SN Misra
The World Health Assembly had set a target to reduce the prevalence of anaemia among women in the age group of 19-49 by 50 per cent by 2025. As per the Global Nutrition Report 2020, India will miss this target by miles. Anaemia is a pernicious social health issue which affects over 800 million women globally. Nearly 53 per cent of women in the reproductive age group of 15-49 years and 58 per cent of children in the age group of 6-59 months in India are affected by anaemia (NFHS-4 survey). The government of India (GOI) launched the POSHAN Abhiyaan in 2018 to reduce anaemia at a faster clip by effective use of technology, convergence of different stakeholders and fostering a Jan Andolan to rev up awareness and behavioural change. In April 2018, it launched the Intensive National Iron Plus Initiative (I-NIPI) for an ‘Anaemia Mukt Bharat’. As against the abysmally small reduction of anaemia cases by 1 per cent per year during 2005-2015, the I-NPI initiative sets a target of 3 per cent reduction per year.
The primary causes of anaemia are iron deficiency and inadequate intake of Vitamin A, folate and Vitamin B12. Infectious diseases like malaria and TB further aggravate this problem. The flagship programme envisages provision of prophylactic iron folic acid supplementation, deworming tablets and IFA tablets to school children and women.
In December 2020, the GOI came up with a survey of 22 states and Union Territories on the trends of anaemia in its NFHS-5 factsheet. According to the factsheet, anaemia among children has come down from 58.4 per cent to 53 per cent (2015-2020). However, among women in the reproductive age group it has gone up from 50.3 per cent to 53 per cent. For developed states like Gujarat, anaemia among children has gone up from 62.6 per cent to 79.4 per cent and among women from 54.9 per cent to 65 per cent. Even in a state like Kerala with better HDI record, anaemia among children has gone up from 35.7 per cent to 39.4 per cent, and among women from 34.3 per cent to 36.3 per cent. Almost all states show an upward trajectory.
Different persuasions, be it the Sen Model or the Bhagwati Model, seem to be apathetic to making effective intervention for reducing anaemia among children and women. The NFHS-5 factsheet does not cover Odisha which has an enviable record of reducing anaemia among children from 65 per cent to 44 per cent (2005-2015) and among pregnant women from 68.1 per cent to 47.6 per cent (2005-2015). With initiatives like the Mamata Yojana and the women’s self-help group movement, Odisha’s record is better than prosperous states like Gujarat.
In case of children, the crucial period when iron-deficient anaemia develops is 6-18 months when iron requirement is ten times higher by body weight compared with an adult. Food diet in most developed countries is adequate in iron content as they consume more animal food, especially meat and fortified food. In developing countries like India infants depend on iron from breast milk, which is not adequate. In Chile, they experimented with milk powder that was fortified with iron, leading to very little iron deficiency. Iron fortified infant food can become a game changer for India.
A large number of Indians subsist on iron-deficient vegetables due to religious, economic and cultural reasons. Large scale iron supplementation and fortification of commonly consumed vegetable food stuff should be promoted. According to the Constitution, it is the duty of the State to improve nutrition level in the country (Article 47), ensure proper maternity care and relief (Article 42) and support early childhood care (Article 44). These were the premises set forth by the founding fathers of our Constitution to promote basic nutritional justice for our children, adolescent girls and expecting and nursing mothers. God-like technology and convergence models solving all problems seem to be ineffective due to lack of appropriate political priority by most states and the Centre. It would be a pity if COVID-19 becomes an excuse for the states and the Centre to fail in their responsibilities to make appropriate nutritional intervention for an ‘Anaemia Mukt Bharat’.
The writer teaches Economics. Views are personal.