Iron supplementation helping to end inter-generational cycle of anaemia in India
By Angela Walker
RANCHI, India, 26 August 2011 - Deepa Kumari, 14, began to feel dizzy and weak in class at the start of her menstrual cycle. Her father, who teaches math at a local private school, and mother decided to take her to a doctor when her symptoms failed to improve.
“My parents didn’t know what was wrong with me, and even my nails went pale,” says Deepa, dressed in her crisp school uniform decorated with a badge of the Hindu goddess of education, Saraswati. “The doctor said I was anaemic.”
According to the National Family Health Survey conducted in 2006, as many as 70 per cent of children between the ages of 6 and 59 months, as well as 70 per cent of women ages 15-49 years were anaemic in Jharkhand. These unacceptably high rates of anaemia were largely due to the low iron content in women’s diet from early childhood to adulthood.
An iron-deficient diet, year after year, perpetuates an inter-generational cycle of anaemia - anaemic women giving birth to infants who are born with low iron stores and grow to become anaemic children. This has devastating consequences for children’s physical growth, mental development and school performance.
The strategy, adopted by the state government and UNICEF was simple and cost effective - target adolescent girls. A single weekly dose of Iron Folic Acid (IFA) – in tablet form - is given to all girls between the ages of 10-19. Students in 13,000 schools in the state are part of the programme. Out-of-school girls are reached through more than 38,000 anganwadi village-based child development and nutrition centres. Providing 52 tablets per girl per year costs only nine rupees. At the current rate the programme could change the face of anaemia in the state within a few years.
Students educating students
Adolescent girls receive information on the causes and consequences of anaemia and the importance of supplementation and iron-rich foods into their diets. Students, like Deepa, help reinforce anaemia prevention with their peers through one-on-one counseling.
Deepa says her 11-year-old sister, Sapna, won’t get anaemia because of the preventive care and information she is receiving at school.
“Our food at home has changed, and we know now to take iron tablets so she will never suffer from anaemia as I did,” she says brightly.
Messages include the importance of eating a balanced diet with a mix of protein, fruits and vegetables, deworming regularly and using mosquito nets to avoid malaria.
Another peer educator, Ankita Kumari, 14, says that many adolescent girls drop out of school when they begin menstruating or suffer from anaemia. Too often, traditional tribal communities in Jharkhand do not value educating girls. Girls are considered an economic burden or “paraya dhan” – investing in education will only benefit a girl’s future husband’s household.
Teachers and principals supervise and monitor the implementation of the anaemia control programme and the data is impressive.
Since the anaemia prevention programme started in 2001 at the school, test results have risen steadily from 59.6 per cent in 2001, to 70.8 per cent in 2005, to 80 per cent in 2010. Drop-out rates, which were formerly more than 50 per cent, are less than five per cent for the 656 girls currently enrolled, 60 per cent of which are tribal.
As the girls’ health and test results have improved, so has the community’s mindset about educating their daughters. The landmark passing of the Right of Children to Free and Compulsory Education 2009, guaranteeing every child the right to quality elementary education in India, should also ensure more girls go and stay in school.