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As India sets its sights on becoming a global leader and a transformative force on the world stage, it must address the growing prevalence of anaemia
Image Source: Getty
This essay is part of the series: World Health Day 2025: Healthy Beginnings, Hopeful Futures
Despite the relatively low levels of spending on health, India has made significant strides in key health indicators over the past three decades. Maternal Mortality Ratio (MMR) declined to 97 per lakh live births, marking an 83 percent reduction since 1990—far exceeding the global average of 45 percent. Similarly, the Under-5 Mortality Rate (U5MR) dropped to 32, achieving a 75 percent reduction since 1990 compared to a global decline of 60 percent. India's Infant Mortality Rate (IMR) also decreased from 84 per 1,000 live births in 1990 to 26 per 1,000 live births, marking a reduction of approximately 69 percent. However, government surveys show that anaemia remains a major policy challenge in India, with little overall improvement over the last two decades (Figure 1). Despite policy focus, and significant government initiatives fighting the problem, anaemia remains a persistent health challenge, and population-level prevalence remains where it was two decades ago, across different demographic groups.
Figure 1: Anaemia prevalence (%) in India, 2005-6 to 2019-21
Source: UNICEF (2025)
In 2012, India committed to achieving the six World Health Assembly targets on nutrition—one of these being a 50 percent reduction in anaemia prevalence among women of reproductive age by 2025, a deadline which was later extended to 2030. However, India is one of the 88 countries that are off-track on all targets, with only eight countries currently on track to achieving all targets. Given that anaemia is associated with increased risks of adverse outcomes for both mothers and newborns, addressing anaemia remains one of the most significant public health challenges of modern India. With World Health Day 2025's theme focusing on ending preventable maternal and newborn deaths, India has a timely opportunity to reaffirm its commitment and intensify efforts to combat anaemia. This article aims to analyse the problem of anaemia across Indian states and explore sub-national differences in its prevalence.
The NFHS-5 (2019–21) data (Map 1) paints a worrying picture of child anaemia in India, with 67.1 percent of children aged 6–59 months found to be anaemic—a sharp rise from 58.6 percent in NFHS-4 (2015–16). While anaemia remains a nationwide challenge, stark state-level variations reveal critical regional disparities. For instance, Ladakh (92.5 percent), Gujarat (79.7 percent), Dadra & Nagar Haveli and Daman & Diu (75.8 percent), and Madhya Pradesh and Jammu & Kashmir (both 72.7 percent) have the highest anaemia prevalence in the country. These figures are well above the national average and demand urgent, tailored interventions. In contrast, a few states such as Kerala (39.4 percent), Meghalaya (45.1 percent), and Lakshadweep (43.1 percent) show comparatively lower prevalence, reflecting the positive impact of localised public health and nutrition strategies.
Map 1: Percentage of children aged 6-59 months who are anaemic in India (2019-21)
Source: Data from the Government of India compiled by the author and visualised using Flourish.
Interestingly, some states that previously performed better have seen a worsening of anaemia rates. Assam recorded a dramatic rise from 35.7 percent to 68.4 percent, and Maharashtra from 53.8 percent to 68.9 percent, reversing previous gains. Similarly, Mizoram, once among the best performers at 19.3 percent, now shows an anaemia prevalence of 46.4 percent—a troubling trend. On the other hand, a few regions have shown improvement. Andaman & Nicobar Islands reduced prevalence from 49 percent to 40 percent, and Chandigarh from 73.1 percent to 54.6 percent, suggesting that targeted, well-implemented strategies can yield positive outcomes. These trends emphasise the need for state-specific approaches, focusing not only on iron supplementation but also on addressing broader determinants such as maternal nutrition, infection control, dietary diversity, and early child-feeding practices.
With WHO calling for a systematic review and the Indian government piloting venous-based surveys, it is increasingly clear that improving measurement practices is critical for accurately understanding and addressing India’s anaemia burden.
The sharp rise in anaemia prevalence reported in NFHS-5 has raised concerns, especially since it contrasts with improvements in other nutrition indicators like stunting and dietary adequacy during the same period. A key factor under scrutiny is the measurement method used: NFHS relies on the capillary method (finger-prick testing), which, while practical for large-scale surveys, may overestimate anaemia prevalence, particularly in children. Studies from countries like Tanzania, along with similar surveys in India using the more accurate venous method, have shown significantly lower anaemia levels, suggesting a potential measurement bias. With WHO calling for a systematic review and the Indian government piloting venous-based surveys, it is increasingly clear that improving measurement practices is critical for accurately understanding and addressing India’s anaemia burden. Amidst global debates on anaemia measurement, India decided that NFHS would no longer track anaemia. Instead, the upcoming Diet and Biomarkers Survey in India (DABS-I), led by ICMR and NIN and using the more accurate venous method, will take over this role.
While there may be a measurement bias, as both NFHS-4 and 5 used the same method, the results remain relevant to track progress. A comparison between NFHS-4 and NFHS-5 data (Map 2) reveals that anaemia prevalence among children aged 6–59 months increased by 8.5 percentage points nationally, but the burden varied widely across states. Some states saw alarming surges—Assam (32.7 pp), Mizoram (27.1 pp), Chhattisgarh (25.6 pp), Odisha (19.6 pp), Manipur and Jammu & Kashmir (18.9 pp each)—indicating a worrying trend that calls for urgent, localised policy responses. In contrast, a few recorded improvements, with Chandigarh (-18.5 pp), Lakshadweep (-10.5 pp), and Andaman & Nicobar Islands (-9 pp) showing notable declines. These divergent trends suggest that while the overall national burden is rising, some regions are demonstrating that reversal is possible, reinforcing the need for targeted interventions, better monitoring, and region-specific strategies.
Map 2: Change in anaemia prevalence among children in Indian states (2015-16 to 2019-21)
Source: Data from the Government of India compiled and analysed by the author, and visualised using Flourish.
Anaemia among women aged 15–49 years in India increased by 3.9 percentage points between NFHS-4 and NFHS-5, reflecting a concerning trend, though less steep than the rise observed among children (Map 3). Some regions witnessed sharp increases, most notably Assam (19.9 pp), Jammu & Kashmir (17 pp), Ladakh (14.4 pp), and Odisha (13.3 pp), highlighting regions where women's nutritional status may be deteriorating or where programme gaps exist. Others like Tripura (12.7 pp) and Gujarat (10.1 pp) also recorded double-digit increases, reinforcing the need for targeted women's health interventions.
Map 3: Change in anaemia prevalence among women in Indian states (2015-16 to 2019-21)
Source: Data from the Government of India compiled and analysed by the author, and visualised using Flourish.
In contrast, several regions demonstrated improvements, with Lakshadweep (-20.2 pp), Chandigarh (-15.6 pp), and Dadra & Nagar Haveli and Daman & Diu (-10.4 pp) showing significant reductions. Declines were also recorded in Andaman & Nicobar Islands (-8.2 pp), NCT of Delhi (-4.4 pp), and Meghalaya (-2.4 pp), indicating that under the right conditions, anaemia in women is reversible. These mixed outcomes across states suggest that while national averages have worsened, some subnational successes offer valuable lessons in programme implementation, dietary improvement, and women-centric health strategies.
Between NFHS-4 and NFHS-5, the gender gap in anaemia among children aged 6–59 months persisted, with anaemia rates consistently higher among girls compared to boys (Map 4). Nationally, the difference rose from 24.9 percentage points in 2015–16 to 28 percentage points in 2019–21, suggesting that girls remain disproportionately affected. States such as Andhra Pradesh (41.4 pp), Tripura (40.7 pp), and Telangana (39.6 pp) reported some of the widest gender gaps in anaemia during the latest survey period. Even in states where overall prevalence may have improved, the gap between girls and boys has widened in many cases. indicating potential gender-based disparities in nutrition, care, and healthcare access.
Map 4: Difference in anaemia prevalence between girls and boys in Indian states (2019-21)
Source: Data from the Government of India compiled and analysed by the author, and visualised using Flourish.
However, a few notable exceptions exist. Kerala’s gap dropped dramatically from 23.5 percentage points to just 5.1, while Ladakh saw a fall from 24 to 3.8—pointing to more equitable outcomes at both ends of the spectrum: Kerala has the lowest and Ladakh has the highest child anaemia prevalence in India. States like Meghalaya, Nagaland, and Jharkhand also saw narrowed gender gaps over time.
A recent systematic review exploring different forms of malnutrition recommended that any measures aimed at treating and reducing stunting should consider anaemia. As India sets its sights on becoming a global leader and a transformative force on the world stage, it must confront the uncomfortable truth that about a third of its children continue to grow up “abnormally skinny and abnormally short,” as Nobel laureate Angus Deaton pointed out about a decade ago. Despite government interventions, the situation has not improved. Evidence suggests that maternal anaemia increases the risk of low birth weight, which is a strong predictor of both stunting and wasting. Jim Yong Kim, the then President of the World Bank, had warned earlier that with such a large share of India’s future workforce affected by early-life undernutrition, the country’s ability to compete in the global economy is at serious risk. Anaemia, especially, remains a silent, persistent and pervasive threat within India’s greatest asset—its demographic dividend—diminishing not only health but also human capital potential. An anaemic population makes for an anaemic economy.
Anaemia, especially, remains a silent, persistent and pervasive threat within India’s greatest asset—its demographic dividend—diminishing not only health but also human capital potential.
Emerging evidence from the Economic Advisory Council to the Prime Minister (EAC-PM) suggests that while iron intake is important, it is the diversity of iron-rich foods that has a stronger inverse relationship with anaemia prevalence across Indian states and regions. In other words, the problem is not just how much iron people consume, but how varied their sources are. This calls into question the overreliance on solutions like universal cereal fortification, which, while easy to implement, have delivered limited impact. To make meaningful progress, India must pivot toward nutrition strategies that expand dietary diversity and empower households to make varied nutritional choices. Tackling anaemia, therefore, must be seen as both a public health priority and a cornerstone of economic development in the journey towards Viksit Bharat.
Oommen C. Kurian is Senior Fellow and Head of Health Initiative at the Observer Research Foundation
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Oommen C. Kurian is Senior Fellow and Head of Health Initiative at ORF. He studies Indias health sector reforms within the broad context of the ...
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