Causing Factors of Anaemia among Pregnant Women

This dissertation explores the causing factors of anaemia among pregnant women, focusing on the prevalence rate in India and the strategies taken by the government to reduce it. It discusses the impact of anaemia on maternal and fetal health, including the risks and consequences. The study also highlights the importance of education and awareness in preventing and managing anaemia. The research aims to provide insights and recommendations for improving the health outcomes of pregnant women in India.

Dissertation

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................3
Background of the study..............................................................................................................4
Aims and Objectives....................................................................................................................5
Research questions.......................................................................................................................5
Rationale of the study..................................................................................................................5
Scope of the study........................................................................................................................5
Limitation of the study.................................................................................................................6
LITERATURE REVIEW................................................................................................................6
Theme 1: Causing factors of Anaemia among pregnant women.................................................6
Theme 2: Prevalence rate of Anaemia among pregnant women in India....................................1
Theme 3: Strategies or actions that have been taken by the government for reducing the rate of
Anemia.........................................................................................................................................4
REFERENCES................................................................................................................................8

INTRODUCTION
Anaemia is one of the main public problem that is affecting populations of both rich and
poor countries because of lack of access to healthcare and lack of having nutritional or healthy
food. Main cause of this problem is deficiency of iron. Other causes that this study will explain
are: blood loss, high rates of red blood cell destruction and lack of nutritional food. There are
some other factors such as: parasitic infection and malaria. People with anaemia experiences
some psychological symptoms such as: depression, irritability. It affects people surrounded them
mentally and physically as well. They have to better take care of their relatives and people,
affected with Anemia. In regard to India it is stated that around 50.4% of pregnant women got
affected with Iron deficiency or Anemia in the year of 2016 as per the NFHS. So, from this data
it can be said that India is the one who has high prevalence of iron deficiency anaemia and one of
the main reasons of it is poor or local vegetarian diet. It complicates pregnancy and also leads to
heart problems. It is also stated that around 30% of the total population is suffering from anaemia
and the rate of Anemia in pregnant women is high in India as compared to world prevalence. It is
also found that the majority of age group of women that are affected and are experiencing with
Anaemia is: 20-30 and it is stated that the prevalence rate of Anaemia among this age group of
people in India is: 72.09%. From routine clinical data of patients it is found that the rate of
anaemia among women found after the menarche period and due to this it can clearly be said that
the main cause is iron deficiency among women that happen after this period. On the other hand,
it is argued by some authors that causes of anaemia is junk food and having lack of nutritional
values of food.
In regard to region of rural India about prevalence rate of Anaemia it is found that it was
around 98%. Among this 41.76% were wild anaemic, 37.06% were moderate anaemic and
3.29% were very serious (Mishu and Deepak, 2016). Some factors have been found as why this
rate is too high in India among pregnant women. With detailed research or analysis it is found
that it is all because of socio demographic factors such as poor diet, kitchen smoke, beedi,
cigarette smoke, irregular iron folic acid tablet consumption etc. After identifying factors,
preventive measures can be taken. It can help in reducing the rate of this disease rate especially
in India among pregnant women because it is becoming the reason of mortality rate in pregnant
women.

Background of the study
Anaemia can be defined as a condition in which blood in human body does not have
enough healthy red blood cells. In this condition, red blood cells become less active as their
activity or main function of carrying oxygen capacity become insufficient. This capacity varies
by sex, attitude, age, smoking habits and period of pregnancy. Anaemia leads to intrauterine
growth and it is found that treatments can help in decreasing this rate and increasing
haemoglobin but it cannot be cured. This present study is going to discuss all main factors that
lead or become reasons of anaemia in pregnant women. It is important for researcher to know
about all causing factors for taking better actions or measures. On the basis of factors only,
prevalence rate of anaemia can be reduced. It will further also discuss some actions that
government of India has taken yet for preventing this situation and reducing this rate.
Some strategies or actions it will discuss that government of India can now take for better
prevention as well as reducing mortality rate of pregnant women that major happens because of
iron deficiency. The main reason of increasing rate of this disease in India is socio-economic
status as well as indigent access to health care as India is developing country and this rate is high
in developing countries (Surekha and et.al., 2020). Some problems have also been found that
anaemic people face or experiences such as: heart palpitations, tiredness and problems in
breathing. Women of reproductive age and pregnant women are measured at high risk of
developing anaemia. This higher risk among pregnant women is too risky because it is associated
or become the reason of child morbidity and mortality. It increases risks of stillbirth, miscarriage
as well as low weight of the baby. This study will also show importance or effectiveness of
elements of research methodology. Some elements that this study will discuss are: inclusion and
exclusion criteria of the study, strategy selection and others. The main reason of adding or
discussing all these elements is to make better decision and accomplish aim of conducting study.
The aim of this study is to discover or research about prevalence of anaemia in pregnant women
or identifying strategies for reducing them. By conducting research and gathering information,
main aim can be accomplished and it can be done with research and performing steps of research
methodology. Some authors argued and stated some other strategies by which condition of
anaemia can be reduced to the great extent. The main strategy or way is healthy food that
contains protein and can help in increase haemoglobin.

Aims and Objectives
Aim
“The main aim of this research study is to identify prevalence of Anaemia in
pregnant women of India”.
Objectives
 To identify risk factors that has been reported and are associated with Anaemia or caused
this disease among pregnant women.
 To explore data that show prevalence rate of Anaemia in pregnant women of India.
 To evaluate strategies or actions that have been taken by the government for reducing the
rate of Anaemia.
Research questions
11 What are some causing factors of Anemia among pregnent women?11 What is the prevalence rate of Anaemia among pregnent women in India?11 What actions have been taken by the Government of India of reducing the rate of Anemia
in pregnant women?
Rationale of the study
Pregnant women are suffering the most with anaemia and it is affecting them mentally
and physically. Anaemia in pregnant women is associated with low weight in child, stillbirth and
rate of mortality or morbidity. So, the main reason of conducting this research is to reduce
prevalence rate of anaemia by making people aware about it and suggesting them ways of
prevention. By conducting this study, several factors can be known that are associated with
anaemia in pregnant women. So, all these factors can help in improving overall health of women.
This study will help in knowing about actions or strategies that have been taken by the
government of India for reducing this rate. On the basis of factors and reasons, changes can be
made in strategies so, it is other reason of conducting this study. With the help of gathered data,
changes can be made that can help in accomplishing goal of reducing prevalence rate of anaemia
in pregnant women.
Scope of the study
Selected topic is related to public health issue so, it has wide scope. This topic can help
public in knowing more about increasing rate of anaemia and problems that it is creating. IT can
help them out in knowing factors or preventive measure with that they can protect themselves

against this. It is beneficial for pregnant women to the great extent because they can decrease
mortality rate by knowing appropriate measures of reducing anaemic condition.
This study is beneficial for care providers also because it can help them out in providing
better treatments to patients as per the causing factor. People can also cooperate them if they area
aware and know about consequences of this situation. When people have more knowledge about
diseases and their consequences then they take care of themselves and also support care
providers. Government can also improve quality of life by knowing limitations of its strategies
that it has already developed for reducing the rate of prevalence of anaemia. By knowing factors
and reasons of these problems, changes can be made accordingly. If this mortality rate decreases
because of decreasing rate of anaemia, then it can improve economic condition as well. So,
overall it can be said that this research topic has wide scope that can be beneficial at all levels
and for all.
Limitation of the study
Conducting research on large scale on main public health is not an easy task. For
accomplishing goals and taking better decision, there is requirement of accurate and authenticate
data or facts. For this, researcher require using appropriate tools, adequate human resources,
financial tools, resources and skills. So, the main limitation of this study was: Lack of technical
staff or tools. Limited financial resources was other main limitation. Other main barriers that
may occur in the future while conducting this research are: climate change, changes in political
situations and others. Due to situation of Covid-19 it was not possible to conduct questionnaire
or survey. So, secondary data was collected with the help of appropriate sources or books and
journals where, data have been published. All these factors that may occur in the future can
create several problems or barrier in the path of successful implementation.
LITERATURE REVIEW
Theme 1: Causing factors of Anaemia among pregnant women
Before discussing factors it is important to know risks that are associated with anaemia in
pregnant women and in this regard it is found that it increases maternal or fatal issues. As per the
Yokoi and Konomi, (2017) main causing factor that is associated with anaemia in pregnant
women is: iron deficiency due to poor diet. It is also stated that due to changing lifestyle,
pregnant women in India do not give priority to pregnancy as like women of other developed
countries. They view this phase as a normal. Most of the women of India are engaging

themselves in different works and also in household chores. It makes them busy throughout the
day, but they do not take care of their health. So, it is the main reason of increasing rate of
anaemia in India among pregnant women. It is important for pregnant women to take extra care
and have nutritional value of food because at the time of delivery they have to bear pain and loss
of blood. So, they require haemoglobin level more than normal or non-pregnant women. So, it
can be said that if they take care of themselves and have food that are enriched in iron, protein
and vitamin then it can reduce prevalence rate of Anaemia in pregnant women. Alaofè and et.al.,
(2017) argued to this view and said that according to them, the main reason of increasing
prevalence rate of Anaemia in India among pregnant women is lack of education. India is still
considered and comes under the list of developing countries. So, it is the reason, women of this
country are not educated as like women of other developed countries. Many people of region of
India are not aware about all problems and consequences of anaemia. Due to lack of education
and awareness they cannot understand that how critical is this disease. They do not know that
around 150-200 mg are lost in the blood loss at the time of delivery and same amount is
expended in lactation. So, as per this, there is total demand of iron in pregnancy is around 900
mg. Out of this 500-600 mg is accounted by the uterus and its contents. It is also found from
survey that was being developed after launching Test Treat Talk anaemia camp in the year of
2018 that many of the people are not aware about consequences of low level of haemoglobin.
They even did not know about their own haemoglobin level. These camps made them able and
actions were being taken accordingly and it helped many of the people in increasing
haemoglobin level within 1-2 months. So, on this basis it can be said that lack of education and
lack of awareness is the main reason of increasing rate of anaemia in pregnant women of India.
So, it is important to take better actions and developing programs that can make people of India
aware about anaemia and they can protect themselves against this disease.
Nonterah and et.al., (2019) study is being conducted in which pregnant women were
taken as a target people. The majority of anaemia was among pregnant women of age group of
26-30 years. So, as per this age group they said that it may be because of poor birth spacing and
recurrent pregnancies in reproductive age women. It makes them more prone to this condition.
Other main thing that was noted: majority of anaemic women were rural population. So, as per
this thing it can be said that the other main cause of this situation in India among pregnant
women is: lack of access or inaccessibility of healthcare centres. Ravishankar and et.al.,

(2017).said in the context of anaemia that maternal anaemia is the main risk factor that leads to
poor pregnancy and post pregnancy problems. It puts life of fetus or infants in danger. As per the
available data from India it is also known that this anaemic health problem in pregnant women
becomes the reason of morbidity rates. This increasing rate affect society and people surrounded
them in all manners. Women and rural population of India do not have easy access to healthcare
so, they do not visit hospitals often. It is also found that they have to wait for 3-4 days for taking
their haemoglobin test reports and also they have to wait in big queue for getting their test of
haemoglobin done. So, because of this reason they do not got ans visit hospitals. It is the reason
many of the people do not have knowledge about anaemia and their own haemoglobin level.
Singal and et.al., (2018) also said in this context that as compared to developing countries,
developed countries have less prevalence rate of anaemia among pregnant women. So, from this
statement it can clearly be said that reason behind it is lack of awareness and education. Rural
population are orthodox and they have categorized works for girls and boys. As per their rules,
girls are not allowed to go for higher studies and go school for educating themselves. They are
asked for doing household chores and it is the reason women of rural population are not educated
as like women of developed countries. Society curse women for anything that happens and cause
negative to them. So, as per this data it can be said that Government of India need to mainly
focus on education for girls. It should give access to education in free of cost and by developing
some awareness programs, parents of girls can also be engaged and encouraged for letting their
girls child go to school.
Hailu and et.al., (2019) stated several other causing and risk factors of anaemia among
pregnant women. Some reasons or factors that are associated with anaemia among pregnant
women of India are: frequent vomiting in morning sickness, heavy pre-pregnancy menstrual
flow. Heavy menstrual flow becomes the main reason of anaemia because during menstrual
cycle loss of blood happen to the great extent. They stated some symptoms of iron deficiency
anaemia during pregnancy such as: weakness, fatigue, chest pain, dizziness, cold hands,
headache and irregular heartbeats. They also stated some risks and problems that pregnant
women may have to face such as: post-partum depression, a baby with anaemia and baby with
development delays. So, it can be said that problems are not limited to during pregnancy as it
creates problems to women after pregnancy as well. Vindhya and et.al., (2019) argued and said
that sometimes because of deficiency of vitamin, women suffers and face problems of anaemia.

People needs folate and vitamin B-12 for producing healthy red blood cells. So, if foods that do
not contain all these nutrients can also lead to anaemia because of decreased red blood cells
production. In this context it is also found that people who consume enough B-12 are less likely
to absorb the vitamin. It causes vitamin deficiency anaemia that is also known as pernicious
anaemia.
Nakade and et.al., (2020) stated some other factors along with deficiency of iron such as:
bone marrow disease. Some diseases such as: Myelofibrosis and leukemia. Both these diseases
affect blood production in bone marrow. And it is already stated that when blood production gets
affected then it causes to anaemia. It is also found that these types of diseases or cancer vary
from mild to life threatening. During pregnancy body of women produces more blood because of
supporting the growth and development of child. So, if women do not get enough nutrients and
iron then their body finds difficulties in producing blood. It leads to anaemia. It is also stated that
having mild anaemia in pregnancy is normal but severe anaemia because of lack of iron and
nutritional values in body, they have to face several problems and it affects development and
growth of child. Women with severe anaemia often experience tired and weak. They find
problems in performing their daily routine activities. It is also stated that women who have
anaemia and do not take proper medications and treatments then it increases risk of serious
complications such as: preterm delivery.
So, overall it can be said that iron deficiency and lack of red blood cell production is the
main reason behind anaemia in India among pregnant women. One of the main reasons of
identifying all these causing factors is to take better decisions and developing strategies
accordingly. On the basis of risk or causing factors of anaemia among pregnant women in India,
some strategies and programs have already being developed. Improvements and gaps of failure
of strategies can be filled. Along with iron deficiency it is found that lack of healthcare access to
rural demographic in India is also other main cause. So, as per this factor, several hospitals
nearby rural areas have been opened. Women and people of this areas are being encouraged to
get their tests done. So, it can be said that all these strategies that have been developed are under
process can decrease prevalence rate of anaemia among pregnant women in India.

Theme 2: Prevalence rate of Anaemia among pregnant women in India
According to Siddiqui and et.al., (2017) a good percentage of foetal or maternal
complications are caused due to greater prevalence of anaemia during pregnancy. It imposes
several other health challenges for the women such as decrease tolerance to bleeding after child
birth, increased risk of infections and intra uterine growth restriction along with the lower child
mortality. One of the most significant cause of anaemia is iron deficiency. During pregnancy the
demand of iron is high for promoting placenta and foetus growth. In many Asian countries such
as India inadequate supply of iron to during pregnancy result in causing anaemia. In the similar
context (Mangla and Singla, (2016) stated that some of social norms such as child bearing at
early age, poor supplementation, short intervals in pregnancy and lack of emphasis on women
health are also responsible for increased rate of Anaemia. Indian women and families tend to pay
less attention to the health needs of women and thus iron deficiency is common.
Higher prevalence rate can be seen in rural India as compare to urban areas. There are
multiple drivers which are responsible for causing higher rate of anaemia during pregnancy. As
per the results of study conducted by Nguyen and et.al., (2018) anaemia rate is high in pregnant
women and children as compare to non-pregnant women of reproductive age. These changes
can be easily traced by the haemoglobin level (Hb level). As per the results of study when
nutrition and health care facilities are improved due to change in social and economic factor then
it affected the Hb level positively and among pregnant women nearly 17% improvement was
observed.
According to Rajamouli and et.al., (2016) nearly 20% of the total maternal deaths in
India are primarily due to Anaemia. The study results also stated that more than 55% of
pregnant women had anaemia from mild to several range. Though results also showed that this
higher prevalence of anaemia in India is contribution of several factors such as age of mother,
dietary habits, social and economic background, family structure and education level. Such
higher percentage of anaemia among pregnant women demands for strict program for Nutrition
Anaemia prophylaxis at national level. Vindhya and et.al., (2019) stated that lack of proper
supplements and nutrition’s are key drivers of causing anaemia but Indian society is considered
to have lot of diversity in its states in terms of education, religious practices, sanitation, fist and
meat consumption.

(Figure 1: Prevalence of anaemia among pregnant women (%) in India)
(Source: World Health Organization, Global Health Observatory Data Repository/World Health
Statistics, 2021 )
In the similar context Rajamouli and et.al., (2016) elucidated that in Indian pregnant
women prevalence rate of anaemia was 33 to 89% in year 2015-2016. One of the significant
findings from the literature is that in India illiterate pregnant women had higher percentage of
anaemia prevalence (46.4%) as compare to women who had graduation or school level
education. Contrary to this Kumar and et.al., (2019) argued that one of the most contradictory
finding in the related studies is that as compare to working class women, housewives had high
prevalence (96.8%). This gives a crucial finding that the women who are working at home tend
to pay less attention to their health requirements. Even during pregnancy working women tend to
manage their nutritional needs but a very limited focus is paid by the housewives.

Figure 2: Prevalence of anaemia among Indian women
(Source: Rajamouli and et.al., 2016 )
As per the view of Mangla and Singla, (2016) women who have daily intake of iron
supplementations have less likelihood of getting anaemia. It has been also analysed by the author
that in Indian societies traditions and religious aspects also play crucial role in the practices and
health beliefs of individuals particularly in maternity phase. For instance, meat is considered to
be great source of supplying zinc, iron and other essential proteins and vitamins. However, in
some sections of India women are not allowed to intake meat or other non-vegetarian products
due to religious aspects or due to old beliefs that women are not supposed to have such healthy
food. This is one of the most obvious reason as well that pregnant women in rural India are more
vulnerable to iron or blood deficiency.
Similarly, Nguyen and et.al., (2018) presented views in a study that among all
forms maternal anaemia is considered to be high probability and severity. Though for pregnant
women supplementation services for iron and folic acid are available under National health
initiatives but still several other risk factors increase the risk and prevalence factor for pregnant
women. As compare to the other developed countries women in India are still having limited
access to health care services due to more emphasis on household services or tendency to pay
less attention to own health. It has been also observed that conceiving at young age and repetitive
pregnancies without adequate gaps between the children also causes women to become

vulnerable to anaemia as compare to the women group who are in reproductive age group but are
not pregnant. As per the view of Vindhya and et.al., (2019) anaemia has various causes such as
menstruation caused heavy bleeding, lack of rich iron diet and pregnancy itself. During
pregnancy iron produced within body is used for enhancing blood volume so that foetus growth
can be stimulated. Thus it can cause deficiency of iron and supplements are needed to ensure the
adequate blood and iron supply. In pregnancy plasma volume is also increased which can cause
reduction in haemoglobin levels and thus pregnant women have more prevalence rate as compare
to the other women group. Hence it is very essential that all the above discussed factors must be
taken into consideration so that high prevalence rate can be controlled and maternity related
deaths can be reduced. The key drivers which are affecting anaemia rates must be identified and
addressed so that during pregnancy both mother and child can be delivered safe health care
services.
Theme 3: Strategies or actions that have been taken by the government for reducing the rate of
Anemia
In regard to preventive measures, it is stated that India has become the first developing
country to take up the National nutritional Anaemia control programme. It helps them out in
preventing many pregnant women against getting affected with this main anaemia health issue.
According to the Swagata, (2019) It is being recommended by the Government of India that
women should consume 100mg+500 ug of folic acid for prophylactic supplementation for
minimum of 100 days. So, it can be said that Anaemia Mukt Bharat program that had been
developed by the government of India reduced prevalence rate of Anaemia among pregnant
women to the great extent. It is also found that when the National Anaemia prophylaxis program
was being launched then the main focus was on distributing folic acid and iron tablets to all
pregnant women as well as children under the age of 5 of India. In the year of 2013, the
government of India launched the weekly IFA supplementation program for adolescent. The
main reason was protecting girls against anaemic in pregnancy. But due to lack of awareness and
education, it is found that among and the rate of taking IFA supplements was too less. Only
3women in every 10 pregnant women of India took IFA tablets for around 100 days of
pregnancy. There were some other reasons also being identified as why only 3 women were
taking these tablets and one of the main reasons was inadequate and disparity in supply and

distribution of IFA tablets. From survey it is also found that women in reproductive age are more
likely to suffer from this disease and around 53% women of the age of 18-25 found anaemic.
Among this around 50% of anaemia is only because of iron deficiency.
Williams and et.al., (2020) said that anaemia is a critical condition as it affects physical
growth, cognitive development as well as behaviour. It also weakens immunity in all age group
of people because our body require proper nutrition and supply of blood and haemoglobin for
proper functioning. It is also stated in the regard to Anaemia Mukt Bharat program that it
focused on filling the gap of previous failed approaches. Along with Poshan Abhiyan in the year
of 2019, Anaemia Mukt Bharat and the National nutritional mission was to decrease prevalence
rate of Anaemia by 3% per year among women of reproductive age, pregnant women and
children. Strategy under this program is mainly focusing on 6 areas and factors and that is why it
is named 6X6X6. It is all about 6 interventions, 6 groups of beneficiaries and 6 institutional
mechanism. 6 beneficiaries are: adolescent boys and girls of the age group of 15-19 years,
pregnant and lactating women, children below 5 years and women in reproductive age 15-49.
Some important institutional mechanism are: anaemia control unit, centre for excellence and
others. Intervention of this strategy include: change communication campaign, treatment of
anaemia by making use of digital methods and others. Kumar, Sharma and Patel, (2021) also
stated in the regard of effectiveness of all strategies and actions that have been taken by the
government of India is: Making IFA supplements available across the state for reducing
prevalence rate. From analysis and results it was found that reducing rate of anaemia in pregnant
women was only 1% point per year because of less coverage of supplements. There is data
available related to anaemia on Anaemia Mukt Bharat dashboard and on the basis of this data,
improvements and actions are being taken.
Nguyen and et.al., (2018) argued and sates that above discussed campaign and program
was developed years ago and it did not reduce prevalence rate to the great extent. So, for better
improvement, Government of the India launched The Test Treat Talk anaemia camp. This
strategy was being developed for generating demand and mobilising people. The main
effectiveness of this camp was to use digital hemoglobinometre to test for anaemia, giving IFA
tablets for treating and counselling beneficiaries on lifestyle measures. The overall aim of using
all in this camp was increasing iron levels in human body as well as on food rich in vitamin C
and protein. In the year of 2018, around 900 camps were conducted and these camps got

successful by reaching 100,000 people. Number of camps were increase to the great extent and
within 1 year around 1,96,000 camps were held and they reached 16.5 million people. T3 camps
were expected to held in all governmental bodies such as: schools, colleges and institutions
across India.
In addition, for supporting view of author, Patel and et.al., (2018) said that many of the
people were not aware about their own haemoglobin level and consequences of anaemia. This
strategy and camps made them able to know about their haemoglobin level and take actions
accordingly. With the help of digital hemoglobinometre, patients get their haemoglobin result at
that time they do not have to wait for 2-3 days. After the development of this strategy it is found
that 9 in 10 pregnant women are receiving IFA supplementation on regular basis and it is
improving their haemoglobin level. There are some factors have been identified that have
become the reason of failure of some of strategies, developed by the government of India. One of
the main limitations is poor financial planning as it lead to poor IFA coverage. So, after
identifying this limitation, government of India is now focusing on some activities such as
research, warehouse logistic, human resource requirement and innovation for the intensified
initiative. It is also stated that there is requirement of only 36% of budget for covering 100%
coverage of IFA supplementation. So, around 2,087 crore will be required to reach 407 million
beneficiaries. Till now only 742 crore have been proposed and 574 was allocated.
Shet and et.al., (2019) said that now for protecting women against complications, happen
because of iron deficiency, iron intravenously is being administered to pregnant women with
anaemia. In this regard it is found that 50 pregnant or lactating women receive iron sucrose at
Ballabhgarh hospital. Since 2014, this hospital has administered around 20,000 infusion and for
making sure efficacy and safety, report and evidences are being shown. It is also stated that this
practice and strategy helped pregnant women and increased haemoglobin level since this hospital
started administering iron sucrose. It means pregnant women has now at lower risk of
haemorrhage and also need less blood transfusion. In addition, it is also found that government
of India has developed educational counselling programs and with this program it is making all
people aware about anaemia disease and way of protecting against it. In survey it is found that
girls of Delhi increased consumption of IFA. They also said that they feel energetic and active
after receiving educational interventions, delivered in schools. So, overall it can be said that the
government of India has developed several effective program and interventions for reducing

prevalence rate of anaemia among pregnant women. Still it is focusing on improving health of
pregnant women by providing IFA supplements and by making sure that they are taking proper
treatment and medication on regular basis or not.
According to Yokoi and Konomi, (2017) comprehensive actions are required throughout
the life cycle for eliminating anaemia among pregnant women. The health care authorities and
responsible officials have set minimum standards so that facility based management of the
disease can be promoted and improved level of care can be provided to anaemia suffering
women. Service quality and anaemia severity can also be reduced by improving the identification
of suitable platforms of good health care services. The national control and prevention guidelines
are not only focusing on pregnant women but also on individuals of all age groups so that at all
stages of life it can be prevented and pregnancy related complications due to anaemia can be
reduced. In the same context Nakade and et.al., (2020) stated that approach of Indian health
ministry to distribute IFA tablets on all community and primary health centres and district
hospitals is good effort to overcome the economic barriers.
Many women in rural areas of India are not able to access the supplements regularly due
to lack of accessible health care facilities or poverty. Thus for pregnant women who are not able
to approach hospitals regularly IFA supplements are distributed by health care authorities at their
home visit. In the similar context Nonterah and et.al., (2019) also elucidated that anaemia
prevention programs in India cannot deliver required output until community engagement and
education is not initiated. Most of the families in India are not aware and concern about the
health and nutritional needs or iron deficiency. Thus women of all age groups must be educated
about the nutritional needs and importance of iron supplements during, before and after
pregnancy. In order to make control programs more efficient along with the women other family
members must also be included and informed about the prevention and control measures for
anaemia.
As per the view of Measures to Reduce Anaemia in Women, (2016) anaemia can be
considered as multi factorial disorder which demands for multi-pronged intervention strategy. It
has been also observed that many women do not pay attention to their nutritional needs which
enhances the risk of anaemia. For addressing this issue it is very important that necessary
nutritional and health education must be given from school level only. Among pregnant women
dietary diversification and iron or folate rich foot items are encouraged so that iron absorption

and be increased and anaemia can be prevented. Indian health care system is also effectively
using information technology to address the challenges of anaemia. Health management IT
system has been implemented at health care centres so that child and mother can be tracked and
anaemic pregnant women with severity can be tracked and treated. For creating awareness in
community and pregnant women safe motherhood booklet and MCP cards are also distributed
which promotes the dietary diversification and related knowledge in the community.
Contrary to this Bahri, (2017) argued that despite several programs and anaemia
prevention strategies still percentage of anaemia pregnant women is quite high in India. The key
reason for this failure is that still a major proportion of intended beneficiaries are not able to
access the supplements. However, the national iron plus programs aims at improving the
situation for not only pregnant women but also for children and reproductive age women who
suffer from the condition. It has been also witnessed by health professionals that due to lack of
monitoring or awareness even if supplements are reachable women tend to avoid their
consumption. Thus along with the active initiatives there is also a need for ensuring that they are
consumed by beneficiaries. It is also required that if women suffer from any kind of adverse
impact such as nausea or dark stools then instead of discontinuing the treatment they must seek
consultation from the health professionals.
According to Alaofè and et.al., (2017) another strategy which can be used by
professionals for anaemia control is to encourage changes in social norms and beliefs in Indian
society. For instance, in many rural and economic backward family’s pregnant women tend to
take meal only after rest of the family members have finished. This sometime result in
insufficient consumption of the food. Thus there is need to bring changes in such practices so
that women can also emphasis on their health and dietary requirements and maternal anaemia
can be reduced. Also regular check-ups must be done so that severity of the disease can be
controlled and identified.
RESEARCH METHODOLOGY
Research type
Research type can be defined as the framework to manage and apply the ways to collect,
analyse and apply the research data for achieving research objectives. Research studies can be
classified as qualitative and quantitative type. Qualitative research studies enhance the in depth

opinion and perspective of individuals following a theoretical approach. On the other hand,
quantitative research is carried by statistical analysis and thus ideas are reflected by measured
values (Newman and Gough, 2020). Quantitative approach tends to provide more accuracy and
impartiality to the research by its improved reliability. However qualitative type of research is
very narrow and are able to provide limited answer for the research questions.
On the other hand, qualitative research studies are helpful in providing more flexible and
in depth discussion. As a result of this; due to qualitative approach researcher is able to analyse
the feelings and particular behaviour of individual with more accuracy and flexibility.
Quantitative research is not preferred in this study because such kind of research depends upon
numerical response and thus it lacks context of behaviour or thought process causing certain
action. Further as compare to the qualitative studies; quantitative research studies show greater
variation from the real findings. In this study qualitative research type is used because as
compare to quantitative approach it is more flexible and allow greater discussion of the research
topic by exploring behaviour of target audience. Another benefit of using qualitative type of
study is that instead of confirming to previous beliefs it helps in discovering actual perception
and motivation behind any particular behaviour.
Data collection
Data collection plays a crucial role in affecting the study results. Data collection techniques
are mainly of two types: primary and secondary. In primary data collection methods such as
interviews, survey questions and questionnaire methods researchers used to collect data directly
from data sources. Existing sources are not used for the data collection purpose. Primary data
collection also provides proprietary rights to researcher as no other individual or organisation can
access to the result or data without permission of researcher. Though primary data collection is
authentic and reliable but it involves higher implementation cost and time (Iovino and Tsitsianis,
2020). Further in some studies shows less feasibility due to complexity of the research topic. On
the other hands secondary data is existing research work which is available to other users for
study or analysis purpose.
One of the key advantage of using secondary data collection method is that this type of
data is less time consuming, cost effective and easily accessible. The most common approach of
secondary data collection is systematic review. In this data collection methodology predefined
eligibility criteria are used so that good and relevant studies are included and analysed. Among

several benefits of secondary data collection key benefit is that secondary analysis generate new
ideas and insights on the basis of previous findings and thus strengthening the key concepts.
Further as compare to costly and huge primary studies large sample size can easily analysed
using secondary data.
In this research project secondary data is collected through systematic literature review in
which existing data is identified and summarised to achieve research objectives. The key benefit
of using systematic review is that it eliminates the biasing in selection of studies so that a fair
review of data can be conducted. Also the transparent nature and effective search strategy of
systematic review is helpful in improving the replicability of the research.
Data analysis
Data analysis is known as the methodology to transform, model and process the collected
data so that related decisions can be taken. Data analysis techniques involve thematic and
statistical approach. For analysis of quantitative data statistical tools such as SPSS are used. In
statistical analysis techniques realistic data can be obtained. Such type of data can be used to
measure performance or the real word trend however with statistical analysis there are higher
chances of misinterpretations (Daniel and Harland, 2017). The data can be used only to draw the
correlation or fixed pattern instead of validating the actual cause or process of research. Another
drawback of using statistical data analysis is that its finding is very narrow and does not allow
researcher to conduct an in depth analysis of the utilised data.
Research approach (300)
Search strategy (300)
Inclusion and exclusion criteria (300)
Screening (300)
Data extraction (300)
Quantity appraisal (300)
Ethical Consideration (300)

REFERENCES
Books and Journals
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