Children in an Odisha school eat their midday meals. Photo: mdmodisha.nic.in
- On August 5, Union health minister Mansukh Mandaviya provided data of the state-wise prevalence of anaemia among children aged six months to five years.
- Based on NFHS-5 data, the current prevalence of anaemia among these children is nine percentage points higher compared to NFHS-4 data.
- A prevalence of anaemia of 40% or more warrants serious concern because persistent anaemia can hinder cognitive development, slow growth and increase infection-related morbidity.
- The number of antenatal check-ups, level of folic-acid supplementation and relevant measures of other nutritional supplementation programmes have increased.
- Against this background, India’s worsening anaemia problem warrants a serious relook of the problem’s aetiology.
Anaemia in children and women of reproductive age has been a persistent public health problem in India. On August 5, in reply to a question in the Lok Sabha, Union health minister Mansukh Mandaviya provided data of the state-wise prevalence of anaemia among children aged six months to five years.
According to the minister, based on data from the fifth National Family Health Survey (NFHS-5, 2019-20), the current prevalence of anaemia among these children is 67.1% – an increase of more than nine percentage points compared to the figure in NFHS-4.
Although the national average indicates that two of three children in India are anaemic, the problem is worse in a few states. The government has been implementing programmes like Anaemia Mukt Bharat (AMB), Poshan Abhiyan and the midday meal scheme through various ministries to address malnutrition among children, adolescents and women of reproductive age. The Ministry of Women and Child Development operates the Integrated Child Development Services (ICDS), started in 1975, to improve nutrition and the health of children in India.
Before looking at the situation and deciphering it, it’s important to understand what exactly anaemia is. The WHO defines anaemia as “the presence or absence of red blood cells, or a low haemoglobin content, which results in the blood’s ability to carry oxygen throughout the body falling below a specified cut-off value”.
Iron is a crucial part of haemoglobin, and experts understand that iron deficiency accounts for half of all anaemia worldwide. Malaria, other helminths, dietary inadequacies, long-term infections and hereditary disorders can also cause anaemia.
India has made significant progress in improving the health and well-being of its citizens after independence, but this improvement has been uneven. The trends are not homogenous either. There is a wide range in the morbidity and mortality rates as well as health status based on caste, class, gender and location.
Why, while we know the prevalence of anaemia among children under the age of five to be 67.1%, it will remain an imperfect picture unless we also include the lens of intersectionality. The NFHS-4 report included data about regional, caste and income-based variations in the prevalence of anaemia among children, visualised below. Unit-level data from NFHS-5 isn’t yet in the public domain.
Note that a prevalence of anaemia of 40% or more is a grave public health concern. Persistent anaemia in children portends more serious issues among children because it can hinder cognitive development, slow growth and increase infection-related morbidity. It’s also a notable symptom of the health of the children in each state.
The occurrence of anaemia has grown in almost all Indian states and around the world. The more recent round of NFHS surveys also found that anaemia has become more common not only among children but in people of all age groups. The prevalence of anaemia among pregnant women increased by 1.8 percentage points, among non-pregnant women by 4 percentage points – both from NFHS-4.
Also read: Does India Know Anaemia Is Running Amok in the Country?
Analysis of the data from the last two rounds has also revealed that the principal determinants of anaemia are nutritional intake by children and mothers during pregnancy, mothers’ education, income, caste and the availability of healthcare services.
In addition, the chance of severe anaemia among women from the poorest income groups and belonging to ‘Scheduled Caste’ groups is more than four-times that among women of the wealthiest income group and belonging to ‘Upper Caste’ groups.
The Comprehensive National Nutrition Survey (2016-2018), conducted by the health ministry, UNICEF and some other partner agencies, found that anaemia is more common among male children than among female children in early childhood. But after two years after birth, the trend reverses.
AMB and Poshan Abhiyan are flagship programs that the Government of India has been implementing to address the burden of malnutrition, anaemia and other nutritional deficiencies in India. Policymakers intended AMB to reduce the burden of anaemia on children from 58% in 2016 to 40% in 2022, and from 50% to 32% among pregnant women. Its strategy targets six beneficiary groups, six interventions and six institutional mechanisms (a.k.a. ‘6 x 6 x 6’).
The Ministry of Women and Child Development, through ICDS, also provides supplementary nutrition for mothers and children, from the inception of pregnancy to the child’s age of six. But there are many lacunae in ICDS’s implementation.
Nonetheless, the number of antenatal check-ups, level of folic-acid supplementation and relevant measures of other nutritional supplementation programmes have increased. Against this background, India’s worsening anaemia problem warrants a serious relook of the problem’s aetiology.
Pankaj Kumar Mishra and Harinder Happy are PhD scholars at the Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi.