In my many decades of practice as a pediatrician, I often come across cases of children suffering from illnesses that cannot be cured by medicines alone. I have seen infants at my clinic who tire easily while feeding, toddlers who fail to grow despite the attentive care of parents, and school-aged children who struggle to concentrate in class, not because they lack intelligence, but simply because their bodies are lacking in iron.
Sadly these issues are quite commonplace and primarily caused by micronutrient deficiencies, or invisible hunger. This issue has silently, and for many years now, been undermining child health and survival in our country. The most common villain among these nutritional deficiencies is anaemia, which is also one of India's most persistent public health challenges.
The latest National Family Health Survey (NFHS-5) data reminds us why this fight is urgent. Nearly two out of three children under five years of age (67.1%) are anaemic, while 57% of women of reproductive age live with the condition. Among pregnant women, the situation is even more alarming, over half are anaemic, placing both mothers and unborn children at risk.
Anaemia is not just a statistic. In my clinical practice, it shows up repeatedly as infections, fatigue and dangerous complications in pregnant women.
For young children, anaemia increases the risk of illness and developmental delays, poor school performance, during a crucial period when their bodies and brains should be growing at a rapid pace. In the case of mothers, this invisible hunger robs them of strength, productivity, and the ability to care for their families. If not addressed, anaemia can persist across generations.
Iron deficiency remains the most common cause of anaemia, but it is not merely a dietary concern. Poverty, food insecurity, repeated infections, parasitic infestations, poor sanitation, and limited access to quality maternal and child health services all play a significant role. In many rural and underserved areas, awareness itself is a barrier. In many cases, families recognize and seek treatment for anaemia only after it has caused a detrimental and lasting impact.
In a bid to tackle the issue, the Government of India launched the Anaemia Mukt Bharat (AMB) programme in 2019, adopting a comprehensive, life-cycle approach. As someone who has closely followed and supported this effort, I believe one of its most powerful interventions, along with IFA supplementation, is food fortification.
Food fortification is an effective, proven, and scalable intervention. By adding essential vitamins and minerals to commonly consumed staples, such as rice, wheat flour, edible oil, milk, and salt, and distributing it through the social safety net schemes, we can reach millions of families without any requirement for traditional dietary habits to change. For children and pregnant women who may not consistently receive or consume supplements, fortified foods can mean the difference between deficiency and sufficiency, illness or health.
Moreover, from a public health perspective, fortification is cost-effective. Global and national evidence has repeatedly shown that iron-fortified foods can improve haemoglobin levels, strengthen immunity, and support cognitive development. For pregnant women, fortification and supplementation together can help prevent severe anaemia and reduce the risk of complications during childbirth. These benefits translate into safer pregnancies, and safer childbirth.
Yet, despite sustained efforts, cases of anaemia in India remain stubbornly high. NFHS-5 data shows a 4% increase in anaemia prevalence among women of childbearing age. This tells us that while our strategies may be sound, their implementation and uptake needto be strengthened.
First, we must close any gaps in existing programmes. We should intensify screening efforts, and ensure adequate supply and adherence to iron–folic acid supplements. We must also seamlessly integrate anaemia management interventions, into routine maternal and child healthcare.
However, all of this will not deliver results, without increased public awareness and uptake of services. Misinformation and hesitation around fortified foods persist, the lack of good health seeking behaviour, and a general dearth of understanding or awareness about existing interventions, hamper efforts. These can only be addressed through clear, empathetic, and culturally sensitive communication that builds trust.
I strongly believe, pediatricians too have a pivotal role to play. We are often the first point of contact for a family after childbirth, and our guidance is foundational. Beyond simply diagnosing and treating anaemia we must make an effort to counsel parents on everyday practices that improve iron absorption, such as pairing iron-rich foods with Vitamin C–rich fruits like amla and guava. We must also remain vigilant for underlying causes of anaemia, including worm infestations and chronic illness, especially in vulnerable children.
As public health professionals, we know there is no single solution to anaemia. But we also recognize that food fortification is a strong, evidence-backed measure, that can deliver tangible results. When combined with supplementation, infection control, education, and robust health systems, it has the potential to transform child health outcomes at scale.
India has made remarkable progress in reducing maternal and child mortality, proving that sustained commitment delivers results. From achieving a polio-free status to immunizing about 94% of its children, we as a nation have surmounted impossible odds in the field of public health.We should now set our sights on ridding India of the scourge of anaemia.
With four years left for nations to clock their progress towards reaching Sustainable Development Goals targets in 2030, we must now ramp up efforts to ensure India's mothers and children are truly healthy—both visibly and invisibly—as we sprint towards the finish line.
Dr Naveen Thacker is Executive Director, International Paediatric Association (IPA)
