New Delhi: Government health and nutrition programs substantially reduce anaemia in children under five years of age and expectant mothers but fail to focus on girls and non-pregnant women, according to a study by the International Food Policy Research Institute (IFPRI).

Considerable progress was made in India between 2006 and 2016 in reducing anaemia in children under five years of age and pregnant women, showed the study titled “Trends and drivers of change in the prevalence of anaemia among 1 million women and children in India, 2006-2016," published in BMJ Global Health journal. However, there was minimal progress in the anaemia status among teenage girls and women under 50.

The study used 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 haemoglobin and anaemia among a million women and children in India to identify key factors contributing to lowering anaemia prevalence in the country.

Haemoglobin and anaemia improved significantly in the period under study among children under five years of age and pregnant women who are 15-49 years old, but not in the non-pregnant women in the same age group, the findings showed.

Anaemia declined by 11 percentage points among children (70% in 2006 to 59% in 2016), 7.6 percentage points among expectant mothers (58 % to 50.4%), and a mere 2.1 percentage points in teenage girls and women under 50 (55% to 52.9%).

“It’s surprising that no progress has been made in reducing anaemia among non-pregnant adult women in India in the last decade. Most programmes have not focused on this group but, instead, have focused on pregnant women and young children. Existence of multiple causes of anaemia in the population and having tunnel vision in our approach to addressing the problem with too much focus on iron and folic acid pills could also be a contributory factor," said Samuel Scott, one of the authors of the study.

Positive changes in mothers’ education, coverage of nutrition and health interventions, socioeconomic status, sanitation, and meat and fish consumption contributed to an improved count —low haemoglobin count indicates anaemia—among both children and pregnant women during 2006-16, the study indicated. Better education alone accounted for nearly one-fourth of the improvement seen in haemoglobin count among expectant mothers, and one-tenth in children.

“More than half of the population of women and children in India is anemic and is, therefore, experiencing reduced quality of life in various respects such as work capacity, fatigue, cognitive function, birth outcomes and child development," said 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 anaemia from a broad set of potential drivers at various levels," he said.

The prevalence of anaemia is greater than 50% among expectant mothers, which is very high, and progress varies greatly between states. Assam showed the greatest reduction in anaemia among children under five, nearly halving it from 69% in 2006 to 36% in 2016, followed by Chhattisgarh with a 30-percentage point reduction. In contrast, anaemia prevalence among children in Goa increased by 9 percentage points.

Among women, both pregnant and non-pregnant, Sikkim showed the maximum reduction (38 percentage points for pregnant, and 24.1 percentage points for non-pregnant women), followed by Assam (27 percentage points and 23.1 percentage points) and Mizoram (21 percentage points and 12.7 percentage points).

In contrast, the problem worsened in states such as Himachal Pradesh and Punjab, where anaemia among non-pregnant women increased by more than 10 percentage points.

Overall, anaemia 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.

anaemia is still a severe public health problem in India, according to the World Health Organization (WHO) criteria (anaemia > 40%), and the country is likely to miss the WHO 2025 target of anaemia reduction by 50%, relative to 2010 levels, among women in reproductive age.

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