India has made significant progress in improving nutrition security, overcoming the barrier of addressing calorie gaps, over the past decades. However, micronutrient deficiencies (MND), commonly referred to as hidden hunger, continue to persist across populations and geographies. Addressing micronutrient deficiencies (MND) is critical to achieving SDG 2 (zero hunger) and SDG 3 (good health and well-being), and remains a priority under POSHAN 2.0 and the National Nutrition Strategy.
A large proportion of women and adolescent girls have limited awareness of MND and their health implications. These deficiencies often remain undetected due to non- specific symptoms such as tiredness, reduced work capacity, disturbed sleeping patterns. Strengthening routine screening through point-of-care testing and anaemia check-ups under Ayushman Bharat Health and Wellness Centres is essential for early detection and management
Anaemia remains one of the most prevalent micronutrient deficiencies in India. According to the NFHS-5, more than half of women (57%) of reproductive age (15-49 years) are anaemic, indicating a significant public health concern. Anaemia during pregnancy is associated with increased risk of adverse maternal and neonatal outcomes, including complications during childbirth. It contributes to an increased risk of maternal morbidity and high risk of postpartum haemorrhage. Maternal anaemia also increases the risk of poor neonatal health and nutrition outcomes, including early childhood anaemia. As per the NFHS-5 data, 68% children age six-59 months are anaemic. It also results in low birth weight, impaired cognitive development in the new born. These outcomes contribute to the persistence of an intergenerational cycle of malnutrition.
Breaking this inter-generational cycle of malnutrition requires sustained, large-scale, and targeted public health interventions. This calls for a life-cycle approach, addressing anaemia and the broader challenge of micronutrient deficiency in children, adolescent girls, women of reproductive age, and pregnant and lactating women. This is implemented through Anaemia Mukht Bharat, a government initiative, launched under National Health Mission to reduce anaemia across India with a 6*6*6 strategy (6 beneficiaries, 6 interventions, 6 institutional mechanisms).
The burden of hidden hunger extends beyond iron alone., Gender norms and deep-rooted household hierarchies have normalised women eating last and eating least. From childhood through adolescence and into pregnancy, their bodies are systematically short-changed, making them not just biologically but socially more susceptible to hidden hunger. Meaningfully improving nutrition outcomes, therefore, calls for women-centred strategies that go beyond supplementation. These strategies actively improve diet diversity, raise awareness of the full spectrum of micronutrient needs, and embed gender perspectives into national nutrition policies and planning.
Micronutrient deficiencies extend beyond iron to calcium, folate, iodine, Vitamin B 12 which are critical for women’s health, pregnancy outcomes, child development. A published study, Micronutrient interventions among vulnerable population over a decade: A systematic review on Indian perspective (2022), shows that women and girls across India under the reproductive age group (15–49 years) carry inadequate levels of essential nutrients, including calcium, folate, iodine, and vitamin B12, each critical to healthy development, pregnancy, and long-term wellbeing. This is consistent with global findings showing a dietary analysis spanning 185 countries: that women are more likely than men to have inadequate intake of iodine, vitamin B12, and iron, underlining the continued nutritional vulnerability of women across the life course.
In many households, women and girls often have comparatively lower access to diverse and nutrient-rich foods due to intra-household food distribution practices, limited decision-making power, increased unpaid care responsibilities, and restricted access to health and nutrition services. Adolescent girls, newly married women, pregnant women, and lactating mothers remain particularly vulnerable due to increased nutritional requirements during these stages.
Addressing micronutrient deficiencies, therefore, requires interventions that are not only nutrition-specific, but also gender-responsive. Nutrition programmes must recognise the differential nutritional needs of women and girls and address barriers related to access, agency, and utilisation of services. This includes strengthening women’s access to counselling, antenatal care services, micronutrient supplementation, and informed decision-making related to diet and health.
Gender-transformative approaches are important because they address underlying social norms and household power dynamics that influence women’s nutrition, access to services, dietary practices, and health-related decision-making. Such approaches go beyond recognising gender differences and seek to improve women’s participation in household food decisions, promote shared responsibility for caregiving and nutrition within families, and engage men and community stakeholders in supporting maternal and adolescent nutrition.
These approaches are aligned with globally recognised frameworks such as the Gender Integration Continuum and social norms-based behaviour change models, which emphasise moving from gender-sensitive to gender-transformative programming. Within nutrition programmes, this may include engaging husbands and mothers-in-law through counselling platforms, integrating gender-responsive counselling within antenatal care services, strengthening women’s participation in community-based groups, and promoting equitable intra-household food allocation practices.
The integration of gender-transformative approaches within reproductive, maternal, and adolescent health programmes by addressing harmful gender norms, strengthens community engagement, and promotes shared responsibility for health outcomes. The ‘men as partners’ approach has highlighted the importance of engaging men as supportive partners in maternal and reproductive health, including improving care-seeking behaviour, supporting maternal nutrition practices, and strengthening women’s participation in health-related decision-making.
Improving nutrition outcomes among women and girls therefore requires convergence between nutrition, maternal health, gender, education, and social protection interventions. Embedding gender considerations within programme planning, implementation, monitoring, and behaviour change strategies will be critical to ensuring equitable nutrition outcomes.
While evidence-based interventions are well established, the key challenge lies in strengthening implementation, enhancing awareness, and ensuring sustained multisectoral convergence across government, private sector, and communities. Improving dietary practices remains fundamental, as sustainable nutritional outcomes rest on a balanced and diversified diet. Food fortification, as endorsed by the FSSAI, provides a cost-effective population-level complement to this goal. Fortified staples can help bridge micronutrient gaps; however, it is complementary to, and not a substitute for, a balanced and diversified diet.
India’s Anaemia Mukt Bharat programme distributes free iron and folic acid supplements to adolescent girls, pregnant women, lactating mothers and women of reproductive age (non-pregnant, non-lactating). It is also strengthening counselling, community engagement, and behaviour change communication alongside service delivery which will be key to improving adherence to regular consumption of these nutritional supplements.
Demand-side barriers, including low awareness and risk perceptions, and misconceptions of MND and anaemia require structured communication strategies delivered by frontline health workers, community champions, schools, and community platforms. The IFA supplementation or a fortified staple that is not consumed is a missed opportunity. The FLWs are the cornerstone in last mile delivery and counselling. Access to nutritious food must be paired with consistent demand generation from the community reducing hidden hunger requires long-term, gender-responsive action, not just supplies.
With continued focus on evidence-based interventions, strengthened implementation, and improved multisectoral convergence, India can accelerate progress in reducing micronutrient deficiencies among women and children. The shift from gender-blind to gender sensitive, gender responsive, and finally gender transformative is imperative to ensure improved maternal nutrition outcome and better newborn health.
(The views expressed are personal)
This article is authored by Dr Ajay Khera, country representative, Engender Health, India.
