The health ministry’s proposal to tackle anaemia by providing iron folic acid (IFA) tablets every week to 130 million adolescent girls across the country ‘is old wine in new bottles, unlikely change things,’ an expert has warned. ‘It is a repeat of the approach that failed miserably even after 40 years of implementation,’ A.K. Susheela, director of Fluorosis Research and Rural Development Foundation in New Delhi and former anatomy professor at the All India Institute of Medical Sciences, told IANS. IFA supplementation to pregnant women visiting antenatal clinics was introduced in 1970 throughout the country, since anaemia in pregnancy leads to birth of underweight babies. But a survey by the Indian Council of Medical Research (ICMR) in 1986 found no change in the prevalence of anaemia and so, from 1992, the dosage of iron was increased from 60 mg to 100 mg, Susheela said.
That too made no difference, the foundation said in a statement. The current prevalence rate of anaemia is 80 percent in children and 70 percent in pregnant women. Susheela pointed out that Gujarat introduced iron supplementation for adolescent girls a decade ago, but the programme miserably failed. ‘The Municipal Corporation of Delhi introduced the same, no one knows the outcome,’ she said.
Susheela said she is surprised at the attempt to re-introduce this failed programme even though the ICMR is aware that taking IFA tablets does not help combat anaemia, unless the intake of fluoride through food and water is simultaneously reduced. Of India’s 35 states and union territories, 19 are ‘endemic’ areas for fluorosis, the main cause being fluoride-laden water derived from deep bore wells. ‘The chemical fluoride not only decreases production of red blood cells by the bone marrow but also destroys microvilli – the microscopic protrusions lining the intestine – resulting in poor absorption of nutrients critical for the biosynthesis of haemoglobin,’ Susheela explained.
In other words, IFA tablets will not help in checking anaemia as long as the fluoride intake is not reduced, she said. Considering the huge cost involved in purchase and distribution of the IFA tablets, she hoped the proposed scheme to be implemented by the National Rural Health Mission (NRHM) does not become another scandal, especially when her foundation has successfully demonstrated a simpler strategy to tackle anaemia in school children as well as in pregnant women. ‘Our strategy only requires withdrawal of fluoride consumption and a nutritive diet (with essential and micronutrients) through vegetables, fruits and dairy products,’ she said.
The foundation, in a letter to NRHM director Auradha Gupta, cautioned that IFA supplementation is an ‘inappropriate and unscientific manner of addressing anaemia and an absurdly futile exercise.’ Research by Susheela and her co-workers published in peer reviewed journals has shown that iron supplementation is neither required nor sustainable. ‘Our recipe is simple, practical and sustainable,’ she said. Susheela said this simple strategy for combating anaemia has been demonstrated by her team in a two-year (2011-2013) ICMR sponsored study that covered over 2,500 adolescent girls and boys from four schools in Delhi. At the start of the study, 81 percent of children were anaemic but their haemoglobin level increased dramatically within six months after reducing their fluoride intake and inclusion of essential nutrients in the daily diet.
The impressive result was also obtained in an earlier study conducted during 2005-2009 covering over 3,000 pregnant women in two Delhi government hospitals, the foundation said. ‘Our simple programme led to a striking increase in haemoglobin, fewer low birth weight babies, and reduced numbers of pre-term deliveries,’ it said. The innovative procedure, according to Susheela, ‘has proven for the first time that anaemia in pregnancy is mainly due to non-absorption of nutrients due to adverse reactions of fluoride rather than malnutrition and that IFA is not a magic bullet to treat this’.