Tackling Anaemia

Even though India has was to dramatically reduce the number of people living in extreme poverty from 306 million people living on less than $1.90 (on a PPP basis) a day in 2011 to 48 million today, it is puzzling to see why it has been unable to show a similar dynamism in its record in fight against malnutrition.

Government’s Interventions in Tackling Malnutrition

• Providing highly subsidised foodgrains to the poorest 67 per cent of the population under the National Food Security Act (NFSA).
• Free Mid-day Meal Scheme (MDM) that targets around 100 million students in government schools.
• Supplementary nutrition programme through the Integrated Child Development Scheme (ICDS) network.

Prevelance of Anaemia

Anaemia is a condition in which there is a deficiency of red cells or of haemoglobin in the blood, resulting in pallor and weariness.

• Even though anaemia among children has declined, it still affects every second child in the country.
• There has been no perceptible decline in anaemia among 15 to 49-year old women; it affects around 60 per cent of them.

This public health emergency needs to be addressed immediately.

Bottlenecks in Fight against Anaemia

• Poverty, gender disparity, poor sanitation, low health and nutrition service coverage and poor nutritional intake particularly an iron-deficient diet are the biggest bottlenecks in the fight against anaemia.
• The daily consumption of iron-rich dark green leafy vegetables has reduced from 64 per cent to 48 per cent of the population in the last decade.
• Also, the NFSA’s focus on wheat and rice has forced millets which were the traditional source for iron and minerals out of the consumption basket.
• The government’s iron supplementation programme to overcome the iron deficiency has led to only 30 per cent of pregnant women consuming iron and folic acid tablets.

Food Fortification: Way Out?

Food fortification has proved an effective, affordable, scalable and sustainable intervention in many countries. Even India had its own share of success when it successfully tackled the widespread problem of goitre by mandating iodised salt in 1962.

Steps have already been initiated in this direction. Comprehensive regulations and standards have been framed by the FSSAI on fortification of food. The Ministry of Women and Child Development and the Ministry of Human Resource Development have issued advisories to the states to mandatorily use fortified wheat flour and edible oil in ICDS and MDM. But India has still miles to go.

Rice is the staple for 65 per cent of the Indian population and most of whom are located in high malnutrition burden states. Supply of fortified rice through a network under PDS (already launched as a centrally sponsored scheme and is facilitated by Niti Ayog) is one of the cost-effective intervention to address anaemia. The pilot project in Odisha’s Gajapati district found that the incidence of anaemia has reduced by 20 per cent between 2012 and 2015, of which 6 per cent reduction can be directly attributable to fortification.

Further, the sustainability of fortification depends on the regular consumption of fortified food by the consumers and thus a comprehensive state-specific strategy should be developed to generate awareness among the consumers.