Forging an Anemia-Free Future
The path to India’s nationwide adolescent anaemia control programme
India has the largest universal adolescent anaemia control programme in the world, targeting 116 million adolescent girls and boys. The programme plays a pivotal role in protecting adolescents from the debilitating effects of anaemia, breaking the country’s inter-generational cycle of malnutrition and safeguarding the health and potential of future generations. Good nutrition – including sustaining adequate iron stores – puts all adolescents on the same starting line. India’s 15-year journey towards nationwide expansion of its adolescent anaemia control programme offers vital lessons to other countries.
A Generation of Untapped Potential
India is home to around 120 million adolescent girls and 133 million adolescent boys – about 20 per cent of the world’s population of adolescents aged 10–19. Many of these adolescents suffer from anaemia – a condition that limits their capacity to learn, participate, and develop into productive adults.
2 Adolescent girls who are anaemic during pregnancy face an increased risk of maternal death, premature delivery and delivering a low-birth-weight baby. Their children are also more likely to become anaemic, transferring the risk of poor growth and development to the next generation.
Iron deficiency is a major cause of anaemia in India. The dietary intake of iron-rich foods among India’s adolescents has remained persistently low, particularly in resource-poor settings, where many families are dependent on a cereal-based staple diet. Income constraints and cultural norms also pose barriers to adequate iron intake in India.
Evidence: a Springboard to Action
Adolescent anaemia has long been recognized as a public health problem in India – but political momentum to address the issue was lagging, in part, because of the lack of national evidence on the magnitude of the situation and potential solutions. The second National Family Health Survey undertaken in 1998 was an important turning point for action.
The survey findings revealed that anaemia affected 56 per cent of all adolescent girls between the ages of 15–19 and 69 per cent in tribal communities. These alarming results drew attention to the scale of the anaemia burden in India, especially among the most vulnerable groups.
Around the same time, national evidence emerged about the positive impact of supervised weekly iron and folic acid supplementation on reducing adolescent anaemia. Studies conducted in different sites across India assessed the effectiveness of weekly iron and folic acid supplementation.
They found that supplementation reduced the prevalence of anaemia and was a safe, practical and effective strategy for reaching adolescent girls. 3,4 These findings were also in line with the growing evidence base from around the world on the effectiveness of such programmes in addressing iron deficiency anaemia among adolescent girls.
Guided by these two key pieces of evidence showing the scale of India’s anaemia problem and presenting weekly iron and folic acid supplementation as a feasible and effective solution, the Government of India, with technical support from UNICEF, agreed to explore the effectiveness of an adolescent girls’ anaemia control programme delivered through existing government service delivery systems.
