Seema Gupta, Advisor, Centre for Knowledge and Development talks about rising issue of anemia and need of the hour
Anemia is a silent epidemic impacting physical growth, mental and work capacity, and lives of current and future generations. All population groups in India are engulfed by anemia, with women and children affected disproportionately. Iron deficiency-anemia has been the biggest cause of disability for the past 10 years and has contributed towards 20 per cent direct and 50 per cent associated maternal deaths in India.[1] The economic burden of anemia is equivalent to about 4 per cent of GDP.[2]
The recently released data from National Family Health Suvery-5 highlights the alarming increase in anemia rates across all age groups – paediatric anemia, with a complex multifactorial aetiology by itself has risen from 58.6 per cent to 67.1 per cent since the last survey results of 2015. Cutting across economic strata, 52.2 per cent of the pregnant women, 59.1 per cent of adolescent girls and 57 per cent of women in their reproductive age in India are anaemic.[3] The Global Nutrition Report 2020 also states that India has made no progress towards achieving WHO global nutrition target of reducing anemia by 50 per cent among women of reproductive age by 2025.
To move the needle on anemia and reverse these trends, a two-pronged approach is required on a mission mode. First, demand-raising efforts like targeting social and behavioural norms affecting an individual, key influencers and the larger community, participation in learning activities, demand for blood testing and supplementation support from the service providers. Second, ensuring supply availability, by cohesive engagement of the government and service providers as well as effective public spending on national schemes and infrastructure for nutrition.
Many philanthropic, NGOs and community based organisations are supporting and strengthening the government initiatives on a war footing. Centre for Knowledge and Development, has launched Suposhit Jharkhand in 2021 to close the gap in nutrition of tribal women and children by using a top-down and bottom-up social accountability approach. Reduction in Anemia through Normative Innovations (RANI), is another successful model of innovation for change from Angul district of Odisha, implemented by IPE Global Ltd. It reduced anemia among women of reproductive age by promoting the consumption of iron folic acid (IFA) along with nutritious food.
In 2018, Government of India launched the Anemia Mukt Bharat (AMB) strategy under the Prime Minister’s Overarching Scheme for Holistic Nourishment (POSHAN) Abhiyaan with the target to reduce anemia by 3 per cent per year with an aim of achieving a 50 per cent reduction in anemia by 2022. Iron Folic Acid (IFA) supplementation has always been the backbone of our national strategies, however, a quick glance at the AMB Dashboard establishes that the supply and demand of the intervention needs urgent attention and transformative action. COVID-19 has further disrupted supply chains and access to service, a case in point being, findings from a survey in Rajasthan between January and May 2020, that reports a significant drop in IFA use by pregnant and lactating women.
Inadequate IFA supply, quality of service delivery by Health Care Workers (HCWs) and a one size fits all approach without a strong social and behaviour change communication (SBCC) strategy, have been major constraints to the program. The uptake and adherence to IFA tablets itself has socio economic barriers associated with it, most of them being beliefs, misconceptions, lack of knowledge, fear of side effects, inadequate Antenatal Care visits, maternal age, education, social and family support & economic empowerment. Efforts to promote IFA consumption in India have adopted a life cycle approach by including women of reproductive age (non-pregnant and non-lactating) for IFA supplementation rather than exclusively targeting pregnant and lactating women, adolescents and/or children. Unlike pregnant women, non-pregnant and out-of-school women are poorly served as the government is currently in the process of rolling out its IFA supplementation strategy to these important sub-populations.
Prioritising nutrition, Hon’ble Prime Minister Narendra Modi during his Independence Day speech this year announced rice fortification in all social safety net schemes by 2024. Rice fortification is a process of adding micronutrients like iron folic acid and vitamin B12. It is an effective, preventive and cost-efficient complementary strategy to address context specific dietary needs and social barriers associated with nutrition problem. Leveraging the momentum of Supplementary Nutrition Program and Pradhan Mantri Matru Vandana Yojana (PMMVY) schemes to address dietary diversification and food fortification would also have a large scale impact on reducing nutrition gaps.
Addressing systemic challenges, interventions must enhance community ownership and collaboration with local and national governments, to implement proven interventions that break the inter-generational cycle of malnutrition and anemia. Learning from and continuously adapting to localized context, ensuring participation of all stakeholders as well addressing all social determinants of health is critical to make healthy and anemia-free life a reality, and not just an aspiration.
References
[1] Comprehensive National Nutrition Survey 2016-18
[2] https://www.niti.gov.in/rice-fortification-effective-way-combat-anemia
[3] National Family Health Survey 5
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