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Slide Speaker’s Notes
1  Good afternoon
 My presentation today is going to be on the topic- “Pregnancy Anaemia in
India”.
 The main motivation of mine behind the chosen topic is that despite of the
existence of a range of policies and programs, anaemia in pregnant women
is still a serious concern for India (Nair et al., 2016).
 My main aim behind this is examining the existence and factors of anaemia
among the pregnant and the non-pregnant women.
2 The main aim of my presentation are to
 Describe about Pregnancy Anaemia with special focus on India
 Estimating the existence of Anaemia among the pregnant women of India.
 Interpret the needs by means of using epidemiological quantitative and
qualitative.
 Assessing the signs and symptoms of anaemia in pregnant and lactic
women.
 Evaluate the prevalence of the anaemia for identifying the rates of mortality
and morbidity.
 Listing down strategies for reducing inequalities and ensuring that mothers
live longer and healthier with their babies.
 Evaluating actions that are specific to nation, state and community level
 Evaluating the intervention
3  Pregnancy Anaemia among women and lacting women is when the blood
of pregnant woman does not have enough healthy RBC (Red Blood Cells)
for carrying the oxygen to her tissues and to her baby (Natale &
Rajagopalan, 2014).
 The main causes of pregnancy anaemia are Premature birth, Cardiac failure
of the mother, Abruption, Maternal deaths, Stillbirths of babies,
Preeclampsia, reduces the tolerating power of bleeding during the child
birth, Uterine atony, infections, behavioural abnormalities, Adult onset
HTN, Low birthweight and Cognitive dysfunction (World Health
Organisation, 2016).
 It further aids to the reduction in the tolerance level of women during and
after the child birth.
 Among the pregnant women, the levels lower than 11.0 g/dl (Haemoglobin)
signifies anemia. It is called 1st trimester.
 Levels below 10.5 g/dl are 2nd trimester and levels below 8 g/dl are 3rd
trimester (Tabrizi & Barjasteh, 2015).
 Levels in between 4 to 7 is severe and below that range is very severe
 The pregnant women in their first trimester have lower risk of being
anaemic than the lactating mothers
4  In the period between 1995 and 2011, pregnancy anaemia was the leading
cause of about 68.4 million years of deaths and disability (YLD) among
women globally (Siddiqui et al., 2017).
 It results in adverse effects on both the child and maternal health outcomes
right from low birth weight, Preeclampsia, cognitive dysfunction, neonatal,
maternal mortality etc.
 IDA in pregnancy is readily manageable but is still an unmet health

demand.
 Implementation of preventive and therapeutic actions is lacking in India.
5  The main cause of pregnancy anaemia includes the nutritional anaemia,
which is the result of B12 deficiency, Folate deficiency and most
importantly, the Iron deficiency (Anand et al., 2014).
 Second are the Haematological conditions like sickle cell disease,
Leukemia and Thalasaemia.
 Infections like HIV and malaria can also be the cause of pregnancy anaemia
 Chronic blood loss due to Haemorroids and GI bleeding can cause
pregnancy anaemia
 Short-birth intervals too can contribute to the same.
6  The data of NFHS suggests that about 50.4% of pregnant women were
found to be Anaemic in the year 2016 in India.
 In India, about 20% of the total maternal deaths are because of Anemia
(Anand et al., 2014).
 80% of the maternal death due to pregnancy anaemia (Chowdhury, Rahman
& Moniruddin, 2014).
7-9 The distribution of anaemia in India can be classified into three groups:
 Age, Education and occupation
 Parity
 Vegetarian and mixed diet
 The table of distribution of anaemia in terms of age, education and occupation
suggests that anaemia among the age group of 20 to 29 years were in total 72%
(mild 28.0%, moderate- 36.8% severe 6.9%). In terms of education, many
going through the same were illiterates in comparison to the other levels of
education, less in primary school (23. 6 %), secondary school (19.2%) and
graduates (10.8%).
 The table of distribution of anaemia in terms of parity shows higher prevalence
of anaemia among the second gravid and 25.7% 2nd trimester pregnant women.
 The table of distribution of anaemia in terms of vegetarian and mixed diet
demonstrate that dietary habits have affected anaemia. Vegetarian groups were
of maximum with anaemia compared to the mixed dietary habits (Rajamouli et
al., 2016).
10  It is to mention that the vicious cycle of anaemia among Indian women begins
right from their first year of birth. They often grow up lacking access and
consumption of iron-rich food due to poverty and this ultimately results in
malnutrition.
 Furthermore, they face gender bias in education and very poor spacing while
growing up as there is an average of 3 children in majority of the Indian
families.
 Also, often in India, girl children are married early. The cases of early
marriages are still prevalent in many parts of the country and as a result they
become pregnant early and turn in anaemic mothers who give birth to anaemic
babies.
11. According to the displayed map, it is clear that the prevalence of pregnancy
anaemia is:
 Highest and severe in majority states of India including Mumbai,
Hyderabad, Bangalore, Karnataka, Kochi, Kolkata, Jaipur, Amritsar,

Chennai, Panaji etc. In these states the prevalence of anaemia is more than
60% (Kaur, 2014).
 It is high in Imphal with 40 to 59.9%.
 It is low in Assam, Meghalaya and Arunachal Pradesh areas with 20 to
39.9%
 It is lowest in Uttarakhand with less than 20%
However, there is no data available for the other parts.
12  The prevalence of anaemia also differs considerably by one country to other.
 It is based on population characteristics such as- “age, sex, socioeconomic
status and biodemographic factors such as pregnancy and lactation”.
 The burden of anaemia is unevenly distributed in among different countries
(Melku et al., 2014).
 It is quite severe in Africa, North America and some parts of Asia, especially
India.
 It is moderate in Asia, Europe and is very mild in North American countries.
13  ANFHS-3 survey was conducted in the year 2005 and 2006 nationwide. A
representative sample survey of about 109,041 households, 124,385 women in
the age group 15-49 years were conducted. It was the only Indian survey that
collected a comprehensive nutrition data with representative samples from all
29 Indian states. The samples of pregnant (n = 5,911), lactating (n = 21,973)
and NP-NL (n = 97,418) women are adequate to carry out the robust statistical
analysis.
14 Certain strategies are proposed for decreasing the death rates due to pregnancy
anaemia. They are mentioned here:
 Managing the iron deficiency in the mother right from the very beginning
of pregnancy.
 Iron supplements to be given by mouth or parental route as intravenous and
intramascular injections.
 Helplines and online help
 Awareness Schemes (Policy Making)
 Care homes
 Work places
 Colleges and Universities
 Primary care physician practice
 Community centres
15  1970 National Nutritional Anaemia Prophylaxis Programme (NNAPP) was
initiated for reducing the rate of anaemia to 25% (Khan, Srivastav & Dixit,
2014).
 Daily dose of elemental iron for prophylaxis and therapy are increased to
150 to 200mg under the Child Survival and Safe Motherhood (CSSM)
Program.
 Under Anemia Prevention and Control Program of Indian Government,
folic acid and iron tablets are distributed to the pregnant women and lacting
women.
 Under Weekly Iron Folic Acid Supplementation (WIFS) programme, folic
acid supplements are distributed (Dhikale et al., 2015)
 However, government must target the disadvantageous areas and social

groups where the buying power, knowledge, and access to health care
facilities are minimal.
16  It is necessary to work around the suggestive measures taking place from
the study.
 Strengthening and monitoring the prevailing programs (e.g., 1970 National
Nutritional Anaemia Prophylaxis Programme (NNAPP), Child Survival and
Safe Motherhood (CSSM) Programe, Anemia Prevention and Control
Program, Weekly Iron Folic Acid Supplementation (WIFS) programme is
important to manage and monitor the improvement
 Promotion of awareness and health related knowledge among women about
nutrition is likely to decrease the negative outcome.
17 For the implemented programs there has been some significant improvements seen
and they are:
 Increasing functionality of the immunisation centres in different parts of
India (especially Rural)
 Continuous monitoring and tracking the improvements and reports from the
public health professionals for collecting the updated data.
 Reduce in the percentage of pregnant women in India who are anaemic
from 58% in 1990 to 50% in 2016 as per the data provided by (Kassebaum
et al., 2014).
 The findings give a message that program interventions are ineffective for
bringing them out of vicious cycle of anaemia.
18 Hence, from the analysis it is to be concluded that:
 The existence of pregnancy Anaemia is highest in India
 It affects about 2/3rd of the total pregnant women in India and aids to
maternal mortality and low birth-weight.
 Nutritional Anaemia (iron deficiency) is the major common cause of this
disease.
 With the proposed strategies, there is likely to be reduction in the outbreak
of this disease.
 The health care policies need to remove the bottlenecks and restructure
existing interventions for taking into consideration the heterogeneous
groups of women and their specific nutritional needs.
References:
Anand, T., Rahi, M., Sharma, P., & Ingle, G. K. (2014). Issues in prevention of iron
deficiency anemia in India. Nutrition, 30(7-8), 764-770.

Chowdhury, S., Rahman, M., & Moniruddin, A. B. M. (2014). Anemia in
pregnancy. Medicine Today, 26(1), 49-52.
Dhikale, P., Suguna, E., Thamizharasi, A., & Dongre, A. R. (2015). Evaluation of weekly
iron and folic acid supplementation program for adolescents in rural Pondicherry,
India. Int J Med Sci Public Health, 4(10), 1360-1365.
Kassebaum, N. J., Jasrasaria, R., Naghavi, M., Wulf, S. K., Johns, N., Lozano, R., ... &
Flaxman, S. R. (2014). A systematic analysis of global anemia burden from 1990 to
2010. Blood, 123(5), 615-624.
Kaur, K. (2014). Anaemia ‘a silent killer’among women in India: Present scenario. European
Journal of Zoological Research, 3(1), 32-36.
Khan, M. S., Srivastav, A., & Dixit, A. K. (2014). The burden of anaemia amongst antenatal
women in the rural population of northern India. International Journal of Scientific
Study, 1(4), 40-42.
Melku, M., Addis, Z., Alem, M., & Enawgaw, B. (2014). Prevalence and predictors of
maternal anemia during pregnancy in Gondar, Northwest Ethiopia: an institutional
based cross-sectional study. Anemia, 2014.
Nair, M., Choudhury, M. K., Choudhury, S. S., Kakoty, S. D., Sarma, U. C., Webster, P., &
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Natale, V., & Rajagopalan, A. (2014). Worldwide variation in human growth and the World
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Siddiqui, M. Z., Goli, S., Reja, T., Doshi, R., Chakravorty, S., Tiwari, C., ... & Singh, D.
(2017). Prevalence of anemia and its determinants among pregnant, lactating, and
nonpregnant nonlactating women in India. Sage Open, 7(3), 2158244017725555.

Tabrizi, F. M., & Barjasteh, S. (2015). Maternal hemoglobin levels during pregnancy and
their association with birth weight of neonates. Iranian journal of pediatric
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World Health Organization. (2016). Guideline daily iron supplementation in infants and
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