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Addressing Anaemia Among Indian Women with Policy Interventions

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Case Study

Saaranya is a student in the 11th grade at The International School Bangalore. Her passion for giving back to her community has been instilled by her family. With a particular interest in public health, she hopes to pursue International Political Economy at the undergraduate level.

Abstract

Anaemia is a medical condition wherein a person lacks sufficient healthy red blood cells to carry oxygen effectively around the body (David & Sawal, 2018). Although countries across the world have already used several approaches to tackle high incidences of anaemia, many nations in South Asia, including India continue to struggle with this issue today. This research article provides fresh insights into the status quo around public health issues in India, particularly in relation to the adverse effect that anaemia has on the health of Indian women. A strong case is made for targeted policy interventions from the Indian government to adopt preventative measures to address anaemia.

Introduction

Anaemia largely affects young children and women of reproductive age around the world. Since the early 2000s, anaemia as a public health issue has been gaining prominence globally. The disease is classified into different categories and the causal factor(s) for each category varies (Peggy and Parekh, 1998). The most prevalent cause of anaemia is a deficiency of iron in the body combined with deficiencies in folate and vitamin B-12 (Arnold, Nangia, and Kapil, 2004).

Although deficiency-based anaemia is seemingly easy to prevent, it is acknowledged as a pressing public health challenge globally today. In this regard, the World Health Organisation estimates that a third of all women of reproductive age and two-fifths of all children are anaemic (De Benoist, Cogswell, Egli, and McLean, 2008). The majority of this population is made up of women from the so-called “Global South”, which implies several developing countries in South Asia, who face socio-cultural challenges and economic difficulties in accessing good healthcare and adequate nutrition.

Countries like Yemen, Nigeria and India observe some of highest incidences of anaemia in the world. Significant numbers of Indian women suffer from high rates of malnutrition. This gives rise to the public health issue of anaemia, several categories of which is often directly linked with lack of access to wholesome nutrition (Mathew, 2015). The region of Ladakh, India provides a case study for this issue, as the data indicates that 90% of adolescent girls from this region between the ages of 15 and 19 struggle with anaemia due to a lack of fresh fruits and vegetables in the region (Anaemia Mukt Bharat, 2022).

In India between 2019 and 2021, 59.1% of girls between ages 15 and 19 are suffering from various categories of anaemia (Arnold, Nangia, and Kapil, 2004). With such high rates of anaemia in the country among women, it is safe to say that India is facing a public health crisis with respect to women’s health and nutrition. In addition to causing fatigue, weakness, and shortness of breath, anaemia can lead to more severe health issues for women. The latter includes premature births, miscarriages, heart failure and even death (Arnold, Nangia, and Kapil, 2004).

The cultural factors that impact women’s nutrition and access to healthcare in India include a strong gendered bias against female children, harmful gendered stereotypes in general and cultural as well as religious norms around food habits and mealtimes (Sheikh and Porter, 2013). To provide an instance of a context, there are cultural scenarios where females are often considered a burden on their families. Hence, women are often relegated to the back of the kitchen in a home and are considered the last priority during mealtimes.

Indian Policies Addressing Anaemia

There have been a series of different policies dedicated specifically to tackling the adverse effects of anaemia among Indian women. The first national campaign launched in 1970 in India was the National Nutritional Anaemia Prophylaxis Program. It was designed to provide children under five, pregnant women and nursing mothers with iron and folate supplements (Global Nutrition Report, 2020). Unfortunately, provision did not guarantee consumption and the programme was largely ineffective.

Subsequent programmes attempted to include counselling services to resolve compliance and awareness challenges around the condition. However, these measures were also met with varied results (Global Nutrition Report, 2020). Notably the program was more successful in urban, adolescent populations than in the target rural, adult populations.

The most recent policy intervention targeting anaemia was launched in 2018 and is called the Anaemia Mukt Bharat (AMB) (which translates to ‘an anaemia free India’ in English). This ambitious programme aims to tackle anaemia through the implementation of a six-pronged approach including bi-annual weworming for children, behaviour change communication campaign focused on raising awareness around healthy living among other initiatives (Habyarimana, Temesgen and Ramroop, 2020).

Policy Recommendations

The AMB’s strategy currently remains a surface-level intervention that fails to address the underlying factors contributing to the higher incidence of anaemia among women in India (relative to other countries in South Asia including Bangladesh and Sri Lanka). This leaves the AMB open to the same limitations that policies of the past have faced in terms of their implementation and their efficacy. One approach that could successfully improve the program can be adopted from Edward Deci and Richard Ryan’s self-determination theory.

This theory focuses on behavioural policy interventions. In their theory, Deci and Ryan outline the different sources of motivation behind an individual’s actions, which they classify as either being autonomously (intrinsically) motivated or as being influenced by outside factors (extrinsically motivated) (Peggy and Parekh, 1998). Intrinsic motivation is associated with societal norms and values, while extrinsic motivation comes from external regulatory practices and the approval of external actors through the emotional responses of the individual. As the struggle of tackling anaemia in India can be considered a developmental issue and a matter of national shame, policy makers can play upon this sense of shame to motivate individuals to act in a way that helps reduce the rates of anaemia (Rani, Sawal, Hamzah and Rajabalaya, 2018). 

The interventions proposed in this paper takes on a two-pronged approach to the problem of anaemia by using non-monetary rewards and special messaging. Although rates of anaemia are high across the country, the following intervention is designed to be implemented in a rural context, because the incidence of anaemia is higher in this context than among urban populations. Moreover, the dynamics and organisational structures of rural communities allow for better implementation of the proposed behavioural intervention (Arnold, Nangia, and Kapil, 2004).

The first method of the intervention is to create a national recognition programme that awards villages that can successfully reduce the number of children and women of reproductive age with anaemia within the first year of implementation. The villages should receive national recognition for their efforts from the central government during the annual nationally televised awards ceremony conducted for India’s Republic Day (David & Sawal, 2018). To further incentivise action, compliance with the current AMB and other anti-anaemia policies will result in higher priority in the distribution of medical services such as vaccination drives and increased access to medicines for their local health care centres. At the village level, the recommendation relies on the strong sense of community within a village. Such sentiments are likely to drive changes that will eventually result in reduced health challenges caused by anaemia (Sheikh and Porter, 2013).

The second approach involves the use of mass media campaigns that focus on the national nature of the issue. These campaigns would emphasise the idea that it is every citizen’s civic duty to try to improve the health of those people suffering from anaemia (Premananda, Som, Chakrabarty, Bharati and Pal, 2008). Additionally, awareness would be spread regarding the importance of reducing the rates of anaemia across age groups. Indian men may potentially be less inclined to support the movement, which is why presenting the movement as a matter of national pride will encourage more widespread participation (D’Silva, 2014). To further highlight the patriotic nature of the campaign, a patriotic figure or public figure could be used in media campaigns across various platforms (such as short-form content videos, radio, and television advertisements, etc) as this will help further push and encourage the current anti-anaemia agendas (Fikree and Pasha, 2004).

The limitations of these strategies would be the extensive need for human, physical and financial resources required to effectively monitor the implementation of this programme independently (Bruno, Cogswell, Egli and McLean, 2008). These requirements render such strategies unsustainable in the long run. However, due to the long history of anti-anaemia policies and the recent creation of the Anaemia Mukt Bharat initiative, an infrastructure to monitor anaemia rates across India does exist (Sheikh and Porter, 2013). This means these policies can and should be incorporated into the current system and monitored through a pre-existing model.

Conclusion

India is facing a public health crisis when it comes to nutrition for children and women. Anaemia is just one of the many medical conditions that manifest this crisis. With one in two women and one in three children still presenting with anaemia in India today, traditional policy interventions are insufficient in addressing this challenge (Aguayo and Paintal, 2017). Employing nuanced public policy techniques that incorporate behavioural changes may be able to better address the underlying causes behind the high incidence of anaemia.  

References

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