Iron deficiency anemia (IDA) – a widespread and severe public health, food borne crisis in India

Iron deficiency anemia (IDA) is a widespread and severe public health issue in India, disproportionately affecting women and children. The National Family Health Survey-5 (2019-2021) revealed a persistent high prevalence, with 67.1% of children and 57% of women aged 15–49 being anemic in India.

A 2025 review found that the prevalence was highest among toddlers (69%) and consistently high across various age groups.

Anemia Prevalence in India (NFHS-5) 

Causes and risk factors

Iron deficiency anemia is a multifactorial condition in India, driven by a complex interplay of nutritional, socioeconomic, and biological factors.

• Inadequate dietary iron intake: The prevalence is linked to low-energy diets, with many Indians relying on cereal-based meals that lack sufficient iron. Many women, in particular have low dietary iron intake and often eat last, getting smaller portions of the most nutritious food

• Poor iron absorption: The bioavailability of iron from plant-based, or non-heme, sources is relatively lower than from meat. Additionally, substances in tea and coffee can inhibit iron absorption thus further fueling the deficiency

• Increased iron demand: Higher iron requirements in pregnant women, lactating mothers, infants, children, and adolescents are often not met, increasing their vulnerability.

• Blood loss: Heavy menstrual bleeding in women of reproductive age is a major cause of iron depletion.

• Parasitic infections, like hookworm infestations, can cause chronic intestinal blood loss

• Internal bleeding from conditions such as peptic ulcers is also a factor.

• Socioeconomic disparities: Poverty limits access to nutrient-rich food and proper sanitation, and low maternal education is associated with higher rates of anemia in children.

• Non-nutritional causes: In some regions, other conditions like malaria, chronic kidney disease, and inherited red blood cell disorders like thalassemia can cause anemia.

Symptoms

Symptoms of IDA can be subtle at first and worsen as the condition progresses.

• Common symptoms:

• Extreme fatigue and weakness.

• Pale or yellowish skin.

• Dizziness or lightheadedness.

• Headaches.

• Cold hands and feet.

• Severe symptoms:

• Shortness of breath or chest pain.

• Rapid or irregular heartbeat.

• Soreness or swelling of the tongue.

• Brittle nails.

• Pica, or unusual cravings for non-food items like ice or dirt.

• Restless legs syndrome

Current Status and Corrective Actions

• Widespread Issue: Anemia affects more than half of Indian women and two-thirds of children under five, thus making Iron Deficiency a National Health Crisis

• Leading Cause: Iron deficiency is considered the primary underlying cause, although other nutritional deficiencies (like B12 and folate), infections, and socioeconomic factors also contribute

• Increasing Trend: The national prevalence of anemia has shown an alarmingly increasing trend from NFHS-4 (2015-2016) to NFHS-5 across all age and gender groups

• Rural-Urban Disparity: Anemia is generally more prevalent in rural areas than in urban areas due to factors like lower socioeconomic status, poor dietary diversity, and limited access to healthcare

• Socioeconomic Link: Lower education levels and household wealth are strongly associated with a higher risk of anemia

• Government Initiatives: The Government of India has implemented programs like the Anemia Mukt Bharat (AMB) initiative and the Weekly Iron and Folic Acid Supplementation (WIFS) to address this public health challenge

National Emergency

The prevalence of anaemia in India remains high in children, especially those in rural areas, and in women of childbearing age. It is concerning that the most recent official data (2019–21) indicate an increased prevalence compared with the period of 2015–16.

There is also considerable variability in childhood anaemia between Indian states and with socioeconomic factors, such as wealth and education contributing to the risk of anaemia among adolescent women. There is now no doubt that anaemia has a multifactorial aetiology.

The consequences of anaemia are very substantial, impacting the neurological development of children, leading to poorer educational attainment and, later, reduced occupational performance, productivity, and income. The impact of anaemia in young women is perhaps less discussed but is associated with greater postpartum haemorrhage and a consequential increased mortality risk.

Moreover, a low vitamin B₁₂ and/or folate status increases the risk of foetal neural tube defects, which is already 4.5 times higher in India than in Europe.

The potential of high-iron millets to reduce IDA looks promising although work on assessing the bioavailability of the iron is urgently needed and obviously these millets will not solve the widespread vitamin B₁₂ deficiency, which also needs urgent attention. Overall, the available evidence points to anaemia having a multifactorial aetiology requiring a multifactorial assessment.

Anaemia Mukt Bharat programme and the usage of Weekly Iron and Folic Acid Supplementation needs to be re-looked at from the perspective of using highly bio-available Haeme Iron or chelated organic Iron and Folic Acid supplements rather than cheaper, lesser bioavailable supplements.