Health ministry revises anaemia diagnosis norms for pregnant women and infants, rolls out new screening framework

THE Union health ministry has lowered the haemoglobin threshold used to diagnose anaemia in two of India's highest-risk groups—young children and pregnant women in their second trimester—as it revamps the country's flagship anaemia-control programme to focus more on targeted screening and treatment than universal iron supplementation.

The revised Anemia Mukt Bharat Abhiyaan framework aligns national clinical guidelines with the World Health Organization's 2024 recommendations, according to a government official and documents reviewed by Mint.

The revised framework has been shared with states and Union territories for implementation.

Under the new guidelines, the haemoglobin cut-off for children aged 6-23 months and pregnant women in their second trimester has been lowered by 0.5g per decilitre to 10.5g/dl. Thresholds for all other population groups remain unchanged.

The changes come against the backdrop of persistently high anaemia prevalence in India. The 2019-21 National Family Health Survey (NFHS-5) found that anaemia affected 67.1% of children aged 6-59 months, 57% of women aged 15-49 years, 52.2% of pregnant women and 59.1% of adolescent girls.

Anaemia is a condition in which the red blood cell count or haemoglobin concentration falls below established levels, reducing the blood's ability to carry oxygen.

"As per the WHO Haemoglobin cut offs (2024), there is a modification in the haemoglobin cut-offs for defining anaemia for two population groups, children 6-23 months of age and pregnant women in the second trimester, both being reduced by 0.5 g/dl from 11g/dl to 10.5g/dl, rest of the values remain the same as those of 2011,” according to the operational guidelines of Anemia Mukt Bharat Abhiyaan posted on the health ministry website.

Queries emailed to the health ministry spokesperson on Sunday morning remained unanswered until press time.

From prevention to treatment

The revised framework also marks a broader shift in how the government plans to tackle anaemia.

“The operational shift forms part of a strategy transitioning away from blanket prophylactic iron distribution toward targeted, screening-led therapeutic management. The health ministry expanded the program's lifecycle target groups by adding low birth weight infants aged 0 to 6 months. Under the protocol, infants born with low birth weight will undergo specialist-guided evaluation to build iron reserves early and interrupt intergenerational deficiency cycles. Point-of-care testing across community and field settings will rely on portable digital invasive hemoglobinometers to categorise cases into mild, moderate, or severe stages,” an official familiar with the matter said, requesting anonymity.

The redesigned programme replaces the earlier three-tier approach with a four-stage Test, Treat, Talk and Track model, anchored in a 7x7x7 strategy spanning seven beneficiary groups, seven interventions and seven institutional mechanisms.

The operational guidelines describe the change as a "strategic shift reorients the programme from a supportive prophylactic supplementation model to a screening-led, targeted therapeutically managed, diet-integrated and digitally monitored continuum of care framework".

Under the revised protocol, beneficiaries diagnosed with mild to moderate anaemia will receive therapeutic oral iron-folic acid for three months, followed by mandatory retesting.

Pregnant women and lactating mothers with moderate anaemia will be eligible for either a single dose of intravenous ferric carboxymaltose or five doses of iron sucrose at public health facilities.

Patients whose haemoglobin levels fail to improve despite adhering to treatment will be referred to secondary or tertiary care centres for investigations into non-nutritional causes, including malaria, tuberculosis and haemoglobinopathies such as sickle cell trait or thalassaemia.

Meanwhile, the ministry has created a digital platform that integrates beneficiary records from the U-WIN, Journey of Antenatal, Natal and Neonatal Integrated Care (Janani), and Rashtriya Bal Swasthya Karyakram portals into a central dashboard. The system generates automated alerts to monitor treatment adherence, schedule follow-up tests and track clinical resolution across beneficiary groups.

Dr. Archana Dhawan Bajaj, director and in-vitro fertility expert at Nurture Clinic, said anaemia remains a major public health challenge in India, affecting children, adolescents, women of reproductive age and pregnant women. She said expanding screening, aligning diagnosis with updated WHO criteria, strengthening digital tracking and promoting locally available iron-rich foods could improve early detection, treatment adherence and prevention.

“However, sustained success will depend on robust implementation, community awareness, regular follow-up and addressing the root causes of anaemia, including nutritional deficiencies, infections and poor dietary diversity,” Bajaj said.

She added that community-level initiatives would remain important in complementing the national programme, citing a pilot anaemia screening and treatment project led by Delhi MLA Umang Bajaj in Rajinder Nagar.

“Local initiatives such as the pilot project led by Delhi MLA Umang Bajaj in Rajinder Nagar constituency for anaemia screening and treatment are crucial, as community-level action and early intervention will collectively help India move closer to becoming an Anaemia Mukt Bharat.”