have long-term consequences on educational attainment and economic productivity.
The Anaemia Mukt Bharat (AMB) strategy was introduced in 2018, to lower the prevalence of anaemia in mothers, children and adolescents by using a life cycle approach. The program uses a 6x6x6 strategy, which consists of six interventions, six target beneficiary categories, and six institutional frameworks, with a focus on bolstering the supply chain, demand generation and strong monitoring to address nutritional and non-nutritional causes of anaemia. AMB is in line with more comprehensive national nutrition plans, including Mission POSHAN 2.0, which combines other nutritional programs and focuses on food fortification, diet diversity, and promoting the use of millets. To bridge dietary gaps, nutrition awareness initiatives under POSHAN 2.0 seek to promote long-term health and well-being via nutritious, regional foods. The food fortification programme seeks to enhance nutritional outcomes by strategically adding vital micronutrients to staple foods and reaching out to vulnerable groups through Public Distribution Systems and Integrated Child Development Services.
A multifaceted approach is required to effectively combat anaemia through nutritional, health, and community interventions. For populations at risk, iron intake can be increased through the increased consumption of foods rich in iron including leafy greens, legumes, nuts, and fortified cereals, as well as through education on dietary diversity. Key foods must be fortified with iron and other minerals to ensure these crucial nutrients are broadly available. Ensuring adherence to Iron folic acid (IFA) supplementation through health education and counselling, along with managing adverse effects can help in the prevention and management of anaemia. Improving anaemia screening techniques by utilising precise diagnostic instruments, such as venous blood samples, will aid in accurate anaemia diagnosis and treatment. Studies have demonstrated the role of empowering community health workers to provide parental counselling for anaemia prevention and cure. Focusing on high-risk groups, including pregnant women, lactating mothers, and children below five years, involves implementing region-specific targeted interventions for anaemia prevention.
India can address the underlying causes of anaemia by adopting a holistic approach that considers all aspects—social, cultural, dietary and economic—alongside clinical components for anaemia prevention and management strategies.
Madhavi Jha is a Research Intern at the Observer Research Foundation
Shoba Suri is a Senior Fellow with the Health Initiative at the Observer Research Foundation.
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Dr. Shoba Suri is a Senior Fellow with ORFs Health Initiative. Shoba is a nutritionist with experience in community and clinical research. She has worked on nutrition, ...
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