In the past twenty years, Indian women of reproductive age have faced a notably higher prevalence of anemia compared to the global average – about 20% more. While globally one in three women suffers from anemia, in India, the number rises to one in two.
The primary cause of anemia is iron deficiency, though deficiencies in folate, Vitamin B12, and Vitamin A also contribute. Anemia’s impact is far-reaching, affecting physical, social, and economic aspects of life. Symptoms include fatigue and stress, leading to reduced productivity. Chronic anemia can cause severe health issues like cardiac failure and even death.
Pregnant women are particularly at risk, needing an extra 15 milligrams of iron daily. A deficiency heightens the risk of maternal mortality. India’s statistics in maternal health due to anemia are alarming, with 80% of Southeast Asia’s anemia-related maternal deaths occurring in India.
India has implemented various national schemes to combat nutrition and anemia issues, such as the Integrated Child Development Services (ICDS), National Nutritional Anaemia Prophylaxis Programme (NNAPP), and Anaemia Mukt Bharat (AMB) strategy. Despite these efforts, the latest National Family Health Survey (NFHS-5, 2018-19) indicates that anemia is still prevalent in Indian women, with increases in certain states compared to the previous survey (NFHS-4).
Let’s explore the societal behaviors that perpetuate these health challenges:
- Undernourishment from Birth: In patriarchal societies, girl children often face discrimination, receiving less breastfeeding and food supplements than boys. This leads to long-term health issues, including anemia. Women typically eat last in households, often leaving them with insufficient iron and protein, which is compounded by blood loss during menstruation and poor absorption due to Vitamin B12 deficiency and hookworm infections.
- Perception of Anemia: Many women and communities lack awareness about anemia’s severity. While clinical terms are not well-known, symptoms like weakness and paleness are recognized. Studies reveal various local terms for anemia across India, reflecting a normalization of weakness, especially during pregnancy, which often goes untreated until it becomes severe.
- Inadequate Uptake of IFA Tablets: Health programs like ICDS provide Iron Folic Acid (IFA) tablets to pregnant women. However, NFHS-5 data shows a gap between tablet availability and actual consumption, suggesting low compliance rates.
- Misinformation About IFA Tablets: Misunderstandings about the importance of IFA tablets, side effects, and doubts about their effectiveness often discourage women from following through with the treatment.
- Lack of Agency: Many women don’t receive necessary antenatal care, including IFA tablets, due to family indifference or cost concerns. Decisions about women’s health are often made by spouses or families, restricting women’s access to care until their condition becomes critical.
To counter these issues, health policies must:
- Address nutrition needs throughout a woman’s life, starting from infancy to tackle the root of anemia.
- Challenge son preference and gender biases through strategic behavior change communications.
- Introduce interventions that recognize and address social norms limiting women’s agency in health and nutrition, ensuring women’s access to essential health care and information.
By addressing these behavioral factors, India can move closer to its goal of eliminating anemia and improving women’s health nationwide.
