Targeting underlying factors to accelerate anemia reduction among pregnant women in India

Monitoring nutrition levels during pregnancy (Photo courtesy: Shivani Kachwaha)

One in two pregnant women in India are anemic. This condition of low blood hemoglobin, the protein component of blood that delivers oxygen to tissues, is one of the most pervasive and persistent public health issues in India. Anemia during pregnancy is particularly worrisome as it affects both the mother and the developing child. Outcomes associated with anemia during this critical period include maternal mortality, risk of infection, preterm delivery, and poor fetal and infant health.

Along with other South Asian countries, India is off track to meet the World Health Assembly target of a 50% reduction in anemia among women of reproductive age between 2012 and 2025. In the last 10 years, anemia has declined by 2 percentage points (pp) in non-pregnant women (from 55% to 53%) and by 8pp in pregnant women (from 58% to 50%) according to the third and fourth rounds of the National Family Health Survey. This translates to between 0.2-0.8pp decline per year, far below the targeted 7pp per year.

Slow progress is not due to lack of government interest. National programs to address anemia have been around for half a century. Recently, under the National Nutrition Mission, the Ministry of Health and Family welfare launched Anemia Mukt Bharat (Anemia free India). In the current context of policy interest, it is imperative to understand which factors have been responsible for the biggest anemia reductions so far, and to strengthen investments targeting those factors.

In their new research article in Public Health Nutrition, Suman Chakrabarti and Samuel Scott—along with their co-authors from the International Food Policy Research Institute, the Public Health Foundation of India, and Oxford Policy Management—have identified sociodemographic, programmatic, and dietary drivers of anemia reduction in pregnant Indian women over 10 years.

Using two rounds of District Level Household and Facility surveys (2002-04 and 2012-13) and two rounds of Household Consumer Expenditure Surveys (2004-05 and 2011-12), the researchers found that the strongest contributors to anemia reduction were the decline in open defecation, the reduction in the number of early pregnancies, and increased dietary consumption of iron and folic acid. These findings suggest that the optimal anemia reduction strategy would take a holistic, nutrition sensitive approach that targets underlying factors such as hygiene, family planning, and healthy diets.

To request the research article or for further questions about this research, please email us at stating “Request for PHN paper on anemia” in the subject line.

 -          Samuel Scott, Associate Research Fellow, Poverty, Health, and Nutrition Division, IFPRI