Recently, in her address to the Lok Sabha, Union Minister of State for Health, Anupriya Patel, highlighted India’s progress in reducing maternal mortality– an achievement that certainly is cause for celebration. Our maternal mortality ratio fell dramatically, from 384 to 103 deaths per 100,000 live births between 2000 and 2020.
Improved access to antenatal care and greater numbers of institutional births have played an enormous role in safeguarding the health of mothers and their babies. What this milestone also emphasises, however, is the need to keep this momentum up by taking a closer look at more complex challenges that pregnant women continue to face. Of these, one of the most persistent threats to progress is maternal anaemia. More than half of our pregnant women suffer from anaemia and without immediate, holistic interventions and better health-seeking behaviours we risk undoing decades of hard-won gains.
Women are disproportionately affected by nutritional deficits that impact their health and limit their ability to become equal social and economic contributors. Low haemoglobin in pregnant women not only heightens the risk of postpartum hemorrhage, a leading cause of maternal death, but also contributes to extreme fatigue, breathlessness, and a cascade of complications that affect both mother and child. Pregnancy demands a nearly 50% increase in blood volume, creating an “iron sink” that depletes maternal iron stores. With over 57% of women between the ages of 15 and 49 being found to be anaemic, according to the latest NFHS-5 data, we must address this silent epidemic with the same urgency as we did in reducing maternal mortality.
Recent evidence underscores that iron deficiency is the predominant cause of anaemia in pregnancy, with studies indicating that approximately 80% of moderate anaemia cases and 90% of severe anaemia cases in pregnant women are attributable to iron deficiency. This finding, published in the Journal of Family Medicine and Primary Care, highlights the critical importance of targeted iron supplementation interventions – both oral and intravenous– to address the root cause of most anaemia cases.
The repercussions of maternal anaemia extend beyond the mother. Infants born to anaemic mothers face a higher likelihood of iron deficiency. This can impair cognitive development and limit children’s future potential. Severe anaemia in children of anaemic mothers is nearly four times higher (5.9%) compared to children of non-anaemic mothers (1.5%), according to NFHS-5. Breaking this cycle requires proactive measures to ensure women enter pregnancy with sufficient iron stores and receive timely treatment when needed.
For this, a multi-pronged approach is necessary, with the administration of iron and folic acid (IFA) supplementation during pregnancy and even pre-conception taking centre stage. Intravenous iron formulations, such as Ferric Carboxymaltose (FCM), may be prescribed to those women in whom IFA supplements are found to make low improvements to their haemoglobin levels. The use of IV iron, including FCM, has been encouraged by the Government of India, in a Guidance Note on The Use of Intravenous Iron Among Pregnant Women, released last year. This single-dose treatment has been found to significantly reduce the risks associated with maternal anaemia.
Routine screening, especially through digital diagnostic devices,which can guarantee quick and reliable results, is also critical. Detecting anaemia, in both pregnant and non-pregnant women, early on can also help health workers initiate treatment early. Overall, significant focus must be placed on ensuring that IFA supplements, intravenous iron and digital screening tools, such as digital haemoglobinometers (DgH), reach the last mile, that health workers are adequately trained and, most importantly, that women and their families are educated about the severity of anaemia’s implications during pregnancy.
Strengthening adherence through robust Information, Education, and Communication (IEC) efforts is a key pillar of the AMB strategy. Empowering women with knowledge about their nutritional needs is essential for sustainable change. Community-based programs that proactively reach out to expectant mothers and their families, sharing practical information about incorporating iron-rich foodsinto their diets can have long-term impact.
Educational campaigns must emphasise the importance of eating leafy green vegetables, legumes, and fortified cereals, as well as vitamin C-rich foods to boost iron absorption and proper meal planning to overcome dietary deficiencies. Improving awareness on the need for early antenatal care checkups and the availability of supplementation and IV iron in local health centres is also critical to ensuring the uptake of government services. By integrating nutritional counseling into routine antenatal-care we can ensure that women not only receive supplements but also adopt healthier eating habits that support improved maternal and fetal outcomes.
Our commitment must be to a future where maternal anaemia is no longer a silent crisis undermining the gains we’ve made in maternal health. Embracing a comprehensive strategy, one that couples robust oral and intravenous supplementation and early detection, with targeted nutrition education and community empowerment, is vital. Our collective efforts, whether through improved patient care or increased messaging around the urgency for anaemia reduction, are key to ensuring women receive the support they need to overcome anaemia. By directly addressing anaemia, we take a crucial step toward healthier mothers, brighter futures for children, and stronger communities, making the vision of an anaemia-free India a reality.
(The authors are Director, National Institute of Nutrition (NIN), at ICMR, Hyderabad, and Scientist E, Reproductive, Child Health and Nutrition, at ICMR, Delhi, respectively)