Fluoride Action Network

Will the iron and folic acid supplementation plan work this time?

Source: Health.India.com | July 17th, 2013 | By Nirmalya Dutta
Location: India

That is the question because it has been tried before. Today The Weekly Iron Folic Acid Supplementation Programme for Adolescents is all set to be launched with much fanfare including full-page ads in major broadsheet papers but the question is – will it work this time?

Child malnutrition is currently one of India’s biggest health problems and it’s nothing less than a matter of natural shame that every other child is stunted or wasted due to an improper diet while growing up. The current prevalence rate of anaemia is 80% in children (56% of girls and 30% of boys) and 70% in pregnant women suffer from anaemia which is mostly due to lack of iron. This isn’t only a problem that afflicts children and pregnant women but even adolescents resulting in poor physical growth, poorer academic performance and diminished concentration in daily tasks impacting overall capacity and well-being. (Read: Dangers of adolescent pregnancies)

In adolescent girls, it also increases the risk of preterm deliveries giving birth to babies with low weight (adolescent pregnancies are one of India’s harsh realities considering the high number of child marriages).  33% of all maternal deaths in India take place in the 15 to 24 age group and Health Ministry believes that these numbers can be brought down by regular folic acid supplementation.Providing supplementation isn’t everything and sessions on Nutrition and Health Education are also being planned at schools and Anganwadi to inform and counsel caregivers and students about nutrition and related health issues. The programme will cover 13 crore adolescents and is one of the most ambitious health plans to be rolled out since the National Rural Health Mission was launched in 2005.

Is the plan doomed for failure?

However, there are many who don’t think the IFA tablets are going to change anything. A.K. Susheela, director of Flourosis Research and Rural Development Foundation in New Delhi said ‘old wine in new bottles is unlikely to change anything. 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 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.

She 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. (Read: What ails India’s healthcare system)

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.

With inputs from agencies and Press Information Bureau