Lok Sabha Question No. 1883 (UNSTARRED), answered on 2024-08-02
Subject: Anaemia and other Mineral Deficiency Diseases
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Shri Suresh Kumar Shetkar

## GOVERNMENTOFINDIA MINISTRYOF HEALTH AND FAMILY WELFARE DEPARTMENTOFHEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUESTION NO. 1883 TO BE ANSWERED ON THE 2 ND AUGUST 2024

## 'ANAEMIAAND OTHER MINERALDEFICIENCYDISEASES'

## 1883. SHRI SURESH KUMAR SHETKAR:

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

(a) whether it is a fact that a large population of women and children are facing several diseases due to anaemia and other mineral deficiencies particularly in tribal and rural areas in the country;

(b) if so, the details thereof, State/UT-wise along with the reasons therefor;

(c) the schemes being implemented and funds released/spent under each scheme during each of the last three years and the current year, State/UT-wise to address it; and

(d) the corrective measures being taken by the Government in this regard to avoid such situation in future?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (SMT. ANUPRIYAPATEL)

- (a) to (d) As per the National Family Health Survey 5 (2019-21) the prevalence of anaemia among all women age 15-49 years across the country is 57.0 percent, among scheduled tribe population is 64.6 percent and among rural population is 58.5 percent. The prevalence of anaemia among children age 6-59 months across the country is 67.1 percent, among scheduled tribe populations is 72.4 percent and among rural population is 68.3 percent, as per the National Family Health Survey 5 (2019-21).

State/UT-wise details of prevalence of anaemia among women and children are provided at Annexure I.

The Ministry of Health and Family Welfare is implementing Reproductive, Maternal, Newborn, Child, Adolescent Health and Nutrition (RMNCAH+N) strategy in a life cycle approach under National Health Mission (NHM). This includes interventions placed below, for addressing anaemia and other mineral deficiency among women and children across the country, including tribal and rural areas:

1. Anaemia Mukt Bharat (AMB): The Government of India implements Anaemia Mukt Bharat (AMB) Program to reduce prevalence of anaemia among six beneficiary groups Children 6-59 months, Children 5-9 years, Adolescents 10-19 years, Pregnant women,

lactating mother and Women of Reproductive Age (20-49 years). The interventions are Prophylactic Iron and Folic Acid Supplementation, deworming among children 1-19 years and pregnant women, Intensified Behaviour Change Communication (BCC) Campaign, Provision of IFA fortified food in government funded public health program and addressing non-nutritional causes of anaemia in endemic pockets with special focus on malaria, haemoglobinopathies and fluorosis, implemented via robust institutional mechanism.

2. Nutrition Rehabilitation Centres (NRCs) are set up at public health facilities to provide in-patient medical and nutritional care to children under 5 years of age suffering from Severe Acute Malnutrition (SAM) with medical complications. In addition to curative care, special focus is given on correction of micronutrient deficiencies through supplementation of potassium, magnesium, zinc, iron and vitamin supplements and on improving the skills for mother and caregivers on complete age-appropriate caring and feeding practices.

The State/UT-wise details of funds approved /utilized under these programs are placed at Annexure II and III.

The Government of India programs to address health issues including anaemia and mineral deficiencies among women and children across the country, including tribal and rural areas , are placed at Annexure IV.

Annexure I State/UT-wise Prevalence of Anaemia among women and children 6-59 months across

## the country (Source: NFHS-5, 2019-21)

|   S No. | State/UT                 |   All women age 15-49 years who are anaemic (%) |   Children age 6-59 months who are anaemic (%) |
|---------|--------------------------|-------------------------------------------------|------------------------------------------------|
|       1 | Andaman &Nicobar Islands |                                            57.5 |                                           40   |
|       2 | Andhra Pradesh           |                                            58.8 |                                           63.2 |
|       3 | Arunachal Pradesh        |                                            40.3 |                                           56.6 |
|       4 | Assam                    |                                            65.9 |                                           68.4 |
|       5 | Bihar                    |                                            63.5 |                                           69.4 |
|       6 | Chandigarh               |                                            60.3 |                                           54.6 |
|       7 | Chhattisgarh             |                                            60.8 |                                           67.2 |
|       8 | Delhi                    |                                            49.9 |                                           69.2 |
|       9 | DNH& DD                  |                                            62.5 |                                           75.8 |
|      10 | Goa                      |                                            39   |                                           53.2 |
|      11 | Gujarat                  |                                            65   |                                           79.7 |
|      12 | Haryana                  |                                            60.4 |                                           70.4 |
|      13 | Himachal Pradesh         |                                            53   |                                           55.4 |
|      14 | Jammu &Kashmir           |                                            65.9 |                                           72.7 |
|      15 | Jharkhand                |                                            65.3 |                                           67.5 |
|      16 | Karnataka                |                                            47.8 |                                           65.5 |
|      17 | Kerala                   |                                            36.3 |                                           39.4 |
|      18 | Ladakh                   |                                            92.8 |                                           92.5 |
|      19 | Lakshadweep              |                                            25.8 |                                           43.1 |
|      20 | Madhya Pradesh           |                                            54.7 |                                           72.7 |
|      21 | Maharashtra              |                                            54.2 |                                           68.9 |
|      22 | Manipur                  |                                            29.4 |                                           42.8 |
|      23 | Meghalaya                |                                            53.8 |                                           45.1 |
|      24 | Mizoram                  |                                            34.8 |                                           46.4 |
|      25 | Nagaland                 |                                            28.9 |                                           42.7 |
|      26 | Odisha                   |                                            64.3 |                                           64.2 |
|      27 | Puducherry               |                                            55.1 |                                           64   |
|      28 | Punjab                   |                                            58.7 |                                           71.1 |
|      29 | Rajasthan                |                                            54.4 |                                           71.5 |
|      30 | Sikkim                   |                                            42.1 |                                           56.4 |
|      31 | Tamil Nadu               |                                            53.4 |                                           57.4 |
|      32 | Telangana                |                                            57.6 |                                           70   |
|      33 | Tripura                  |                                            67.2 |                                           64.3 |
|      34 | Uttar Pradesh            |                                            50.4 |                                           66.4 |
|      35 | Uttarakhand              |                                            42.6 |                                           58.8 |
|      36 | West Bengal              |                                            71.4 |                                           69   |

Annexure II

## SPIPApprovals and Expenditure towards anaemia under NHM for the period of F.Y. 2021-22 to 2023-24

(Rs. in lakhs)

| S. No.   | State/UT          | FY 2021-22*   | FY 2021-22*   | FY 2022-23     | FY 2022-23    | FY2023-24   | FY2023-24      |
|----------|-------------------|---------------|---------------|----------------|---------------|-------------|----------------|
| S. No.   | State/UT          | App           | Exp           | App            | Exp           | App         | Exp            |
|          | India             | 220371.28     | 161369.22     | 80175.41       | 27067.96      | 98479.11    | 33560.26       |
| 1        | A&N Island        | 4.45          | 0.00          | 9.99           | 0.51          | 44.75       | 4.62           |
| 2        | Andhra Pradesh    | 2018.16       | 2018.16       | 8569.74        | 3037.45       | 8,570.74    | 6,896.00       |
| 3        | Arunachal Pradesh | 28.85         | 17.23         | 27.30          | 14.11         | 27.30       | -              |
| 4        | Assam             | 11360.33      | 13808.37      | 2257.45        | 1721.50       | 1,564.65    | 1,225.98       |
| 5        | Bihar             | 4078.28       | 310.52        | 7569.52        | 137.11        | 7,569.52    | 2,267.92       |
| 6        | Chandigarh        | 0.50          | 0.04          | 0.00           | 0.00          | -           | -              |
| 7        | Chhattisgarh      | 2762.19       | 3413.05       | 1816.00        | 1654.30       | 1,734.61    | 615.67         |
| 8        | DNH &DD           | 6.57          | 0.00          | 12.84          | 8.42          | 12.84       | 3.59           |
| 9        | Delhi             | 365.95        | 0.00          | 311.00         | 2.24          | 472.90      | 3.20           |
| 10       | Goa               | 816.29        | 286.71        | 123.97         | 33.45         | 123.97      | 30.29          |
| 11       | Gujarat           | 4252.93       | 4146.37       | 2534.90        | 996.70        | 2,133.04    | 1,947.15       |
| 12       | Haryana           | 13.65         | 0.10          | 1685.18        | 1833.31       | 1,695.64    | 1,863.62       |
| 13       | Himachal Pradesh  | 6510.00       | 6500.48       | 336.24         | 169.52        | 108.64      | 89.59          |
| 14       | J&K               | 2236.78       | 53.88         | 777.48         | 343.20        | 927.48      | 42.09          |
| 15       | Jharkhand         | 3204.63       | 1726.22       | 5185.43        | 1967.88       | 4,798.84    | 451.52         |
| 16       | Karnataka         | 13289.90      | 4384.06       | 2594.06        | 50.48         | 3,462.93    | 718.55         |
| 17       | Kerala            | 20103.00      | 17950.99      | 2540.73        | 1070.38       | 2,214.74    | 230.48         |
| 18       | Ladakh            | 60.50         | 10.64         | 8.48           | 13.60         | 8.48        | 7.94           |
| 19       | Lakshadweep       | 38.85         | 10.14         | 5.25           | 5.00          | 5.47        | 0.90           |
| 20       | Madhya Pradesh    | 10350.21      | 9664.21       | 8518.16        | 4561.94       | 13,397.85   | 4,912.23       |
| 21       | Maharashtra       | 29607.98      | 25825.79      | 7285.50        | 970.40        | 7,366.95    | 1,918.71       |
| 22       | Manipur           | 21.73         | 168.78        | 139.01         | 47.45         | 173.87      | 8.52           |
| 23       | Meghalaya         | 100.10        | 153.08        | 490.74         | 357.13        | 504.82      | 39.67          |
| 24       | Mizoram           | 381.54        | 179.65        | 132.10         | 1.82          | 111.06      | 50.12          |
| 25       | Nagaland          | 686.88        | 753.75        | 165.68         | 0.00          | 311.73      | 1.31           |
| 27       | Odisha            | 54.22         | 39.20 45.17   | 2119.17        | 322.96        | 1,988.06    | 1,090.38 20.27 |
| 26       | Puducherry        | 384.71        |               | 248.49         | 83.99         | 248.49      |                |
| 28       | Punjab            | 4744.00       | 4902.03       | 1082.42        | 75.77         | 1,082.42    | 1,082.42       |
| 29       | Rajasthan         | 60348.00      | 41320.12      | 3837.04        | 853.58        | 3,837.04    | 668.56         |
| 30       | Sikkim            | 344.10        | 503.82        | 49.74          | 43.68         | 49.74       | 38.20          |
| 31       | Tamil Nadu        | 13125.48      | 12917.85      | 1273.11        | 233.90        | 1,273.11    | 669.63         |
|          | Tripura           | 200.50        | 194.61        |                |               | 679.93      | 543.17         |
| 32 33    | Telangana         | 1161.00       | 601.62        | 2390.04 605.05 | 3881.33 51.48 | 2,390.04    | 83.43          |
| 34       | Uttar Pradesh     | 17379.51      | 55.65         | 11768.65       | 834.48        | 25,785.11   | 4,349.42       |
| 35       | Uttarakhand       | 2285.91       | 1570.20       | 1372.12        | 226.46        | 1,420.41    | 218.18         |
| 36       | West Bengal       | 8043.60       | 7836.72       | 2332.83        | 1462.45       | 2,381.95    | 1,466.93       |

1. SPIPApproval and Expenditure is as per the available Financial Management Reports submitted by State/UTs and are provisional.
2. Expenditure includes Expenditure against Central Release, Corresponding State share release & unspent balances at the beginning of the year.
3. * the above data comprises of inter alia follow up mechanism for the severely anaemic women and the women with blood disorders, one day orientation of frontline workers (ASHA/ANM) and allied department workers (Teachers/AWW) on Anaemia Mukt Bharat strategy as per RCH training norms, IFA syrups (with auto dispenser) for children (6-60months), IFA tablets (IFA WIFS junior tablets- pink sugar coated) for children (5-10 yrs), IFA tablets for non-pregnant & non-lactating women in reproductive age (20-49 years), orientation activities on vitamin A supplementation and Anaemia Mukt Bharat Program, printing for Micronutrient Supplementation Program including IEC materials, reporting formats, guidelines / training materials etc. (for AMB and Vitamin A supplementation programs), etc
4. App-Approvals, Exp-Expenditure

4

## Annexure III SPIPApprovals and Expenditure for Nutritional Rehabilitation Centres under NHM for

## the period of F.Y. 2021-22 to 2023-24

| S.no.   | State/UT          | 2021-22*   | 2021-22*   | 2022-23   | 2022-23   | 2023-24   | 2023-24   |
|---------|-------------------|------------|------------|-----------|-----------|-----------|-----------|
| S.no.   | State/UT          | App        | Exp        | App       | Exp       | App       | Exp       |
|         | India             | 98083.71   | 61867.71   | 10831.70  | 6922.01   | 10921.99  | 7682.01   |
| 1       | A&N Island        | 42.92      | 1.67       | -         | -         | -         | -         |
| 2       | Andhra Pradesh    | 3,789.23   | 3,595.01   | 185.45    | 75.50     | 254.60    | 198.18    |
| 3       | Arunachal Pradesh | 469.99     | 271.61     | 19.04     | 10.31     | 26.78     | -         |
| 4       | Assam             | 3,581.65   | 2,772.85   | 164.19    | 126.12    | 169.70    | 166.58    |
| 5       | Bihar             | 1,616.20   | 1,004.23   | 896.63    | 352.33    | 870.51    | 364.90    |
| 6       | Chandigarh        | 4.15       | 1.75       | 0.18      | -         | 0.18      | 0.12      |
| 7       | Chhattisgarh      | 5,514.90   | 3,392.78   | 649.50    | 649.49    | 649.50    | 534.39    |
| 8       | DNH-DD            | 73.00      | 37.25      | 0.78      | 3.16      | 0.78      | 1.13      |
| 9       | Delhi             | 1,287.10   | 105.47     | 58.83     | 7.33      | 50.83     | 5.81      |
| 10      | Goa               | 50.37      | 15.91      | -         | -         | -         | -         |
| 11      | Gujarat           | 7,384.49   | 5,210.48   | 1,046.41  | 671.26    | 1,048.33  | 1,211.81  |
| 12      | Haryana           | 1,620.39   | 1,662.66   | 27.51     | 27.18     | 27.51     | 22.46     |
| 13      | Himachal Pradesh  | 526.31     | 291.94     | 15.74     | 4.00      | 17.09     | 4.58      |
| 14      | J&K               | 1,595.43   | 393.83     | 31.95     | 8.21      | 31.95     | 4.05      |
| 15      | Jharkhand         | 5,585.63   | 1,198.62   | 1,217.75  | 602.76    | 1,232.40  | 765.59    |
| 16      | Karnataka         | 3,871.08   | 2,257.98   | 336.68    | 274.51    | 326.60    | 178.89    |
| 17      | Kerala            | 653.25     | 231.14     | 8.41      | 11.22     | 8.41      | 8.09      |
| 18      | Ladakh            | 92.53      | 18.66      | 11.58     | 0.60      | 19.30     | 5.10      |
| 19      | Lakshadweep       | 6.98       | 0.45       | -         | -         | -         | -         |
| 20      | Madhya Pradesh    | 9,236.78   | 6,549.28   | 3,406.29  | 2,244.1   | 3,155.05  | 2,200.59  |
| 21      | Maharashtra       | 6,171.02   | 5,281.94   | 420.91    | 272.16    | 410.03    | 315.76    |
| 22      | Manipur           | 530.32     | 85.26      | 8.40      | -         | 8.40      | 0.69      |
| 23      | Meghalaya         | 634.95     | 259.07     | 30.06     | 16.95     | 31.57     | 23.76     |
| 24      | Mizoram           | 197.64     | 66.55      | -         | -         | -         | 7.30      |
| 25      | Nagaland          | 373.35     | 145.46     | 9.55      | 0.50      | 22.40     | 8.13      |
| 26      | Odisha            | 5,446.05   | 3,973.61   | 740.29    | 560.73    | 740.29    | 538.26    |
| 27      | Puducherry        | 44.76      | 26.75      | -         | -         | -         | -         |
| 28      | Punjab            | 1,330.00   | 882.77     | 21.12     | -         | 21.12     | 21.12     |
| 29      | Rajasthan         | 5,365.19   | 2,473.80   | 230.88    | 125.64    | 230.88    | 167.16    |
| 30      | Sikkim            | 66.71      | 6.72       | -         | -         | -         | -         |
| 31      | Tamil Nadu        | 826.56     | 863.41     | 35.85     | 20.61     | 31.85     | 22.76     |
| 32      | Telangana         | 2,176.58   | 1,683.48   | 123.20    | 30.13     | 123.20    | 38.44     |
| 33      | Tripura           | 282.49     | 190.99     | 12.30     | 0.70      | 7.30      | 0.89      |
| 34      | Uttar Pradesh     | 21,449.81  | 8,398.65   | 682.22    | 418.48    | 888.28    | 454.38    |
| 35      | Uttarakhand       | 547.13     | 203.83     | 5.52      | 1.96      | 6.20      | 5.90      |
| 36      | West Bengal       | 5,638.77   | 8,311.85   | 434.48    | 406.07    | 510.96    | 405.20    |

(Rs. in lakhs)

1. SPIP Approval and Expenditure is as per the available Financial Management Reports submitted by State/UTs and are provisional.
2. Expenditure includes Expenditure against Central Release, Corresponding State share release & unspent balances at the beginning of the year.
3. 5 3. * Includes budget allocation for all CH programs like MAA, NDD,AMB,NRC, VitA, IMNCI,F-IMNCI,IDCF, HBYC, HBNC, NBSU,NSSK,SNCU, KMC, SAANS,Family Participatory Care, CDR, Paed-HDU etc
4. App-Approvals, Exp-Expenditure

## Annexure IV

Programs implemented by the Government of India to address health issues including anaemia and mineral deficiencies among women and children across the country, including tribal and rural areas are as follows :

-  Mothers' Absolute Affection (MAA) Program is implemented to improve breastfeeding coverage emphasizing on early initiation of breastfeeding and exclusive breastfeeding for first six months followed by age-appropriate complementary feeding practices through capacity building of frontline health workers and comprehensive IEC campaigns.
-  Village Health Sanitation and Nutrition Days (VHSNDs) are observed for provision of maternal and child health services and creating awareness on maternal and child care including nutrition in convergence with Ministry of Women and Child Development.
-  Mother and Child Protection Card is the joint initiative of the Ministry of Health & Family welfare and the Ministry of Woman and Child Development which addresses the nutrition concerns in children.
-  Under Rashtriya Bal Swasthya Karyakram (RBSK) , Children from birth to six years of age are screened at Anganwadi centres twice a year and children from 6 years till 18 years of age enrolled in Government and Government aided schools are screened once a year for 4 DsDefects at birth, Diseases, Deficiencies and Development delays, spanning 32 common health conditions for early detection and free treatment and management for these identified health conditions. Anaemia is one of the health conditions for screening under RBSK, children suspected to be anemic are referred to the nearest Government health care facility.
-  National Food Security Act (NFSA) 2013 , which provides highly subsidized food grains under Targeted Public Distribution System (TPDS) for coverage up to 75% of the rural population and up to 50% of the urban population
-  Under Pradhan Mantri Garib Kalyan Anna Yojana (PMGKAY) , free food grains are provided to beneficiaries of Antyodaya Anna Yojana households and Priority Households, for a period of five years with effect from 1 st January 2024.

-  Under Mission Poshan 2.0, Supplementary Nutrition Program provides nutritional support to children less than 6 years age, adolescent girls (14-18 years), pregnant women and lactating mothers as per nutrition norms under Schedule II of NFSA Act 2013.
-  Pradhan Mantri Poshan Shakti Nirman (PM POSHAN) under Ministry of Education, provides one hot cooked meal in Government and Government-aided schools as per nutrition norms under Schedule II of NFSA Act, 2013 to school going children from Balvatikas (pre-school) to Class VIII.
-  Calcium supplementation -360 Calcium Carbonate tablets (500 mg elemental calcium and 250 IU vitamin D3) for 6 month period are given to pregnant women after 1 st trimester & post natal mothers after delivery for reducing the risk of mineral deficiency.
-  Janani Shishu Suraksha Karyakram (JSSK) entitles every pregnant woman to free delivery, including caesarean section, in public health institutions along with the provision of free transport, diagnostics, medicines, blood, other consumables and diet.