The document discusses anaemia prevalence rates among pregnant women in India and steps taken by the government to address this issue. It finds that 52.2% of pregnant women nationwide are anaemic, with rates varying widely by state. In 2018, the government launched the Anaemia Mukt Bharat strategy targeting women, children, and adolescents with interventions like iron/folic acid supplementation and behaviour change communication. The government is also providing support to states/UTs under programs like the National Health Mission to strengthen healthcare services and tackle anaemia.

2. • Govt of India is closely working with WHO on various health issues including
anaemia. As per recently released National Family Health Survey-V data, 52.2
percent pregnant women in the age group 15-49 years are estimated to be anaemic
in the country. The details on State/UT-wise prevalence of anaemia in percentage
in pregnant women are placed as follows:
• A&Nicobar Islands (53.7), Andhra Pradesh (53.7), Arunachal Pradesh (27.9),
Assam (54.2), Bihar (63.1), Chhattisgarh (51.8), DNH & D&D (60.7), Delhi
(42.2), Goa (41), Gujarat (62.6), Haryana (56.5), Himachal Pradesh (55.4), Jammu
& Kashmir (44.1), Jharkhand (56.8), Karnataka (45.7), Kerala (31.4),
Lakshadweep (20.9), Ladakh (78.1), Madhya Pradesh (52.9), Maharashtra (45.7),
Manipur (32.4), Meghalaya (45.1), Mizoram (34), Nagaland (22.2), Odisha (61.8),
Puducherry (42.5), Punjab (51.7), Rajasthan (46.3), Sikkim (40.7), Tamil Nadu
(48.3), Telangana (53.2), Tripura (61.5), Uttar Pradesh (45.9), Uttarakhand (46.4)
and West Bengal (62.3).

3. • The primary responsibility for strengthening health care services
including implementation of National Programs lies with the
respective State/UT government. However, Ministry of Health and
Family Welfare is providing financial and technical support to
States/UTs under National Health Mission (NHM).

4. • In 2018, the Government of India launched the Anaemia Mukt Bharat
(AMB) strategy with the target to reduce anaemia in women, children
and adolescents in life cycle approach. The interventions for pregnant
women under Anaemia Mukt Bharat (AMB) including Rajasthan,
Madhya Pradesh, Haryana, Jharkhand and Bihar for tackling anaemia
cases are as follows:
1. Prophylactic Iron and Folic Acid Supplementation including Adolescents girls
(10-19 years)
2. Intensified year-round Behaviour Change Communication (BCC)
• Campaign including ensuring delayed cord clamping

5. 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
•

6. ANAEMIA MUKT BHARAT
• In 2018, the Government of India launched the Anaemia Mukt Bharat
(AMB) strategy 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 through a
6X6X6 strategy including six target beneficiaries, six interventions
and six institutional mechanisms for all stakeholders to implement the
strategy. Under AMB strategy, the interventions for tackling the
problem of anaemia in all the States and UTs include:

7. • The prevalence of anaemia among six groups as per the National
Family Health Survey 5 (2019-21), is 25.0 percent in men (15-49
years) and 57.0 percent in women (15-49 years). 31.1 percent in
adolescent boys (15-19 yrs), 59.1 percent in adolescent girls,52.2
percent in pregnant women (15-49 years) and 67.1percent in children
(6-59 months).

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. • The National Nutritional Anaemia Prophylaxis Programme (NNAPP) was initiated nation wide in
1970 as a measure to prevent anaemia in the country. The specific objectives of the programme15
were to: (i) assess the baseline prevalence of nutritional anaemia in 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; and (v)
motivate the mothers to consume tablets through relevant nutritional education (and also to give
the appropriate dose to their children). The IFA interventions provided under NNAPP were: (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; and
(iii) preschool children (1-5 yr) - one small (paediatric) tablet (containing 20 mg elemental iron
and 100 μg folic acid) daily for 100 days. For young children who could not swallow tablets, liquid
syrup containing the same amount of IFA was given. 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 tablets16.

10. • Following the evaluation of the NNAPP in 1989 by the ICMR17, an
expert group meeting organized by the Ministry of Health & Family
Welfare (MoHFW) recommended that the dose of iron in the adult
may be increased to 100 mg elemental iron17. In 1991, the MoHFW
revised the policy guidelines for the prevention and control of
anaemia. The NNAPP programme was renamed as National
Nutritional Anaemia Control Programme (NNACP). The emphasis was
shifted from prevention to the management of anaemia. However,
the objectives and service components essentially remained the
same. An increased emphasis was laid on the health and nutrition
education activities18.

11. • In 2007, the national policy of iron supplementation was again revised19,20 to include
provision 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). The liquid
formulation was to be dispensed in bottles so that only 1 ml can be dispensed each time.
The logistics of introducing dispersible formulation of IFA were to be expedited under the
programme. School children aged 6-10 yr and adolescents aged 11-18 yr were included
in the 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
suggested18. 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. 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 are detailed
in Tables ​TablesII-III21,22,23,24,25.

12. Initiatives to Tackle Anaemia in Pregnant Women
• Health is a state subject and the primary responsibility for strengthening
health care services including implementation of national programs lies
with the respective State/UT government. However, Government has taken
steps to improve the condition of anaemia among all identified groups in all
States/UTs.Under National Health Mission (NHM) the Government
provides financial and technical support to States/UTs for implementation
of Anaemia Mukt Bharat Strategy as proposed by the States/UTs in their
annual Programme Implementation Plans.
• The Government has ascertained the condition of pregnant women in the
country and various steps taken by the Government of India, to improve
health condition of pregnant women including for anemia, in all States/UTs,
are as follows:

13. •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.
•Under 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.
•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.
•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.

14. • 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.

15. • Globally, anaemia is considered a serious global public health problem that particularly
affects young children and pregnant women. According to the World Health Organization
(WHO), the prevalence of anaemia among women of reproductive age (aged 15−49
years) is calculated as the percentage of women in the said age group with a
haemoglobin concentration less than 120 grams per Litre (g/L) or 12 grams per decilitre
(g/dL) for non-pregnant and lactating women, and less than 110 g/L or 11 g/dL for
pregnant women, adjusted for altitude and smoking. Similarly, the prevalence among
children (aged 6 – 59 months) is calculated as percentage of children in the said age
group with a haemoglobin concentration less than 110 g/L or 11 g/dL, adjusted for
altitude. Prevalence of 40% and above is considered severe.
• WHO estimated that the prevalence of anaemia worldwide in 2019 was 39.8% among
children aged 6 to 59 months and 36.5% among pregnant women. 29.9% of the women
of reproductive age were anaemic in 2019. According to WHO’s dashboard, it is seen that
the prevalence of anaemia in women of reproductive age in India was 53% in 2019, the
fifth-highest globally, after Yemen, Mali, Benin, and Nigeria. In the case of children (6 to
59 months), the prevalence in India was 53.4%.

16. • NFHS Survey records prevalence of anaemia
• The Union Health Ministry recently released the key findings of both
the phases of the National Family Health Survey that was conducted
between 2019 & 2021. This is the fifth edition of the NFHS covering
6.1 Lakh sample households across the country. The sample size for
the survey varies from state to state because of the differences in
population & age composition. The representative survey also
records the prevalence of anaemia among men, women, and children
by collecting blood samples of all men (15 to 54 years of age) and
women (15 to 49 years of age) who voluntarily give consent to the
testing. For children (6 to 59 months), parents or their guardians will
have to give consent.

17. • Anaemia Mukt Bharat was launched by GoI in 2018
• On the whole, findings of NFHS-5 reveal that the states of Gujarat, Assam, and West Bengal
witnessed a significant increase in prevalence in anaemia among children and women
respectively, compared to NFHS-4. Though Kerala and some north-eastern states have recorded a
low prevalence across categories, these states have also witnessed an increase in prevalence
since NFHS-4.
• At the same time, in the states of Uttarakhand, Jharkhand, and Haryana, there has been 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.
• Likewise, 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.