Why are women and children in India becoming more anaemic?

The prevalence of anaemia in India was a concern in 2000 and has worsened two decades later despite gains in the intervening period

The World Health Assembly endorsed a comprehensive implementation plan for maternal, infant and young children nutrition in 2012, fixing a 50 per cent reduction in anaemia in women of reproductive age by 2025. Anaemia has been widely prevalent in countries in South Asia, especially in India and Central and West Africa. In 2018, the government of India launched the Anaemia Free India programme to eliminate anaemia in the country. But data from the fifth National Family Health Survey (NFHS-5), which exhaustively surveyed and tested children, women, and men across the states for anaemia, indicates a rising proportion of anaemic people in the country.

In anaemia, the number and size of the red blood cells, or the haemoglobin concentration, falls below an established cut-off value, impairing the capacity of the blood to transport oxygen around the body. There are many reasons for anaemia, but most cases are due to iron deficiency. Anaemia is an indication of nutritional deficiencies and poor health. Other causes of anaemia include malaria, hookworm and other helminths, other nutritional deficiencies, chronic infections, and genetic conditions.

Anaemia causes fatigue and lethargy and adversely affects an individual’s work performance and physical capacity. Anaemic people may have shortness of breath, dizziness, headaches, or an irregular heartbeat. Anaemia can impair cognitive development, stunt growth, and increase the morbidity of children from infectious diseases. Anaemia in women is associated with maternal mortality and morbidity in the mother and baby, including the risk of miscarriages, stillbirths, prematurity, and low birth weight.

Also Read: Food insecurity and hunger continue to plague India

Anaemia among children has been a serious concern in India for a long time. The government’s efforts resulted in a reduction in anaemia among the children significantly. The NFHS-4 carried out in 2015-16 recorded an 11 per cent reduction in the prevalence of anaemia among children, compared to the NFHS-3 carried out in 2005-06. Anaemia reduction among the children of the Scheduled Castes (SCs), Scheduled Tribes (STs), and Other Backward Classes (OBCs) was even better at 11.60 per cent, 13.50 per cent and 11.70 per cent, respectively. However, anaemia reduction among women from NFHS-3 to NFHS-4 was less pronounced and was only 2.2 per cent. In the case of the SC, ST and OBC women, the reduction in anaemia was 2.4 per cent, 8.6 per cent and 2.2 per cent, respectively, whereas, in the case of other women, the reduction in anaemia was a mere 1.5 per cent.

Compared to women or children, anaemia among men is less pronounced. The NFHS-3 in 2005-06 recorded that nationally 24.2 per cent of men were affected by anaemia, which is less than half of the women. The NFHS-4 recorded that 22.7 per cent of men were anaemic compared to 55.30 per cent of women, an improvement of 1.5 per cent over the NFHS-3.

The above analysis indicates that the efforts made by the governments in tackling nutritional deficiencies and anaemia in the early years were successful, even if moderately. To further speed up the elimination of the scourge of anaemia, as mentioned earlier, the government launched Anaemia Mukt Bharat in 2018.

Is India becoming more anaemic?

The NFHS-5 data reporting the nutritional status of children, women, and men are worrying. Anaemia among children has increased significantly. The NFHS-5 says that more than 67 per cent of children had some degree of anaemia. Twenty-nine per cent of children had mild anaemia, 36 per cent had moderate, and two per cent had severe anaemia.

Between 2015-16 (NFHS-4) and 2019-21 (NFHS-5), the prevalence of anaemia among children aged 6-59 months increased from 59 per cent to 67 per cent, and it continues to be higher among rural children. Prevalence of anaemia is highest in Gujarat, where 80 per cent of children aged 6-59 months have anaemia, followed by 73 per cent in Madhya Pradesh, 72 per cent in Rajasthan and 71 per cent in Punjab. It is estimated that about 100 million children suffer from varying degrees of anaemia.

According to a Lancet study, Yemen, India, Cambodia, Haiti, and 20 countries in west and central Africa had a prevalence of anaemia of more than 50 per cent among women aged 15-49 years in the year 2000. In 2019, the absolute difference in total anaemia prevalence between non-pregnant and pregnant women aged 15-49 years was 3 per cent or higher in Yemen, India, the Maldives, Jordan, and Afghanistan.

The NFHS-5 data corroborate these findings. According to the NFHS-5 report, anaemia prevalence has increased between NFHS-4 and NFHS-5 from 53 per cent in 2015-16 to 57 per cent in 2019-21 among women and from 23 per cent in 2015-16 to 25 per cent in 2019-21 among men. Sixty-one per cent of breastfeeding women are anaemic, compared with 52 per cent of women who are pregnant.

The prevalence of anaemia is more than 60 per cent in Gujarat, Chhattisgarh, Odisha, Bihar, Jharkhand, Assam, Tripura and West Bengal, and anaemia prevalence in the Union Territories of Ladakh, Jammu and Kashmir, and Chandigarh is 93 per cent, 66 per cent, and 60 per cent, respectively.

Anaemia is higher among the women and men of Scheduled Castes, Scheduled Tribes and Other Backward Classes than the Others. Anaemia among the Scheduled Castes (59 per cent) and Scheduled Tribes (65 per cent) women is higher than the 56 per cent among the Others. Among the women who have anaemia, 27 per cent have mild, 32 per cent moderate, and about 3 per cent have severe anaemia. In the case of men, 24 per cent of men had mild, 3 per cent moderate, and only 0.2 per cent had severe anaemia.

Since 2000, the prevalence of anaemia in India has been a serious concern. Two decades later, in 2022, anaemia is much more prevalent, making India anaemic.

(Ashok Bharti is Chairman, National Confederation of Dalit and Adivasi Organisations)

Disclaimer: The views expressed above are the author's own. They do not necessarily reflect the views of DH.