Preconception Anaemia Management

Recent medical observations by leading practitioners highlight a persistent and overlooked challenge in India’s maternal health system — undiagnosed and untreated anaemia among women prior to conception. Despite notable improvements in maternal mortality, the prevalence of anaemia among women of reproductive age poses serious threats to maternal and neonatal outcomes.

Magnitude of the Problem

• Prevalence of Anaemia: Over 57% of Indian women aged 15–49 suffer from anaemia (NFHS-5, 2019–21).
• Preconception Phase Neglect: Public health interventions have largely focused on pregnancy and childbirth, ignoring the preconception phase critical for maternal and fetal health outcomes.

Consequences of Preconception Anaemia

• Adverse Pregnancy Outcomes:
• Preterm birth
• Low birth weight
• Preeclampsia
• Postpartum haemorrhage
  • Increased maternal and perinatal mortality
• Systemic Underdiagnosis:
  • Symptoms like fatigue and weakness are often normalized or ignored, delaying diagnosis.
  • Lack of regular screening during adolescence and pre-marital stages.

Policy and Programmatic Gaps

• Focus Skewed Towards Antenatal Care (ANC):
  Current public health policies emphasize ANC over preconception health.
• Implementation Gaps in Anaemia Control Programmes:
  • Anaemia Mukt Bharat (AMB) remains pregnancy-centric.
  • Low community awareness and weak adolescent engagement in interventions.

Need for a Paradigm Shift

• Reframing Public Health Discourse: Move from “Are you ready for motherhood?” to “Is your body ready for pregnancy?”
• Lifecycle Approach to Women’s Health: Focus on early adolescence to preconception as part of a continuous care framework.
• Strengthening Primary Health Systems: Integration of haemoglobin testing into routine health checkups for girls and women from adolescence.

Way Forward:

• Integrate Preconception Care in RMNCH+A Framework: Add specific targets for anaemia screening and Iron-Folic Acid (IFA) supplementation in pre-marital and pre-pregnancy
• Mandatory Haemoglobin Check-ups at Adolescent Level: Institutionalize school-based anaemia testing and weekly IFA supplementation.
• Community-Level Awareness Campaigns: Utilize ASHA, ANM, and Anganwadi workers to raise awareness about pre-pregnancy health.
• Strengthening Data Systems: Implement real-time anaemia tracking dashboards using Health Management Information Systems (HMIS).
• Link Anaemia Management with POSHAN Abhiyaan & School Health Programme: Converge nutrition, hygiene, and deworming strategies for holistic anaemia prevention.