Every few years, India conducts one of the most comprehensive health surveys in the world. The National Family Health Survey (NFHS) covers every district in every state/Union Territory. Demographic and health related data along with biomarkers are collected from thousands of households. The data analysed drives policy and action.
When NFHS-5 (2019–21) results were released, the anaemia numbers showed that a staggering ~57 % of women (15-49-year-old), 52.2% pregnant women, 59% adolescent girls and ~ 67% of children under the age of five years, were anaemic. Despite years of programmes, budget allocations, and beneficiary tracking, prevalence of anaemia in India has not decreased.
Anaemia is not a mysterious or poorly understood condition. We know that the major causes include iron deficiency, poor dietary diversity, repeated infections, and parasitic load. We also know that anaemia is a debilitating condition that impacts human productivity and reduces physical and cognitive progress in children. Iron supplementation and fortification programs are interventions that have been going on for decades and closely monitored by state and central governments. Anaemia Mukt Bharat and POSHAN Abhiyaan of central government schemes are adopted by states. Yet the cycle of anaemia persists, as women of reproductive age give birth to children who are themselves at high risk of becoming anaemic.
This shows that we need to relook at our strategies to curb anaemia.
As they say, what cannot be measured, cannot be changed. Early, Point-of-Use (PoU) diagnosis can provide appropriate and timely interventions. PoU haemoglobin testing devices do exist that can give accurate readings in under a minute, at low cost, without requiring laboratory infrastructure. However, these tools are not uniformly deployed across India’s health systems. Second, the findings using technologies should be synchronous with live, personalised clinical and other interventions.
Food fortification is another area where the science is ahead of the implementation. Fortifying staples like rice, wheat flour, milk etc with iron, folic acid, and vitamin B12 is not a new idea. It has transformed anaemia outcomes in several countries. In India, large-scale fortification has been politically contentious and operationally uneven. The technology is not the barrier. The will to standardise and enforce quality parameters across the food supply chain is. Also, the behaviour change in consumers/communities is a huge barrier. This matters because supplementation programmes have failed because the beneficiaries are either not aware of the purpose or they are averse to organoleptic differences in the intervened product, e.g., iron fortified rice is slightly different in appearance and floats on water, which the women meticulously remove before cooking, thus beating the purpose.
Then there is the layer of myth that surrounds anaemia, particularly in relation to women. Fatigue is normalised. Breathlessness after climbing stairs is attributed to age or fitness. Pallor in a pregnant woman is sometimes read as common during pregnancy. These are not marginal misunderstandings — they are widespread, and they delay women from seeking care they need. In communities where menstruation is not openly discussed, the monthly iron loss that worsens anaemia in adolescent girls goes unaddressed.
Public awareness must go deeper than posters at health centres. It requires community-level conversations, and those require trust built over time, not one-off campaigns.
What gives me some confidence, working in health sciences education, is how much the research and technology landscape has shifted. We now have AI-assisted screening tools that can flag anaemia risk from non-invasive indicators. Community health workers equipped with smartphones and structured decision-support tools can do far more than their predecessors with a checklist.
Researchers are mapping the regional variation in anaemia causes — because iron deficiency, while dominant, is not the whole picture. In parts of India, haemoglobinopathies like thalassemia and sickle cell anaemia are significant. Water, Sanitation and Hygiene (WASH) contribute to repeated infections, diarrhea which leads to malnutrition, especially in children. A programme designed only around iron supplementation / fortification will miss the other causes entirely.
We can do some plain speaking and accept that anaemia at this scale among women and children is not a background condition. It is costing India in cognitive potential, in maternal mortality risk, in labour productivity, and in the development outcomes of an entire generation of children. The science is not in dispute. What it demands now is not another programme launch. It needs to be a serious, sustained, science-led movement — one that brings better diagnostics led personalised interventions strategies, alongside public health interventions.
Adopting scientifically validated traditional practices would face less of a challenge in behaviour change when compared to pill popping, wherein compliance has been found to be huge issue among Indian women and children. Interventions including diet diversification, clean water and environment, and health communication strategies for awareness are must.
(The views expressed are personal)
This article is authored by Dr Padma Venkat, dean, School of Health Sciences and Technology, UPES.
