Over the past couple of years, there have been questions and counter-questions when it comes to anaemia in India. Is it being over-diagnosed? Are the cut-offs that are being tested for not accurate for India? Is it purely driven by a deficiency of iron, or are there other factors at play? This month, as we explore a range of women’s health issues, here is all you need to know about anaemia, a condition that primarily affects women and children, and one that remains a public health challenge in India.
What is anaemia and whom does it affect?
Anaemia is a condition where the body has red blood cells that are lower than normal levels, or when the haemoglobin within these cells is lower than it should be. Haemoglobin is an iron-containing protein that carries oxygen from the lungs to all of the body’s tissues. This means that if there are not enough red blood cells or not enough haemoglobin in them, there is a decreased supply of oxygen to the body.
Anaemia is a very common blood disorder. The World Health Organization classifies it as a major public health concern, and estimates that 40% of all children aged 6–59 months, 37% of pregnant women and 30% of women 15–49 years of age are affected by anaemia. It also states that anaemia mainly affects young children, pregnant and postpartum women, and menstruating adolescent girls and women. Low- and lower-middle income countries bear the greatest burden of anaemia, particularly populations living in rural settings, in poorer households.
What are the causes and symptoms of anaemia?
There are many different types of anaemia. Some of them are inherited (such as sickle cell anaemia), some are caused by nutritional deficiencies (such as iron deficiency anaemia, Vitamin B12 deficiency anaemia and pernicious anaemia), some are caused by abnormal red blood cells (such as aplastic anaemia) and some are caused due to having a chronic disease or an infection.
Iron deficiency anaemia is considered to be the most common type of anaemia. This occurs primarily due to inadequate intake of iron in the diet. Vitamin-deficiency anaemia can occur due to low levels of vitamin B12 or folate (folic acid), also usually due to poor intake in the diet. Pernicious anemia is a condition in which Vitamin B12 cannot be absorbed by the body.
Tiredness, fatigue and weakness are common symptoms of anaemia. Other symptoms include dizziness or lightheadedness, chest pain, pale or yellow skin, headaches, cold hands and feet and heart palpitations.
How is anaemia diagnosed?
Anaemia is diagnosed on the basis of blood haemoglobin concentration. There are specified thresholds for this, based on age, sex and physiological status.
In India, as per National Family Health Survey data, anaemia has been on the rise: from 53% of women in the age group 15-49 and 58.6% of children between six months and 59 months being found anaemic during NFHS-4 (2015-16), the number spiked to 57% of women and 67% of children in these age groups during NFHS-5 (2019-21). However in the latest NFHS-6 (which started in July 2023), questions related to anaemia were dropped, after experts pointed out that the WHO cut-offs for anaemia may not be suitable for India, and that the methods used to estimate anaemia could be flawed, leading to an overestimation of cases.
The WHO defines anaemia in children aged under five years and pregnant women as a haemoglobin concentration <110 g/L at sea level, and anaemia in non-pregnant women as a haemoglobin concentration <120 g/L. These cut-offs may not be suitable to the Indian population, according to experts. They also pointed to the way blood is drawn for sampling: the NFHS survey measures haemoglobin in a drop of capillary blood that oozes from a finger prick; the WHO recommends that venous blood be used to estimate anaemia.
What is the situation with regard to anaemia in India?
Anaemia continues to remain a cause of concern in India. The Union Health Ministry has said the assessment of anaemia in India is being shifted to the Diet and Biomarkers Survey in India (DABS-I), launched in 2022, to map diet, nutrition and health status.
A study that was published in January this year in the European Journal of Clinical Nutrition and funded by the Department of Biotechnology, measured venous blood haemoglobin (Hb) concentrations from about 4,500 people in eight States. Overall, the study found, 34.9% of those tested were anaemic. However, only 9% of them had what could be medically characterised as iron-deficiency anaemia; 22% of them were characterised as having anaemia from ‘unknown’ causes, signifying the need, one of the authors of the study previously told The Hindu, for a more nuanced policy intervention to address anaemia. Concentrating on single interventions, such as iron tablets or folate acid on their own, was inadequate, and the key remained, to diversify diets, with more fruits, milk and vegetables made available to a wider population, which would improve absorption of essential nutrients, the researcher had said.
What are the consequences of anaemia?
Anaemia, the WHO says, can affect school performance (through developmental delays and behavioural disturbances such as decreased motor activity, social interaction and attention to tasks), productivity in adult life and overall quality of life in general. During pregnancy, anaemia has been associated with poor maternal and birth outcomes, including premature birth, low birth weight and maternal mortality. In addition to the health consequences, anaemia can have important financial impacts for individuals, families, communities and countries.
How do you prevent and treat anaemia?
Treatment for anaemia depends on what is causing it. Dietary changes and dietary supplements may be recommended. These may include iron supplements, folic acid supplements and vitamin B 12 supplements. Other kinds of medication may also be prescribed. If there is an underlying cause, then it has to be treated in order to treat the anaemia. A healthy well-balanced diet can help prevent iron and vitamin-deficiency anaemia. Getting vaccinated, practicing good hygiene and managing chronic diseases properly, can also help. If you believe you have anaemia or are at risk for, it is essential to talk to your healthcare provider.
Published – March 19, 2025 02:57 pm IST