India’s Anaemia Challenge: Building On Strong Foundations For Healthier Futures - Dr. Sumita Misra

India’s rise to an economy of more than $4 trillion reflects sustained policy efforts, economic resilience and national ambition. This transformation has been accompanied by a strong expansion of social and public-health infrastructure to ensure that the benefits of growth reach every section of society. Under Ayushman Bharat, the government has also expanded access to affordable quality healthcare through both public facilities and a wide network of empanelled private hospitals, ensuring that financial constraints do not deprive the poorest of essential treatment. Within this broader health framework, the government has also undertaken targeted measures for the prevention, screening and treatment of anaemia, particularly among women, adolescents and young children, which is a significant health challenge.

Through targeted interventions for prevention, screening, diagnosis and treatment, the Government has sought to address anaemia as an important component of the country’s larger commitment to improving nutrition, health outcomes and the overall well-being of its people.

According to the National Family Health Survey-5 (2019-21), 57.2 per cent of women aged 15-49, 67.1 per cent of children aged six to 59 months, 59.1 per cent of adolescent girls aged 15-19, and 52.2 per cent of pregnant women were found to be anaemic in India. NFHS-6 (2023-24) did not release anaemia prevalence, as haemoglobin testing was deliberately set aside owing to concerns about the accuracy of capillary blood sampling. In its place, the ICMR's Diet and Biomarkers Survey, which uses the more accurate venous method, is expected to provide robust national estimates.

At the same time, NFHS-6 records clear progress on several process indicators that form the foundation of anaemia control. Mothers who consumed iron-folic acid for 100 days or more rose from 44.1 per cent to 54.9 per cent, while those completing the recommended 180 days increased from 26.0 per cent to 37.8 per cent. Antenatal care coverage improved from 92.6 per cent to 95.9 per cent, with mothers receiving at least four ANC visits rising from 58.5 per cent to 65.2 per cent. Stunting among children under five declined sharply from 35.5 per cent to 29.3 per cent, and severe wasting fell from 7.7 per cent to 5.2 per cent. Adequate diet coverage among children aged 6–23 months also improved from 11.0 per cent to 15.3 per cent. However, it still remains a matter of concern that several South Asian countries with lower demographic and economic profiles continue to report better anaemia outcomes at the national level than India.

The Union Health Ministry has long recognised the wide-ranging effects of iron-deficiency anaemia—impaired cognitive and motor development in children, reduced work capacity in adults, and elevated risks during pregnancy, including prematurity and low birth weight.

Anaemia Mukt Bharat Abhiyan, launched in 2018, represents a significant leap forward. Built on earlier iron-supplementation efforts, it introduced the 6x6x6 strategy targeting six priority groups through six interventions backed by strong institutional mechanisms.

In 2026 the programme has been taken to its next stage as Anaemia Mukt Bharat Abhiyaan. The new 7x7x7 framework adds low-birth-weight babies as a seventh beneficiary group, "Eating Right" as a seventh intervention, and a digitally integrated monitoring framework as a seventh institutional mechanism. The approach has moved from T3 to T4, Test, Treat, Talk and Track, so that every diagnosed case is followed until the desired outcome is achieved.

Government programme documents have candidly identified areas requiring greater attention: procurement and distribution systems, consistency of supplies at district and block levels, and monitoring of actual consumption.

The distinction between tablets supplied and tablets consumed is now central to programme design. Frontline workers, anganwadi centres, schools and primary health facilities form an integrated delivery chain that is being reinforced precisely so that every intervention reaches the intended beneficiary in usable form.

Anaemia is recognised as a complex condition with multiple causes. Iron deficiency remains important, yet infections, other micronutrient gaps, inherited disorders, malaria and reproductive health factors also play roles. It now combines supplementation with dietary improvement, fortification, testing, treatment and management of non-nutritional drivers—an evidence-based evolution that positions India among countries taking a comprehensive view of the problem.

If we look at Haryana, the state is well placed to convert resources into outcomes. It recorded Rs. 3,207 per capita in government health expenditure in 2022-23, about 15 per cent above the national figure of Rs. 2,786, according to the tenth round of National Health Accounts estimates published by the National Health Systems Resource Centre. Haryana presents a peculiar picture: a state that has achieved remarkable economic prosperity, high per capita income & GSDP, yet has not translated that prosperity into equally strong gains in the nutritional health of its women and children. Anaemia affects well over half of the state's women and a large majority of its young children, and the burden is heavy even among pregnant mothers. The problem is not confined to poverty, as anaemia remains widespread even among better-educated and relatively advantaged sections, while rural women, adolescents and Scheduled Caste women face particularly high vulnerability. Income alone, it is clear, does not guarantee nourishment.

Against this backdrop, the central question has shifted from whether resources exist to how effectively they reach the right people at the right time in forms that produce measurable health improvement. Districts are being encouraged to track not only distribution but also actual receipt, consumption, diagnosis, treatment and subsequent decline in prevalence.

Haryana has recorded a significant decline in anaemia prevalence across several beneficiary groups. Data from the State’s Anaemia Tracking Web Application shows that the overall tracked prevalence of anaemia has declined from 59.3 per cent in 2022-23 to 47.7 per cent in June 2026, providing the State with a strong platform for the next, more aggressive phase of the campaign.

The sharpest improvement has been recorded among children aged 6-59 months, where anaemia prevalence has fallen from 57.7 per cent in 2022-23 to 34.1 per cent in June 2026, a reduction of more than 23 percentage points.

Among children aged 5-9 years, the prevalence has declined from 54.8 per cent to 45.4 per cent. Among pregnant women, anaemia prevalence has fallen from 69.8 per cent to 53.3 per cent, while among women in the reproductive age group, it has declined from 70 per cent to 63.8 per cent.

NFHS-6 data for Haryana further reinforces the progress on process indicators. Mothers who consumed iron-folic acid for 100 days or more rose from 51.2 per cent to 65.2 per cent, and those completing 180 days or more increased from 31.9 per cent to 48.7 per cent. Mothers receiving at least four antenatal care visits improved from 60.9 per cent to 79.0 per cent. Institutional deliveries stand at 96.3 per cent. Stunting among children under five declined modestly from 27.5 per cent to 25.9 per cent, although wasting rose from 11.5 per cent to 16.6 per cent, underscoring the need for continued attention to complementary feeding and dietary quality.

Haryana’s strategy is finely nuanced and focused on both macro- and micro-level interventions. Adequate complementary feeding for infants and young children, diet and supplementation during adolescence, attention to women’s nutrition across the life cycle, and early testing and treatment in pregnancy form the core of the response. For example, dietary behaviour is as important as supplementation, which is why a comprehensive 360-degree Information, Education and Communication (IEC) effort is being emphasised to help families make small, practical changes at home. Tea and coffee contain tannins that reduce the absorption of iron from food, so they are better taken at a gap from meals rather than with them. Similarly, in a popular combination such as palak-paneer, the calcium in paneer can interfere with the absorption of iron from spinach, whereas palak with corn is a better combination, and a squeeze of lemon or a vitamin C-rich food such as tomato or amla alongside iron-rich meals helps the body absorb more. Carried through anganwadis, schools, ASHA workers and community platforms, such everyday guidance costs little and reaches every household.

A nation with an economy of more than $4 trillion measures its success not only by infrastructure and growth but by the health of its mothers, adolescents and children. With special attention to equity, women in poorer households, tribal communities, remote districts and areas with limited healthcare access face distinct risks. National progress must therefore be accompanied by targeted reduction in these high-burden pockets, an objective that district-level planning and monitoring are designed to achieve. The government's sustained investment in Anaemia Mukt Bharat Abhiyan and the National Health Mission demonstrates a clear commitment to turning economic progress into healthier lives.

About the Author: Dr. Sumita Misra is an IAS officer currently serving as Additional Chief Secretary, Health & Family Welfare Department, Government of Haryana. A seasoned administrator and acclaimed author, her work weaves together public policy expertise, administrative leadership, and literary expression.

Disclaimer: The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of the publisher. While every effort has been made to ensure the accuracy of the information, the publisher is not responsible for any errors or omissions, or for the results obtained from the use of this information.