India’s anaemia fight turns to fortified salt as delivery gaps persist

Double-fortified salt could help tackle anaemia at scale, but uneven delivery, poverty, poor sanitation and non-nutritional causes continue to hamper India’s response.

Anaemia remains one of India’s most persistent public health problems, with especially heavy effects on women, children and adolescents. The ForumIAS article says the condition is driven not only by iron deficiency but also by shortages of vitamin B12, folate, vitamin A and zinc, as well as infections and poor sanitation. A narrative review published on PubMed Central adds that anaemia in India is shaped by a wider mix of factors, including undernutrition, low maternal education, household poverty and exposure to unhygienic conditions that increase worm burden. Together, these pressures make anaemia far more than a simple dietary problem.

The scale of the burden is striking. The ForumIAS piece cites National Family Health Survey data showing anaemia in 67.1% of children and 59.1% of adolescent girls, while the PubMed Central review says more than 58% of children aged six to 59 months are anaemic, with higher rates in rural areas. The consequences run well beyond tiredness or weakness. Anaemia in adolescence and pregnancy raises the risk of maternal death, premature birth and low birth weight, while also impairing cognition, reducing productivity and passing disadvantage from one generation to the next. The economic cost is substantial, with iron deficiency anaemia estimated to drain around 4% of gross domestic product.

Food fortification has emerged as one of the most practical ways to reduce the burden at scale. Double-fortified salt, which contains both iron and iodine, builds on the near-universal use of iodised salt in India. The Cochrane review cited in the related material found that double-fortified salt may improve haemoglobin and body iron stores and reduce anaemia, although the authors also noted the need for more real-world evidence and careful monitoring of iodine levels. Another study found that the intervention improved haemoglobin in most trials and could generate a benefit-cost ratio of roughly 2.4:1 to 5:1, depending on the population considered. The ForumIAS article also notes that double-fortified salt has already been delivered to millions of people through government safety-net schemes, while fortified rice offers another channel because rice is a major staple in India.

Government policy has increasingly tried to combine prevention, detection and treatment. According to the ForumIAS article, the Anaemia Mukt Bharat programme uses a 7X7X7 framework that brings together several beneficiary groups, seven interventions and seven institutional mechanisms. These include iron-folic acid supplementation, deworming, screening, counselling, dietary diversification and care for non-nutritional causes. The article says the government has also expanded monitoring through the Test, Treat, Talk and Track approach, alongside initiatives such as monthly village health and nutrition days, antenatal screening under Pradhan Mantri Surakshit Matritva Abhiyan and maternal support schemes such as Janani Shishu Suraksha Karyakram. In the latest quarter cited, 15.4 crore children and adolescents received iron-folic acid supplements.

Yet the problem is not only one of design; delivery remains uneven. The ForumIAS article says double-fortified salt has not been integrated consistently into the public distribution system across states, and scaling it up requires stronger financing, reliable supply chains, better quality control and wider public awareness. The PubMed Central review suggests that anaemia cannot be tackled by nutrition policy alone, because poverty, sanitation, worm infections and other health conditions all play a part. That makes the strongest response a blended one: fortification for broad coverage, supplementation for high-risk groups, screening and treatment for clinical cases, and better diets over the long term. In practice, anaemia control in India will depend on how well these pieces work together, especially for vulnerable children, adolescents, pregnant women and families with limited access to nutritious food.