Lok Sabha Question No. 442 (UNSTARRED), answered on 2023-02-03
Subject: Anaemia in Pregnant Women
Ministry: WOMEN AND CHILD DEVELOPMENT
Asked by: Keshari Devi Patel, Omprakash Bhupalsinh alias Pawan Rajenimbalkar, Sanjay Haribhau Jadhav

## GOVERNMENT OF INDIA MINISTRY OF WOMEN & CHILD DEVELOPMENT

## LOK SABHA UNSTARRED QUESTION NO. 442

TO BE ANSWERED ON 03.02.2023

## ANAEMIA IN PREGNANT WOMEN

442. SHRIMATI KESHARI DEVI PATEL: SHRI OMPRAKASH BHUPALSINH ALIAS PAWAN RAJENIMBALKAR: SHRI SANJAY JADHAV:

Will the Minister of WOMEN AND CHILD DEVELOPMENT be pleased to state:

- (a) the steps taken by the Government to improve the health of mother and child including improvement in nutrition index of NITI Aayog;
- (b) whether a large number of women including pregnant women of Osmanabad and Parbhani districts  of  Maharashtra  and  Phulpur  of  Uttar  Pradesh  are  suffering from anaemia, if so, the immediate steps taken by the Government to eradicate the same; and
- (c) the other steps being taken by the Government to control the rate of mortality of women and children?

## ANSWER

## MINISTER OF WOMEN AND CHILD DEVELOPMENT (SHRIMATI SMRITI ZUBIN IRANI)

(a) As  per  inputs  received  from  Niti  Aayog,  it  does  not  have  a  Nutrition  Index. However, Government has accorded high priority to improve the nutritional status of maternal and child health  in  the  country.  POSHAN  Abhiyaan  was  launched on  8 th March 2018 with an aim to achieve improvement in nutritional status of Children under 6 years, Adolescent Girls, Pregnant Women and Lactating Mothers in a time bound manner by adopting a synergised and result oriented approach. POSHAN Abhiyaan addresses  malnutrition  issues  across  the  nation  through  components  like  ICT Application,  Convergence,  Community  Mobilization,  Behavioural  Change  &  Jan Andolan, Capacity Building, Incentives and Awards, and Innovations. The Abhiyaan has been rolled out in all the 36 States/UTs covering all the districts across the country.

Further, Mission Saksham Anganwadi and Poshan 2.0 (Mission Poshan 2.0), an integrated  nutrition  support  programme  includes  key  schemes  such  as Poshan Abhiyan, Anganwadi Services, Supplementary Nutrition Programme and Scheme for Adolescent  Girls.  It  seeks  to  strengthen  nutritional  content,  delivery,  outreach  and outcomes  with  focus  on  developing  practices  that  nurture  health,  wellness  and immunity to disease and malnutrition. Steps have been taken to improve nutritional quality  and testing in accredited labs, strengthen delivery and leverage technology under  Poshan  Tracker  to  improve  governance.  States/UTs  have  been  advised  to promote use of AYUSH systems for prevention of malnutrition and related diseases. Guidelines  of  Mission  Poshan  2.0  support  development  of  Poshan  Vatikas  at

Anganwadi Centres to meet dietary diversity gap leveraging traditional knowledge in nutritional  practices.  Streamlined  Guidelines  were  issued  for  transparency  and accountability in delivery of supplementary nutrition and to track nutritional outcomes on 13.01.2021.

(b) As per NFHS-5 (2019-21), the number of women including pregnant women of Osmanabad and Parbhani districts of Maharashtra and Prayagraj district including Phulpur of Uttar Pradesh suffering from anemia is as follows:

|   S.No. | State         | District                             |   %of all women (age 15-49 yrs) who are anaemic (<11.0 g/dl) |   %of pregnant women (age 15-49 yrs) who are anaemic (<11.0 g/dl) |
|---------|---------------|--------------------------------------|--------------------------------------------------------------|-------------------------------------------------------------------|
|       1 | Maharashtra   | Osmanabad                            |                                                         49.1 |                                                              44.4 |
|       1 | Maharashtra   | Parbhani                             |                                                         58.8 |                                                              48   |
|       2 | Uttar Pradesh | Prayagraj district including Phulpur |                                                         46.4 |                                                              43   |

POSHAN Abhiyaan is a programmatic approach in addressing the life cycle issues of malnutrition. Reduction of anemia is one of the important objectives of the POSHAN Abhiyaan in convergence with key Ministries/ Departments, mainly Ministry of Health & Family Welfare (MoH&FW). A range of efforts are underway to improve the  integration  of  nutrition  interventions  into  the  existing  health  platforms  through various strategic measures. As part of its comprehensive strategy to tackle anemia, Government of India has included staple food fortification from central ministries for schemes/programs  in  multiple  States.  To  reduce  the  malnutrition  and  anemia  in women and children arising due to deficiency of micro nutrients like Iron, Folic Acid and Vitamin B-12, under Supplementary Nutrition Programme of Anganwadi Services, Fortified Rice was allocated to 21 States/UTs during the 2nd quarter of FY 2021-22. From the 3rd quarter of FY 2021-22 onwards, only Fortified Rice is being allocated to all the State/UTs. So far, this Ministry has allocated 731962 MTs of Fortified Rice in FY 2021-22 and 938207 MTs of Fortified rice up to third quarter of FY 2022-23 to all States/UTs.

Further, greater emphasis is being given on the use of millets for preparation of Hot Cooked Meal and Take Home rations (not raw ration) at Anganwadi Centres for Pregnant Women, Lactating Mothers and Children below 6 years of age, as millets have high nutrient content which includes protein, essential fatty acid, dietary fibre, BVitamins, minerals such as calcium, iron, zinc, folic acid and other micro-nutrients thus helping to tackle anemia and other micro-nutrient deficiencies common among women and children.

Under POSHAN Abhiyaan, efforts are also being made to strengthen processes for community engagement, empowerment of beneficiaries and behavioural change towards  better  nutrition  for  which  the  Abhiyaan  provides  a  platform  for  organizing Community Based Events (CBEs) in Anganwadi Centres. Under Community Based Events, messages related to public health for improvement of nutrition and to reduce illness, prevention of anemia, importance of nutritious food, diet diversity etc. are being conducted. Many States/UTs have developed indigenous best practices like use of iron utensils for cooking to reduce iron deficiency, integrating Ayurveda products and formulations with supplementary nutrition etc.

Further,  the  Government of India has launched Anemia Mukt  Bharat (AMB) under  Ministry  of  Health  and  Family  Welfare,with  the  target  to  reduce  anemia  in women, children and adolescents in life cycle approach. The 6x6x6 strategy under AMB implies six age groups, six interventions and six institutional mechanisms. The six interventions under Anemia Mukt Bharat strategy include, Prophylactic Iron Folic Acid Supplementation, Periodic de-worming,  Testing and treatment of anemia, using digital methods and point of care treatment, etc.

- (c) This  Ministry  is  implementing  the  Pradhan  Mantri  Matru  Vandana  Yojana (PMMVY) with effect from 1st January 2017. As part of Mission Shakti, under PMMVY cash incentive is provided to improve health seeking behaviour amongst Pregnant Women.  Under  the  scheme,  maternity  benefits  of  Rs.5,000/-  is  provided  in  two installments to expectant mothers and for the second child, (if girl), Rs 6000 in a single installment is provided.

As informed by Ministry of Health and Family Welfare, the steps taken by the Government of India to improve maternal health and to control the rate of mortality of pregnant women are:

-  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.
-  Janani Suraksha Yojana (JSY) ,  a  demand promotion and conditional cash transfer scheme for promoting institutional delivery.
-  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
-  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.
-  LaQshya i mproves 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.
-  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.
-  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 post-natal care.
-  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.
-  Setting  up  of  Maternal  and  Child  Health  (MCH)  Wings at  high  caseload facilities to improve the quality of care provided to mothers and children.
-  Functionalization  of  First  Referral  Units  (FRUs) by  ensuring  manpower, blood storage units, referral linkages to improve the access to quality of care for pregnant women.

Further, Ministry of Health and Family Welfare has also informed that Government of India has taken following steps to improve child health, check child mortality rate and provide easily accessible treatment:

-  Facility  Based  New-born  Care :  Sick  New-born  Care  Units  (SNCUs)  are established at District Hospital and Medical College level, New-born Stabilization  Units  (NBSUs)  are  established  at  First  Referral  Units  (FRUs)/ Community Health Centres (CHCs) for care of sick and small babies.
-  Community Based care of New-born and Young Children :  Under  Home Based  New-born  Care  (HBNC)  and  Home-Based  Care  of  Young  Children (HBYC) program, home visits are performed by ASHAs to improve child rearing practices and to identify sick new-born and young children in the community.
-  Mothers' Absolute Affection (MAA) : Early initiation and exclusive breastfeeding  for  first  six  months  and  appropriate  Infant  and  Young  Child Feeding  (IYCF)  practices  are  promoted  under  Mothers'  Absolute  Affection (MAA).
-  Social  Awareness  and  Actions  to  Neutralize  Pneumonia  Successfully (SAANS) initiative  implemented  for  reduction  of  childhood  morbidity  and mortality due to Pneumonia.
-  Universal  Immunization  Programme  (UIP) is implemented  to  provide vaccination to children against life threatening diseases such as Tuberculosis, Diphtheria, Pertussis, Polio, Tetanus, Hepatitis B, Measles, Rubella, Pneumonia  and  Meningitis  caused  by  Haemophilus  Influenzae  B.  The Rotavirus vaccination is rolled out in the country for prevention of Rota-viral diarrhoea.  PneumococcalConjugate  Vaccine  (PCV)  is  introduced  in  all  the States and UTs.
-  Rashtriya Bal Swasthya Karyakaram (RBSK) : Children from 0 to 18 years of age are screened for 32 health conditions (i.e. Diseases, Deficiencies, Defects and Developmental delay) under Rashtriya Bal Swasthya Karyakaram (RBSK) to improve child survival. District Early Intervention Centres (DEICs) at district health facility level are established for confirmation and management of children screened under RBSK.
-  Nutrition Rehabilitation Centres (NRCs) are set up at public health facilities to  treat  and  manage  the  children  with  Severe  Acute  Malnutrition  (SAM) admitted with medical complications.
-  Intensified Diarrhoea  Control  Fortnight initiative is implemented  for promoting ORS and Zinc use and for reducing diarrhoeal deaths.
-  Capacity  Building: Several capacity building programs  of  health care providers are taken up for improving maternal and child survival and health outcomes.

As  a  result  of  Government  interventions,  there  has  been  significant  reduction  in Maternal Mortality Ratio from 130 in 2014-16 to 97 per lakh live births in 2018-20. The Infant Mortality Rate (IMR) has also registered significant decline from 39 per 1000 live births in 2014 to 28 per 1000 live births in 2020.

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