Anaemia continues to be a major problem in India, affecting over half of pregnant women, young children, and women of reproductive age. Several government programmes have aimed to reduce anaemia prevalence through iron and folic acid supplementation, deworming, behaviour change communication, and treatment of severe cases. The National Iron Plus Initiative and Anaemia Mukt Bharat programme follow a 6x6x6 strategy targeting six groups through six interventions and institutional mechanisms. Some states have seen increases in anaemia prevalence while others like Jharkhand and Haryana have implemented specific plans and seen declines in certain categories.

1. Anaemia is still a menace – Disease
burden

2. 76 years after independence
Anaemia - still widespread in India - causing a significant percentage of
maternal deaths in the country
Various reasons
General disregard to health issues
Poverty
Educational backwardness
According to National Family Health Survey-V 2019-21 data
52.2 percent pregnant women in the age group 15-49 years are
estimated to be anaemic in the country.

3. Prevalence of anaemia among six groups
As per the National Family Health Survey 5 (2019-21)
25.0 percent - men (15-49 years)
57.0 percent - women (15-49 years)
31.1 percent - adolescent boys (15-19 yrs)
59.1 percent - adolescent girls
52.2 percent -pregnant women (15-49 years)
67.1percent - children (6-59 months)

4. WHO estimated prevalence of anaemia worldwide in 2019 was 39.8%
among children aged 6 to 59 months
36.5% among pregnant women
29.9% of the women of reproductive age were anaemic in 2019
According to WHO’s dashboard
Prevalence of anaemia in women of reproductive age in India was 53% in
2019- the fifth-highest globally, after Yemen, Mali, Benin, and Nigeria
Children (6 to 59 months)- prevalence in India was 53.4%

5. • Gujarat, Assam, and West Bengal significant increase in prevalence in
anaemia among children and women respectively, compared to
NFHS-4
• Kerala and some north-eastern states - low prevalence across
categories but increase in prevalence since NFHS-4
• Uttarakhand, Jharkhand, and Haryana a decline in prevalence or only
a marginal increase in prevalence in certain categories. In Jharkhand,
the Health Department of the state rolled out an action plan covering
pregnant women, lactating women, infants and children in order to
tackle anaemia in the state

6. ANAEMIA MUKT BHARAT
Anaemia Mukt Bharat was launched by GoI in 2018
• with the target to reduce anaemia in the vulnerable age groups
• such as women, children and adolescents in life cycle approach providing
preventive and curative mechanisms
6X6X6 strategy
• six target beneficiaries,
• six interventions
• six institutional mechanisms for all stakeholders to implement the strategy

7. 1. Testing of anaemia using digital methods and point of care treatment
2. Addressing non-nutritional causes of anaemia in endemic pockets with special focus
on malaria, hemoglobinopathies and fluorosis
3. Management of severe anaemia in pregnant women undertaken by administration of
IV Iron Sucrose/Blood transfusion
4. Providing incentives to the ANM for identification and follow-up of pregnant women
with severe anaemia in high priority districts (HPDs)
5. Training and orientation of Medical Officers and front line-workers on newer
Maternal Health and Anaemia Mukt Bharat guidelines
6. Field level awareness by ASHAs through community mobilization activities and IEC
and BCC activities focused on anaemia in pregnant women
•

8. • The measures taken by the Government to make AMB programme more
effective are:
1.working with other line departments and ministries for strengthening
implementation
2.engaging National Centre of Excellence and Advanced Research on
Anaemia Control (NCEAR-A) at AIIMS, Delhi in capacity building of
health care providers
3.strengthening supply chain and logistics
4.development of AMB Training Toolkit for capacity building of health care
providers in anaemia management and recent launch of Anaemia Mukt
Bharat e-Training Modules to facilitate training of the health care providers
through virtual platform amid COVID 19 pandemic which has posed a
challenge in capacity building through physical trainings.

9. Programmes launched by GOI till now
The National Nutritional Anaemia Prophylaxis Programme (NNAPP) -
1970
(i) assess the baseline prevalence of nutritional anaemia 1970 as a measure to prevent anaemia in the country specific mothers
and young children through the estimation of Hb levels
(ii) give prophylaxis and treatment doses of IFA to mothers and children
(iii) monitor the quality of the tablets, distribution and consumption of the IFA supplements continuously
(iv) assess the Hb levels of the beneficiaries periodically
(v) motivate the mothers to consume tablets through relevant nutritional education (and also to give the appropriate dose to their
children
IFA interventions provided under NNAPP
(i) Pregnant women - one big (adult) tablet (each tablet containing 60 mg of elemental iron and 500 μg folic acid) daily for 100 days
(ii) lactating women and intrauterine device acceptors - one big (adult) tablet (containing 60 mg of elemental iron and 500 μg folic
acid) daily for 100 days
(iii) preschool children (1-5 yr) - one small (paediatric) tablet (containing 20 mg elemental iron and 100 μg folic acid) daily for 100
days
(iv) Women with severe anaemia (<7 g/dl) were administered with one big (adult) tablet twice daily for 100 days
The programme was implemented through the network of primary health centres (PHCs) and subcentres.
The paramedical staff was responsible for the distribution of IFA tablets

10. NNAPP in 1989 recommended that the dose of iron in the adult -100
mg elemental iron
MoHFW in 1991 revied the policy guidelines for the prevention and
control of anaemia
NNAPP programme renamed as National Nutritional Anaemia Control
Programme (NNACP)
emphasis was shifted from prevention to the management of anaemia
Objectives and service components essentially remained the same
Increased emphasis - on the health and nutrition education activities

11. • In 2007 -national policy of iron supplementation was again revised
• rovision of liquid formulation of ferrous sulphate and folic acid containing 20 mg
elemental iron and 100 μg folic acid per millilitre for children (6-60 months)
• Incluion of School children aged 6-10 yr
• Incluion of Adolescents aged 11-18 yr under NNAPP
Children aged 6-10 yr were provided with 30 mg elemental iron and 250 μg folic acid daily
for 100 days in a year
Adolescents aged 11-18 yr were given priority and supplemented at the same doses and
duration as adults.
Importance of multiple channels and strategies to address the problem of iron deficiency
anaemia were suggested
Use of newer products such as double-fortified salts/sprinklers/ultra rice and other
micronutrient candidates were suggested to possibly be explored as an adjunct or
alternative supplementation strategy.

12. • In 2013, MoHFW expanded the NNACP and renamed it as a National
Iron Plus Initiative (NIPI) programme.
• The dose of iron, frequency and duration of iron and roles and
responsibilities of functionaries

13. Initiatives to Tackle Anaemia in Pregnant Women
•Surakshit Matritva Aashwasan(SUMAN) provides assured, dignified,
respectful and quality healthcare at no cost and zero tolerance for denial of
services for every woman and newborn visiting public health facilities to
end all preventable maternal and newborn deaths.
Janani Suraksha Yojana (JSY), a demand promotion and conditional cash
transfer scheme for promoting institutional delivery

14. Janani Shishu Suraksha Karyakram (JSSK), every pregnant woman is
entitled to free delivery, including caesarean section, in public health
institutions along with the provision of free transport, diagnostics,
medicines, other consumables & diet
Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) provides
pregnant women a fixed day, free of cost assured and quality antenatal
check up by a Specialist/Medical Officer on the 9th day of every month.

15. •LaQshya improves the quality of care in labour room and maternity
operation theatres to ensure that pregnant women receive respectful and
quality care during delivery and immediate post-partum
•Monthly Village Health, Sanitation and Nutrition Day (VHSND) is an
outreach activity at Anganwadi centers for provision of maternal and child
care including nutrition in convergence with the ICDS

16. Delivery Points- Over 25,000 ‘Delivery Points’ across the country have
been strengthened in terms of infrastructure,equipment, and trained
manpower for provision of comprehensive RMNCAH+N services
•MCP Card and Safe Motherhood Booklet are distributed to the pregnant
women for educating them on diet, rest, danger signs of pregnancy, benefit
schemes and institutional deliveries

17. Delivery Points- Over 25,000 ‘Delivery Points’ across the country have
been strengthened in terms of infrastructure,equipment, and trained
manpower for provision of comprehensive RMNCAH+N services
•MCP Card and Safe Motherhood Booklet are distributed to the pregnant
women for educating them on diet, rest, danger signs of pregnancy, benefit
schemes and institutional deliveries

18. • Anemia Mukt Bharat (AMB) program was launched in 2018, focusing on reducing anemia
from 50% in 2016 to 32% by 2022.
• The programme follows a 6×6×6 strategy estimated to reach 450 million beneficiaries.
• It focuses on “six target beneficiary groups through six interventions and six institutional
mechanisms” to achieve the envisaged target under the POSHAN Abhiyaan.
• The six beneficiary groups are
• children aged 6–59 months
• children aged 5–9 years,
• adolescent girls and boys
• women of reproductive age
• pregnant women
• lactating women

19. six primary interventions
• Providing prophylactic iron and folic acid supplements
• deworming
• intensifying the year-round behaviour change communication (BCC)
campaign
• ensuring delayed cord clamping in new-borns
• increasing testing and treatment of anemia
• mandating the provision of iron and folic acid-fortified foods in
government-funded health programs, and intensifying the awareness,
screening, and treatment of non nutritional causes of anemia
focusing on malaria, hemoglobinopathies, and fluorosis

20. Six institutional mechanisms
Intra-Ministerial Coordination
National Anemia Mukt Bharat Unit
National Centre of Excellence and Advanced Research on Anemia
Control (NCEAR-A)
Convergence with other Ministries
Strengthening Supply Chain and Logistics
Anemia Mukt Bharat Dashboard and Digital Portal – One-Stop Shop on
Anemia

21. • Reproductive and child health (RCH) portal is a name-based web-enabled tracking system for
pregnant women and new born so as to ensure seamless provision of regular and complete services
to them including antenatal care, institutional delivery and post-natal care.
• The details of the steps taken by the Government to address the problem of anaemia across the
country including Odisha are:
1.Prophylactic Iron and Folic Acid Supplementation in all six target age groups.
2.Intensified year-round Behaviour Change Communication (BCC) Campaign for:(a) improving
compliance to Iron Folic Acid supplementation and deworming, (b) enhancing appropriate infant
and young child feeding practices, (c) encouraging increase in intake of iron-rich food through diet
diversity/quantity/frequency and/or fortified foods with focus on harnessing locally available
resources.
3. Management of severe anaemia in pregnant women undertaken by administration of IV Iron Sucrose/Blood
transfusion.
4. Field level awareness by ASHAs through community mobilization activities and IEC and BCC activities.

22. • Gujarat, Assam, and West Bengal significant increase in prevalence in anaemia among
children and women respectively, compared to NFHS-4
• Kerala and some north-eastern states - low prevalence across categories but increase in
prevalence since NFHS-4.
• Uttarakhand, Jharkhand, and Haryana a decline in prevalence or only a marginal increase
in prevalence in certain categories. In Jharkhand, the Health Department of the state
rolled out an action plan covering pregnant women, lactating women, infants and
children in order to tackle anaemia in the state.
• The plan was taken up prioritizing the Centre’s Anaemia Mukt Bharath program that was
launched in 2018 under National Health Mission as part of Intensified National Iron Plus
Initiative (NIPI) Program. The action plan aimed to provide micronutrient drugs like IFA,
Calcium, Vitamin A and Albendazole, to the last mile.
• Haryana launched the Anaemia Mukt Haryana program under state scheme ‘Atal
Abhiyaan’ (Assuring total Anaemia Limit Abhiyaan) to reduce anaemia in all age group
across Haryana, in line with the Centre’s Anaemia Mukt Bharat program in 2019.