Prevention and management of Anaemia in Pregnancy in India: Challenges and Opportunities

Seven decades ago, over 80% of Indian pregnant women were anaemic. About 3/4th of anaemia was due to nutritional deficiencies of: iron (most common), folic acid (second) and vitamin B12 (not as common). Anaemia in pregnancy was associated with higher maternal morbidity and mortality, low birth weight and high perinatal mortality. Detection and appropriate management of anaemia, including parenteral iron therapy and intensive care for severe anaemia were important components of antenatal care in India, but only about 10% of women had access to antenatal care. In 1970s the national programme for anaemia in pregnancy focussed on identifying all pregnant women and providing them iron and folic acid (IFA) supplementation. The coverage and compliance with supplementation were low. In 1990 when the primary health care infrastructure was established, the anaemia control programme embarked on testing and providing appropriate treatment to anaemic women. The tertiary care centres operationalised this “test and treat” strategy. In primary and secondary care settings, accurate test for diagnosis of anaemia was not available. In the absence of accurate Hb estimation at all levels of care, it was not possible to provide appropriate treatment based on Hb levels. So, all pregnant women continued to receive one tablet of IFA throughout pregnancy. Over the next two decades, coverage under antenatal care and IFA supplementation improved but compliance with supplementation was low because about a third of pregnant women had gastrointestinal side effects with IFA. Despite these problems, between 2002 and 2015, there had been a decline in the prevalence of severe and moderate anaemia. To accelerate the decline in anaemia in pregnancy the country is focusing on the ‘test and treat’ strategy in pregnant women using an accurate method for Hb estimation and providing appropriate treatment. Nutrition education to improve iron intake prior to and during pregnancy, is focussing on dietary diversification and use of iron fortified salt or cereals. Progress will be monitored through national surveys and locale specific appropriate mid-course modifications in the programme will be made.