Anaemia Prevention in India: Dietary Diversity, Iron Absorption and One-Third Cases Without Identified Cause

The news

India’s decades-long approach to anaemia prevention, centred on iron and folic acid (IFA) supplementation and staple-food fortification, has failed to reduce the persistently high prevalence among women and children, according to an analysis published on November 11, 2026. National survey evidence shows that iron deficiency is not the major cause of anaemia in the country, and roughly one-third of cases have no identified micronutrient deficiency or obvious cause. The analysis argues that the conflation of anaemia with iron deficiency has led to strategies that may not address the actual underlying causes.

The IFA tablet programme is a targeted intervention for vulnerable groups, while fortification is a population-wide strategy. Fortification has shown effectiveness in controlled clinical trials but has not worked in real-world settings, the analysis notes, and may have adverse effects when given to people for whom the additional iron was not intended. Even among those with iron-deficiency anaemia, the analysis raises two questions: whether dietary iron intake in India is truly deficient, and whether the administered iron is being adequately absorbed and utilised for haemoglobin formation. The analysis calls for a pivot toward dietary diversification as a longer-term approach that is also compatible with India’s goals for reducing non-communicable diseases.

What is the Anaemia Mukt Bharat strategy?

The Anaemia Mukt Bharat (AMB) strategy was launched in 2018 as part of the POSHAN Abhiyaan to accelerate the reduction of anaemia across the life cycle. It operationalised the earlier National Iron Plus Initiative (NIPI) guidelines from 2013, which had expanded the National Nutritional Anaemia Prophylaxis Programme that began in 1970. The AMB strategy uses a 6x6x6 framework—six beneficiary groups, six interventions, and six institutional mechanisms—with IFA supplementation, deworming, and behaviour change communication as core components. The programme targets a reduction of anaemia prevalence by 3 percentage points per year among children, adolescents, and women of reproductive age.

Why has the current strategy not worked?

The analysis attributes the failure to a mistaken conflation of anaemia with iron deficiency. National surveys show that iron deficiency is not the major cause, and about one-third of anaemia cases have no identified micronutrient deficiency or obvious cause. Even for cases that are iron-deficiency anaemia, the analysis questions whether dietary iron intake is truly deficient and whether the iron administered through supplements or fortified foods is adequately absorbed and used by the body to form haemoglobin. Programme implementation inefficiencies may also play a role.

What are the limits of fortification and supplementation?

IFA supplementation is described as a targeted approach for women and children, while fortification is a broad population-wide strategy. Fortification has shown results in controlled settings but has not worked in real-world settings, according to the analysis. It may also have adverse effects when given to people for whom the additional iron was not intended. The analysis argues that no amount of supplementation or fortification will work in the long term if the focus is not shifted to better diets through diversification.

What is the proposed way forward?

The analysis recommends a multidimensional strategy that combines dietary diversification with assessment of dietary iron intake, iron absorption and programme implementation. Addressing different underlying causes of anaemia, rather than assuming all cases are due to iron deficiency, is essential. Dietary diversification is also aligned with India’s goals for reducing non-communicable diseases, making it a non-negotiable element of public health policy, the analysis states.