Anaemia Burden: Iron Alone Is No Solution

November 05, 2026
Current Affairs

Anaemia Burden: Iron Alone Is No Solution

Source: The Hindu

Syllabus: GS II: Health, nutrition, government policies. GS III: Food security

Why in news?

NFHS-5 found that more than half of Indian women and about two-thirds of young children are anaemic. Double-Fortified Salt (DFS), containing iodine and iron, has been proposed as a convenient fix. The editorial argues that convenience does not ensure effectiveness: heavy salt intake, risks of iron accumulation and the many causes of anaemia make universal fortification questionable.

Contradiction between iron fortification and salt reduction

DFS works only if people keep eating salt.
Indians eat about twice the WHO limit of 5 g a day. Nearly one in three adults has hypertension, and the National NCD action plan targets a 30% cut in salt intake.
DFS therefore conflicts with salt-reduction goals.
Adult men eat more salt than women and children, so those who need more iron may get less.

Risks of excess iron

1. International evidence

Pemba trial, Tanzania (2006): Iron and folic acid in children in a malaria-endemic area were linked to more hospitalisations and deaths.
Kenya trial (2015): Iron-fortified foods shifted infants' gut microbiota towards pathogenic bacteria and raised diarrhoeal infections.
Relevant to India because many regions have malaria and poor sanitation.

2. Haemoglobinopathies and iron overload

India has millions of beta-thalassaemia carriers, and sickle cell disease is concentrated in tribal regions.
People with thalassaemia, especially those on repeated transfusions, risk iron overload.
Screening everyone first is impractical, with the PDS reaching about 800 million people.

3. Cumulative iron exposure

Fortified rice already goes through the PDS, PM POSHAN and ICDS, and IFA tablets reach several groups.
DFS could add iron through multiple programmes at once. There is no comprehensive research on cumulative intake, so a nationwide rollout is premature.

Lessons from other countries

*Country*	What worked	Lesson
*Peru*	Double-digit fall in child anaemia in the early 2010s through political priority, tracking each child, iron supplements, micronutrient powders and cash transfers. Progress reversed when COVID-19 disrupted health services	Sustained health services and institutional accountability matter
*Vietnam*	Fall in anaemia among women through weekly IFA, deworming and fish sauce fortified with NaFeEDTA (iron better absorbed in phytate-rich diets), helped by rising incomes and varied diets	Fortification must suit local diets and come with broader nutrition measures

Policy recommendations

India should avoid an immediate nationwide DFS rollout and instead:

Run monitored district-level pilots.
Measure haemoglobin, ferritin and inflammation markers.
Assess cumulative iron exposure across schemes.
Monitor risks in malaria-endemic and haemoglobinopathy-prone regions.
Use better-absorbed iron forms and targeted fortification.
Strengthen diagnostics, deworming, malaria prevention and sanitation.
Improve affordable access to diverse, nutritious food.

Conclusion

Anaemia needs urgent action, but universal iron fortification through DFS may create health risks and clash with salt-reduction goals. Peru and Vietnam show that success needs integrated nutrition programmes, targeted supplementation and strong health delivery. Anaemia is a multidimensional public health challenge, not a deficiency that an additive in the salt bottle can fix.