Lok Sabha Question No. 1748 (UNSTARRED), answered on 2022-02-11
Subject: Anaemia in Pregnant Women
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Sukanta Majumdar, Jayanta Kumar Roy, Sangeeta Kumari Singh Deo

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUESTION. NO. 1748 TO BE ANSWERED ON 11 TH  FEBRUARY 2022

## ANAEMIA IN PREGNANT WOMEN

## 1748:  DR. SUKANTA MAJUMDAR, DR. JAYANTA KUMAR ROY SHRIMATI SANGEETA KUMARI SINGH DEO:

## Will the MINISTER of HEALTH AND FAMILY WELFARE be pleased to state:

- a) whether the World Health Organisation (WHO) has expressed concern over anaemia in pregnant women in the country;
- b) if so, the details thereof
- c) whether the Government has ascertained the condition of pregnant women in different parts of the country;
- d) if  so,  the  details  thereof  along  with  the  steps  taken  by  Government  to  deal  with  the situation, State/ UT-wise; and
- e) the corrective steps taken by Government to deal with the predicament of anaemia in the country, State/ UT-wise including West Bengal?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (DR. BHARATI PRAVIN PAWAR)

## (a) to (b)

The  World  Health  Organisation  (WHO)  publishes  report  on  anaemia.  The  detailed information on prevalence of anaemia in pregnant women in the country and State /UTwise as per the National Family Health Survey-5 is placed at annexure.

Health  is  a  State  subject  and  the  primary  responsibility  for  strengthening  health  care services including implementation of national programs lies with the respective State/UT government. However, Government has taken steps to improve the condition of anaemia among all identified groups in all States/UTs. Under National Health Mission (NHM) the Government provides financial and technical support to States/UTs for implementation of Anaemia Mukt Bharat Strategy as proposed by the States/UTs in their annual Programme Implementation Plans.

## (c) to (d)

The  Government  has  ascertained  the  condition  of  pregnant  women  in  the  country  and various steps taken by the Government of India, to improve health condition of pregnant women in all States/UTs, are as follows:

1. Surakshit Matritva Aashwasan (SUMAN) provides assured, dignified, respectful and quality healthcare at no cost and zero tolerance for denial of services for every woman and newborn visiting public health facilities to end all preventable maternal and newborn deaths.
2. Janani  Suraksha  Yojana (JSY),  a  demand  promotion  and  conditional  cash  transfer scheme for promoting institutional delivery.
3. Under Janani Shishu Suraksha Karyakram (JSSK), every pregnant woman is entitled to free delivery, including caesarean section, in public health institutions along with the provision of free transport, diagnostics, medicines, other consumables & diet.
4. Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) provides pregnant women a fixed  day,  free  of  cost  assured  and  quality  antenatal  check  up  by  a  Specialist/Medical Officer on the 9th day of every month.
5. LaQshya improves the quality of care in labour room and maternity operation theatres to ensure  that  pregnant  women  receive  respectful  and  quality  care  during  delivery  and immediate post-partum.
6. Monthly  Village  Health,  Sanitation  and  Nutrition  Day (VHSND)  is  an  outreach activity at Anganwadi centers for provision of maternal and child care including nutrition in convergence with the ICDS.
7. Delivery PointsOver 25,000 'Delivery Points' across the country have been strengthened in terms of infrastructure, equipment, and trained manpower for provision of comprehensive RMNCAH+N services.
8. MCP  Card  and  Safe  Motherhood  Booklet  are  distributed  to  the  pregnant  women  for educating them on diet, rest, danger signs of pregnancy, benefit schemes and institutional deliveries.
9. Reproductive  and  child  health (RCH)  portal  is  a  name-based  web-enabled  tracking system for pregnant women and new born so as to ensure seamless provision of regular and complete services to them including antenatal care, institutional delivery and postnatal care.

## (e)

The  details  of  the  steps  taken  by  the  Government  to  address  the  problem  of  anaemia across the country including West Bengal are:

- i. Prophylactic Iron and Folic Acid Supplementation in all six target age groups.
- ii. Intensified  year-round  Behaviour  Change  Communication  (BCC)  Campaign for:(a) improving compliance to Iron Folic Acid supplementation and deworming, (b) enhancing appropriate infant and young child feeding practices, (c) encouraging increase in intake of iron-rich food through diet diversity/quantity/frequency  and/or  fortified  foods  with  focus  on  harnessing locally available resources, and (d) ensuring delayed cord clamping after delivery (by 3 minutes) in health facilities.
- iii. Testing  and  treatment  of  anaemia,  using  digital  methods  and  point  of  care treatment, with special focus on pregnant women and school-going adolescents.
- iv. Addressing  non-nutritional  causes  of  anaemia  in  endemic  pockets  with  special focus on malaria, hemoglobinopathies and fluorosis.
- v. Management of severe anaemia in pregnant women undertaken by administration of IV Iron Sucrose/Blood transfusion.
- vi. Providing  incentives  to  the  ANM  for  identification  and  follow-up  of  pregnant women with severe anaemia in high priority districts (HPDs).
- vii. Training  and  orientation  of  Medical  Officers  and  front  line-workers  on  newer Maternal Health and Anaemia Mukt Bharat guidelines.
- viii. Field level awareness by ASHAs through community mobilization activities and IEC and BCC activities.

Measures taken by the Government to make AMB programme more effective are:

- (i) working with other line departments and ministries for strengthening implementation.
- (ii) engaging  National  Centre  of  Excellence  and  Advanced  Research  on  Anaemia Control  (NCEAR-A)  at  AIIMS,  Delhi  in  capacity  building  of  health  care providers.
- (iii) strengthening supply chain and logistics.
- (iv) development  of  AMB  Training  Toolkit  for  capacity  building  of  health  care providers in anaemia management and recent launch of Anaemia Mukt Bharat eTraining Modules to facilitate training of the health care providers through virtual platform  amid  COVID  19  pandemic  which  has  posed  a  challenge  in  capacity building through physical trainings.

Annexure Comparative anaemia prevalence in Pregnant women in 36 States/UTs: NFHS-4 v/s NFHS-5

| S.N   | State/UT          | Pregnant women age 15-49 years who are anaemic (<11.0 g/dl) (%)   | Pregnant women age 15-49 years who are anaemic (<11.0 g/dl) (%)   |
|-------|-------------------|-------------------------------------------------------------------|-------------------------------------------------------------------|
| S.N   | State/UT          | NFHS-5                                                            |                                                                   |
|       | India             | 52.2                                                              | 50.4                                                              |
| 1     | A&N               | 53.7                                                              | 61.4                                                              |
| 2     | Andhra Pradesh    | 53.7                                                              | 52.9                                                              |
| 3     | Arunachal Pradesh | 27.9                                                              | 37.8                                                              |
| 4     | Assam             | 54.2                                                              | 44.8                                                              |
| 5     | Bihar             | 63.1                                                              | 58.3                                                              |
| 6     | Chandigarh        | *                                                                 |                                                                   |
| 7     | Chhattisgarh      | 51.8                                                              | 41.5                                                              |
| 8     | DNH&DND           | 60.7                                                              | 62.3                                                              |
| 9     | Goa               | 41                                                                | 26.7                                                              |
| 10    | Gujarat           | 62.6                                                              | 51.3                                                              |
| 11    | Haryana           | 56.5                                                              | 55                                                                |
| 12    | Himachal Pradesh  | 42.2                                                              | 50.4                                                              |
| 13    | Jammu &Kashmir    | 44.1                                                              | 46.9                                                              |
| 14    | Jharkhand         | 56.8                                                              | 62.6                                                              |
| 15    | Karnataka         | 45.7                                                              | 45.4                                                              |
| 16    | Kerala            | 31.4                                                              | 22.6                                                              |
| 17    | Lakshadweep       | 20.9                                                              | 39                                                                |
| 18    | Ladakh            | 78.1                                                              | 79.3                                                              |
| 19    | Madhya Pradesh    | 52.9                                                              | 54.6                                                              |
| 20    | Maharashtra       | 45.7                                                              | 49.3                                                              |
| 21    | Meghalaya         | 45                                                                | 53.3                                                              |
| 22    | Manipur           | 32.4                                                              | 26                                                                |
| 23    | Mizoram           | 34                                                                | 27                                                                |
| 24    | Nagaland          | 22.2                                                              | 32.7                                                              |
| 25    | Nct Of Delhi      | 42.2                                                              | 46.1                                                              |
| 26    | Odisha            | 61.8                                                              | 47.6                                                              |
| 27    | Punjab            | 51.7                                                              | 42                                                                |
| 28    | Puducherry        | 42.5                                                              | 26                                                                |
| 29    | Rajasthan         | 46.3                                                              | 46.6                                                              |
| 30    | Sikkim            | 40.7                                                              | 23.6                                                              |
| 31    | Tamilnadu         | 48.3                                                              | 44.4                                                              |
| 32    | Telangana         | 53.2                                                              | 48.2                                                              |
| 33    | Tripura           | 61.5                                                              | 54.4                                                              |
| 34    | Uttar Pradesh     | 45.9                                                              | 51                                                                |
| 35    | Uttarakhand       | 46.4                                                              | 46.5                                                              |
| 36    | West Bengal       | 62.3                                                              | 53.6                                                              |