Despite multiple programmes, anaemia among Indian women has worsened between NFHS-4 and NFHS-5. Critically examine the reasons and suggest a multi-pronged strategy.

Anaemia among women aged 15–49 rose from 53.1% (NFHS-4, 2015–16) to 57.0% (NFHS-5, 2019–21) [1]. This happened even though Anaemia Mukt Bharat (AMB, 2018) runs under POSHAN Abhiyaan [1]. The rise reflects gaps in targeting and delivery more than a lack of programmes.

Reasons for the worsening

• Many causes, but an iron-only response: AMB itself flags non-nutritional causes of anaemia in endemic pockets [2]. Where low iron is not the cause, more iron cannot bring the numbers down.
• Survey timing: AMB began in 2018 [2]. NFHS-5 fieldwork overlapped with COVID-19 disruptions to health services, so it captured only the programme's early years.
• Uneven implementation: 13 States/UTs recorded declines while the national figure rose [1]. This points to delivery gaps on the ground, not design alone.
• Policies working against each other: double-fortified salt (iodine + iron) needs people to keep eating salt steadily. Yet India targets a 30% relative cut in salt intake [6], and WHO advises under 5 g of salt a day [5]. If one policy succeeds, the other weakens.

Strengths not to overlook

• AMB's 6×6×6 framework (six target groups, six interventions, six institutional mechanisms) is a sound design that covers every life stage [2].
• WHO rates large-scale fortification as evidence-based and cost-effective [3]. The problem is relying too much on one tool, not the tool itself.

Multi-pronged strategy

• Diagnose before treating: expand digital haemoglobin testing and screening for sickle cell and thalassaemia so treatment matches the cause [2].
• Target the need: deliver iron-folic acid and deworming through AMB's priority groups (adolescent girls, pregnant and lactating women) [2] instead of through everyone's salt.
• One joint plan: run salt reduction and salt fortification together, as WHO advises [4]. Messaging on fortified salt should state the 5 g limit [5].
• Learn from improving States: study and share what the 13 improving States/UTs did differently [1].
• Evaluate on results: scale up interventions based on measured haemoglobin gains, not ease of delivery.
• Social factors: promote a more varied diet and give women a greater say in how food is shared within the household.

The rise in anaemia reflects failures of targeting and of policies pulling in different directions, not a lack of intent. Testing first, targeting those most at risk and aligning nutrition with NCD goals within AMB can reverse the trend. This would advance SDG 2.2 and fulfil the State's duty under Article 47 to raise nutrition levels.