India has the highest incidence of anaemia in the world which equates to fatigue and undernourishment in daily life and a handicapped country in the long-term. With the pandemic overburdening the health system, existing health programs have been halted inducing severe repercussions on individual lives and productivity. Neglected pregnancies during this crisis will also result in miscarriages and deaths which need to be prevented.
Anaemia: From health condition to creeping crisis
Anaemia is a decrease in the oxygen carrying capacity of blood, caused by a low level of red blood cells (RBCs) or lower levels of hemoglobin (Hb) concentration within RBCs. This causes reduced oxygen flow to the body’s organs. The most common cause of anaemia is iron-deficiency, which can be treated through regular consumption of iron-rich food or elemental iron supplementation.
53% of women in India suffer from anaemia and this statistic is unlikely to change in the foreseeable future. Even today women in Indian households are most likely to eat last in the entire family leaving them with smaller portions and less nutritious meals. Gender-based discrimination in meals, compounded over years, leads to girls being debilitatingly weak when they reach child-bearing age. Providing access to formal health systems where ill-effects of poor nutrition could be reversed is one major ways in which this can be addressed. But societal minimisation of women’s health concerns and restrictive norms governing women’s mobility outside their households results in limited engagement of women with health service providers.
Policy focus has therefore been on creating village-level platforms to increase service access. The locus of iron supplementation distribution for pregnant women in rural areas is the monthly Village Health Sanitation and Nutrition Day (VHSND) – a public event where frontline health workers (FLWs) engage with families. The VHSND is being restructured in light of physical distancing norms and expecting women and FLWs to focus on other health concerns at these events, while the sword of COVID-19 hangs over their heads, is imprudent. Meanwhile the Weekly Iron Folic Acid Supplementation program, which targets adolescents in order to break the intergenerational cycle of anaemia and ensure women hold optimal iron reserves before child-bearing, has also slowed down due to closures of schools and anganwadi centers.
To ensure women safely carry their pregnancy to term, there is a very short window of six months (second and third trimester) where interventions to detect and manage levels of anaemia are focused. Immutable cultural and religious beliefs around pregnancy-related medication and food consumption further confound these interventions. UNFPA estimates suggest almost 7 million unplanned pregnancies could occur in low and middle-income countries due to COVID-19 induced disruptions in contraceptive supply and health services. Service lags extend to both healthcare provisioning as well as the ability and resources of people to access the necessary quality of diet. Isolation from external channels of healthcare in the current environment is weakening the progress made till now for pregnant women and impacting the survival and future of their children.
Responding responsibly to the anaemia crisis
With the pandemic here to stay, we must persist in evolving conscious long-term practices that can prevent neglected public health emergencies from creating a vicious circle of exacerbation with the effects of COVID-19. Absence of a silver bullet cure for anaemia has till now produced fragmented policy approaches ignoring its gendered sociology, instead of using a coordinated lifecycle perspective. Anaemia is dismissed since there are no outward symptoms except for the fatigue and pain primarily suffered by women. However relegating pain as a woman’s load to carry has not prevented its irreversible impact on lifelong physical, financial and mental well-being of the nation.
Anaemia is dismissed since there are no outward symptoms except for the fatigue and pain primarily suffered by women. However relegating pain as a woman’s load to carry has not prevented its irreversible impact on lifelong physical, financial and mental well-being of the nation.
The invisible nature of anaemia has led to consistent neglect of an otherwise easily remediable public health problem. Increasing awareness and ability of women to recognise symptoms of their own discomfort should be now prioritised through responses that are visionary rather than reactionary. We have seen that reactionary responses such as the lockdown may flatten some curves but show an inverse correlation with other health and economic indicators, with unpredictable effects which morph over time. Individual attempts to educate and support those around us must not stop with the symptoms of COVID-19, but also enable marginalised groups like young women to demand equal treatment and access benefits of health programs.
The invisible nature of anaemia has led to consistent neglect of an otherwise easily remediable public health problem. Increasing awareness and ability of women to recognise symptoms of their own discomfort should be now prioritised through responses that are visionary rather than reactionary.
Vulnerable populations are being heavily impacted by the pandemic and both policy vision and individual efforts should be cognizant of the multitudinous ways in which access to a safe future can be denied to many. This will allow us to rebuild lives and livelihoods in an inclusive manner and move towards the dream of a resilient economy and a self-reliant India.
(The author is a researcher at Center for Social and Behavior Change, Ashoka University. Views, thoughts, and opinions expressed in the text belong solely to the author, and not necessarily to the author’s employer, organisation, other group or individual.)
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