Women in India today face a risk that is both widespread and severely underestimated. The problem is described, fittingly, as khoon ki kami, or ‘a deficiency of blood,’ which reflects two parallel and competing problems. The first is anaemia, where levels of oxygen-carrying haemoglobin in the blood fall, affecting physical and cognitive health. In pregnancy, this could be fatal. A second, related threat is the sometimes unavailability of blood in our health system, causing problems when these women need these transfusions the most.
These are not separate problems. They are two sides of the same emergency. More than half the women of reproductive age in India are anaemic (57%), as are over half of pregnant women (52%). Thousands of women enter pregnancy with anaemia and when there is a need of immediate transfusion, specifically in cases of postpartum haemorrhage (massive uncontrolled bleeding at the time of delivery), the blood may not be available. This turns a routine childbirth, which is a physiological normal state, into a high-risk event for many families.
Given the risks, it is crucial that we nip the problem in the bud. One reliable option is to give girls and women the access to excellent nutrition and increase the availability to screening tests and remedial treatment now, in order to prevent severe complications later.
This process is simple but must start at an early age and remain a consistent life-long effort. Adolescent girls must consume iron-rich foods such as green leafy vegetables, millets, pulses, dry fruit, paired with vitamin C containing foods to boost absorption and if possible eggs, fish etc. Locally available greens include often-discarded items such as cauliflower leaves and beetroot leaves, which were traditionally cooked and eaten.These are excellent sources of iron. Information on food choices and combinations that are socially acceptable and culturally relevant are needed. Avoiding tea, coffee and dairy during meals is also key, as these inhibit absorption.
Besides this, we must make haemoglobin testing routine across the life course. Girls in school, women in family-planning and preconception contacts, and every pregnant woman at the first antenatal contact should have documented Hb measurement and a clear follow-up plan. Early detection helps to ensure that the problem is identified and addressed before it becomes an emergency. Today, digital screening tools deployed across the country by the government have made testing accurate and results are available within minutes. There’s really no reason not to get tested.
If a deficiency is detected, Iron and Folic Acid (IFA) tablets are available free of cost at public health centres. These are administered weekly for adolescents, routinely as per national schedules for women of reproductive age, and daily during pregnancy. These are accompanied by adherence counselling to ensure women and their families know why they should take the tablets and what to expect. Currently, there are so many reports of IFA tablets remaining unused due to minor gastrointestinal side-effects, dislike of the metallic taste or lack of perceived benefits. Our programs must address the real-world reasons women stop taking tablets, keeping in mind that education and information alone could significantly alter attitudes and improve uptake.
Today, when various new interventions are available that can help address some of the gaps above, we must incorporate these within our health systems. Intravenous iron therapies, for example, can significantly improve levels of iron in the blood. Currently, the government recommends IV iron in women with severe or moderate anaemia in their second or third trimesters. By directly delivering iron into the bloodstream, this method is a faster, more effective way to increase haemoglobin compared to oral tablets.
But we need to accept that Intravenous (IV) Ferric Carboxymaltose (FCM) and other IV new iron formulations are not a magic bullet for poor nutrition. They are safe, single-dose clinical tools that can raise haemoglobin quickly when women present with moderate-to-severe iron-deficiency anaemia late in pregnancy. Operational guidance from the Ministry of Health and Family Welfare supports the judicious use of IV iron within safety protocols, making it a powerful clinical bridge to safer deliveries for women who are already anaemic. However, without addressing the root cause, these same women will all return to their state of mild or moderate anemia in one year.
This year on International Women’s Day, the UN Agencies and the World Health Organization (WHO) call for "Rights. Justice. Action. For ALL Women and Girls". For this, ensuring good health is a key stepping-stone toward equal opportunities. Anaemia reduction stands at the forefront of our efforts to ensure long-lasting gains in women’s health.As a clinician who witnesses hundred of cases of preventable illness caused by this condition, I feel very strongly that our time and attention must be focused on introducing more effective measures to address it.
My closing ask is that we make screening at first antenatal check-up (ANC) and during pregnancy non-negotiable, that we scale adolescent and preconception programs so girls enter adulthood with positive iron reserves, not deficits, and that we ensure the new interventions and treatments are integrated in the remotest regions, but with focus and care.
(The author is Professor, Haematology, All India Institute of Medical Sciences (AIIMS), New Delhi)