Washington D.C.: Improved public health and nutrition programs for children under five years of age, and higher education and wealth among expectant mothers substantially contributed to lowering anemia among these two groups in India between 2006 and 2016, according to the findings of a new study conducted by the researchers at the International Food Policy Research Institute (IFPRI). Anemia reduction among teenage girls and women under 50 years, however, showed minimal progress.
“More than half of the population of women and children in India is anemic and is, therefore, currently experiencing reduced quality of life in various respects such as work capacity, fatigue, cognitive function, birth outcomes and child development,” says Phuong Hong Nguyen, lead author and IFPRI researcher. “In addition to describing the problem, showing slow improvements, and showing high variability between different states, our paper identifies drivers of anemia from a broad set of potential drivers at various levels,” adds Nguyen.
The study, “Trends and drivers of change in the prevalence of anemia among 1 million women and children in India, 2006-2016,” co-authored by IFPRI’s Phuong Hong Nguyen, Samuel Scott, Rasmi Avula, and Purnima Menon; and FHI360’s Lan Mai Tran, was recently published in BMJ Global Health journal. Using data from two rounds of the National Family Health Survey (NFHS) conducted in 2005-06 and the latest one in 2015-16, the researchers examined changes in hemoglobin and anemia among a million women and children in India, and to identify key factors contributing to lowering anemia prevalence in the country.
Among various drivers, positive changes in mothers’ education, coverage of nutrition and health interventions, socioeconomic status, sanitation, and meat and fish consumption contributed to improved improvement of hemoglobin count—low hemoglobin count indicates anemia—among both children and pregnant women during 2006-16. Better education alone accounted for nearly one-fourth of the improvement seen in hemoglobin count among expectant mothers, and one-tenth in children.
“Further improvements in these common drivers can substantially impact maternal and child anemia, simultaneously bringing down anemia prevalence across the country in these two groups,” says Nguyen.
Hemoglobin and anemia improved significantly among children less than five years; and pregnant women 15-49 years old, but not in the non-pregnant women in the same age group between 2006 and 2016. Anemia declined by 11 percentage points among children (70 percent in 2006 to 59 percent in 2016), 7.6 percentage points among expectant mothers (58 percent to 50.4 percent), and a mere 2.1 percentage points in teenage girls and women under 50 (55 percent to 52.9 percent).
“It’s surprising that no progress has been made in reducing anemia among non-pregnant adult women in India in the last decade. Most programs have not focused on this group but, instead, have focused on pregnant women and young children. Existence of multiple causes of anemia in the population and having tunnel vision in our approach to address the problem with too much focus on iron and folic acid pills could also be a contributory factor,” says Samuel Scott.
At greater than 50 percent, anemia prevalence is still very high, and progress varies greatly by states. Among states, Assam showed the greatest improvement in reducing anemia among children under five, nearly halving it
from 69 percent in 2006 to 36 percent in 2016; followed by Chhattisgarh with a 30-percentage point reduction. In contrast, anemia prevalence among children in Goa increased by 9 percentage points. Among women (including both pregnant and non-pregnant women), Sikkim showed the maximum improvement in anemia reduction (38 percentage point for pregnant, and 24.1 percentage point for non-pregnant women), followed by Assam (27 percentage point; 23.1 percentage points) and Mizoram (21 percentage point; 12.7 percentage points). In contrast, the problem worsened in states such as Himachal Pradesh and Punjab, where anemia among non-pregnant women increased by more than 10 percentage points. Overall, anemia prevalence declined in most states, but increased in two states (Delhi and Goa) for children, three (Delhi, Himachal Pradesh and Punjab) for expectant mothers, and eight (Delhi, Haryana, Himachal Pradesh, Kerala, Meghalaya, Punjab, Tamil Nadu and Uttar Pradesh) for non-pregnant women.
Despite some progress, anemia is still a severe public health problem in India, as per the World Health Organization (WHO) criteria (anemia > 40 percent), and the country is likely to miss the WHO 2025 target of anemia reduction by 50 percent, relative to 2010 levels, among women in reproductive age.
India’s recently launched Anemia Mukt Bharat initiative lends focus on women of reproductive age (20-49 years), who will start receiving weekly iron-folic acid supplementation, which supports our finding on the need to attend to this population segment. In addition, Government of India has mandated the fortification of salt with iodine and iron, and wheat flour with iron, folic acid and Vitamin B-12. “The social safety-net programs in the country including the public distribution system, mid-day meal scheme, and the integrated child development services program are now mandated to use these fortified products with an intent to benefit the vulnerable population in the society,” says Rasmi Avula.
To further reduce anemia prevalence, Avula recommends focusing on improving women’s education; ensuring access to and timely provision of high-quality health services for all women; creating livelihoods for poor households to boost their economic condition and reducing open defecation; and implementing behavior change campaigns to promote hygiene and sanitation in rural communities.
“Additionally, government should include all ages in national surveys: there is no good reason, for example, for children aged 6-14 years to be excluded from NFHS. It should take time to appropriately identify at-risk groups such as non-pregnant adult women, invest in large-scale surveys to better understand the prevalence of various causes of anemia, develop strategies that target multiple causes rather than single causes and integrate behavior change campaigns in all programs,” says Scott.
Click here to access the full study: Trends and drivers of change in the prevalence of anemia among 1 million women and children in India, 2006-2016
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The International Food Policy Research Institute (IFPRI) seeks sustainable solutions for ending hunger and poverty. IFPRI was established in 1975 to identify and analyze alternative national and international strategies and policies for meeting the food needs of the developing world, with particular emphasis on low-income countries and on the poorer groups in those countries Visit: www.ifpri.org