Anaemia is the biggest killer of girls and women in India. The latest National Family Health Survey has shown that most Indians have anaemia. The survey’s findings reveal that over 70% of children, 55 per cent women and about 24 per cent Indian men are anaemic, but unfortunately, few are aware of the same.
UP is responsible for the high maternal mortality rate (MMR) in the country were the Hindutva supermascist party has 32 per cent vote . Approximately 52 per cent of the most backward classes voted for the BJP during the last parliament election of 2008. Now Anaemia spread over to the rank and files of hindutva fascist party, and they are definitely inter related to their hatred politics.
Anaemia is hugely prevalent among children in the age group of six to 59 months; the survey puts the figure at over 70 per cent. Furthermore, more than 56 per cent of children between the ages of 12 to 23 months do not get fully inoculated against major childhood illnesses such as tuberculosis, diphtheria, pertussis, tetanus, polio and measles (rubella), the survey found.
Other important findings are the prevalence rate of 0.28 per cent in cases of HIV in the age group of 15 to 49 years, as well as a decline in female fertility rates.
The state of affairs in Lucknow is no different, though slightly better than other parts of UP. According to health department sources, 50% women in the age group of 15-49 years in the state are anaemic. While 52% of pregnant women are anaemic, 58% of breastfeeding women have been found with haemoglobin level less than the prescribed 12 units. The surprising fact is that 46% women in high income group and 45% women in urban area too have been found anaemic due to various reasons.
MMR ratio (deaths/lakh live births) of India is 301 and of UP 517, as per the sample survey conducted by the registrar, Government of India. There are about 28 million pregnancies per year in India and 25.5 million deliveries. Nearly 77,000 maternal deaths are reported per year. Around 211 women die every day, of which 42 deaths are due to anaemia during pregnancy. UP figures among the worst performing states in the country. There are over 56 lakh births every year in the state and around 28,000 pregnant women die every year, which means that out of total women dying in India during pregnancy, one-third are from UP.
Besides dietary habits and availability of nutrition, one of the major factors responsible for anaemia in women is `worms in digestive track’. A research done by the gynaecology department of CSM Medical University has revealed that large rural populace, including pregnant women, face problem of worms because of unhygienic conditions and habits, defecation in open, bare feet walking, among other things. However, there is a controversy over whether or not pregnant women should be given dewormification drugs. There are varied opinions about the effect of such drugs, if given, to the pregnant women and the embryo.
“We don’t give any extra drug in the first three months of pregnancy as during this period development of various organs of baby takes place but it’s safe to give dewormification drug after three months,” said Prof Vinita Das, head, gynaecology department. “There is no unanimity over universal dewormification of pregnant women but we can safely do it in those suffering from anaemia but albeit after conducting stool test and finding out the type of the worm,” she said. For hookworm, she said, `pyrantel pamoate’ is recommended and for other types `nebedazole’. Prof Das also emphasised on the need of more research in this area.
Dr Neelam Singh, city-based gynaecologist and a social activist working for safe motherhood and girl child, recommends a multi-pronged strategy to counter the problem of anaemia among females, pregnant women in particular. A healthy mother means healthy household, which in turn makes a healthy nation, Singh said. “From counselling of individuals by doctors to the awareness drives in schools and from dewormification in anaemic pregnant women to community mobilisation at panchayat level by involving pradhans and officials of the district administration — we need to work in all directions,” she said.
Significantly, the MMR has come down in UP to 517 from 707 in 1995. Number of girls married before the age of 18 years has reduced from 64% to 53%. As per the District Level Household Survey (DLHS) of the state released earlier this year, the institutional deliveries have increased from 23% in 2006 to 25% in 2008 because of the Janani Suraksha Yojana (JSY). Clearly, the situation has improved but the MMR is not dropping at a faster rate. The reason: the number of anaemic women is increasing and nearly 40% of the prospective mothers are not getting any ante-natal care before delivery. As a result, 70% births are still unsafe.
Problem
* Dietary habits. While some girls are victim of self neglect, many are neglected by families.
* Nearly 50% deaths during deliveries are because of haemorrhage as women are anaemic.
* Women do not consume iron tablets: because of taste, nausea, constipation etc.
* Myths: Baby would be dark if iron is taken. Baby would be heavy, problem in delivery.
* No feedback to assess if spending on maternal care actually yielding results.
SOLUTION
* 100% ante-natal care, 100% JSY registration, capacity building at village level.
* Availability of iron tablets, ensure that women take them, feedback of response.
* Besides six visits by midwives, expecting mother should be given at least one tetanus injection.
* Awareness drives in schools among girls, awareness drive in rural areas, community action.
* Extra meal to women, dewormification, sensitisation of males in family as well.
LUCKNOW STATUS
* 40% women anaemic across every sections of the society.
* 47.3% institutional births, including 33.2% in rural areas.
* 48% women get post-natal care within 48 hours of delivery.
* 45.5% use family planning methods, 27.4% needs still unmet.
* 19.2% girls are married before completing 18 years of age.
* 52.4% are mothers of two or more kids by the age of 24 years.
* 8% girls become mothers between the age of 15-19 years.
* Only 11.6% of prospective mothers get full ante-natal coverage.
ANAEMIA IN UP’S WOMEN
50% in age group of 15-49 years.
52% of pregnant women.
58% of breastfeeding women.
46% of women in the high wealth group.
45% women in urban area.
