Seven out of ten women in West Bengal are anaemic, according to the last figures available. The National Family Health Survey (NFHS-5, 2019–21) showed the rate to be 71.4% among women aged 15 to 49, the highest in India’s major states, as compared with 39% among men. However, when NFHS-6 released its fact sheets this year, the section on anaemia was omitted. For the first time since the late 1990s, India has a national health survey that does not include an estimate of anaemia, so it is now impossible to tell whether the situation for women in West Bengal has improved or gotten worse.
This more than a minor omission: anaemia in India is a major public health concern, of greater significance in women, since the difference between men and women when it comes to rates of anaemia is generally attributed to biology. This, however, isn’t entirely accurate.
A burden that kept rising
From 2015 to 2016, the rate of anaemia among women of reproductive age increased nationally from 53% to 57%. In West Bengal, the figure rose by approximately 9 percentage points, and for children between 6 months and 5 years, it rose from 54% to 69%. The gap appears early on: nationally, 59.1% of adolescent girls were anaemic as compared with 31.1% of boys, and this difference becomes greater as people go through their reproductive years. Within the State, the severity of anaemia is linked to disadvantage, so that in districts like Purulia and Uttar Dinajpur almost four out of five women were anaemic.
Anaemia prevalence, NFHS-5 (2019–21)
| Anaemia prevalence NFHS-5 (2019–21) | West Bengal | India |
| Women 15–49 | 71.4% | 57.0% |
| Men 15–49 | ~39% | 25.0% |
| Children 6–59 months | 69.0% | 67.1% |
Source: IIPS & ICF, NFHS-5 (2021). NFHS-6 (2026) did not report anaemia.
Not just biology
The usual explanation given in textbooks is that women lose more iron because they menstruate, carry pregnancies, and breastfeed; this is correct, but it does not explain a 30-point gap or why this gap changes so markedly across districts, castes, and wealth levels. The answer may lie in examining gender rather than biology alone.
It takes four factors to accomplish this. The first of these is time: since women’s duties, both at home and in agriculture, are mostly unpaid, they have little time for rest, for preparing iron-containing meals, or for visiting a health centre. The second is the meal pattern: in many households, food is given to men and children before it is offered to women, so that the women end up eating last and the least of the food from the kitchens that they manage. The third is social norms: it is considered a woman’s responsibility to look after people, and their own health is of secondary importance, and anaemia is regarded as a ‘women’s ailment.’ That stigma has a double effect in that about four out of every five men in West Bengal are anaemic as well, but they are almost never checked or treated. The fourth is money: women who rely financially on others are often unable to act on what they already know about diet.
An anaemia programme that ignores the gender dimension and merely distributes free iron tablets encounters all four of these obstacles and fails to alter any of them. Fieldwork carried out in Bankura in 2025 illustrates exactly what happens in practice. Pregnant and breastfeeding women discarded the fortified (with iron) rice kernels they were given, since they ‘looked like plastic’. They skipped the iron-folic acid tablets, which they did not like, and forgot their doses because of household chores no one else took on. Husbands, who are mostly engaged as migrant labourers, played almost no role in household nutrition. An improved supply chain would not remedy any of this.
The present scenario
The government has, this year, restructured the Anaemia Mukt Bharat programme. In June, the previous 6×6×6 arrangement (six target beneficiary groups, six interventions and six institutional mechanisms) was replaced by a 7×7×7 scheme which includes testing and treatment, a digital ‘T4’ tracking system and a new national centre of excellence for anaemia. On paper, these steps are the correct ones. A digital tracking system broken down by sex could finally show the problem affecting men, a factor kept out of sight because previous messaging had focused only on women.
Yet, in this same year, the country lost its standard for measurement. The official stance is that that anaemia has been omitted from NFHS-6 since blood samples taken from finger pricks are not fully reliable and may have inflated the figures, and also because India had been following the World Health Organization’s cut-offs for anaemia, which may not be suited to the local context. Instead, venous blood sampling was recommended.
All of these are valid concerns, and there is merit in them. The government had also justified dropping the anaemia reading in the NFHS-6 by stating that it would be surveyed more scientifically in the Diet and Biomarkers Survey in India (since renamed the SAMPADA survey), spearheaded by the ICMR-National Institute on Nutrition, and launched in December 2022. Venous blood samples were collected from residents across 183 districts. The problem is, that SAMPADA has not yet released any of its results, despite the survey being completed in November 2025. Until it does, there is no up-to-date national or State figure against which to assess the new programme. It is therefore impossible to verify or alter West Bengal’s status as the most severely affected of the major States, and nobody can tell whether the new framework is having the desired effect.
At present, reform and measurement have become detached from each other, even though they should be closely linked. A programme which is not measurable cannot be held responsible for its actions.
What should follow
There are three issues. The first is that the government ought to make available SAMPADA’s findings on a specific date, breaking the findings down by sex, age and State, and it should ensure that the methods used are sufficiently similar to those employed in the NFHS so that the new figures can be compared with the old ones rather than simply replacing them. An improved measure must not cause the trend to disappear.
The second point is that the new tracking system should regularly provide data by sex, and supplementation for men should be carried out in exactly the same way as it is for women. The third is that counselling and outreach activities must treat anaemia as a problem that affects the entire household, not merely as a problem of women; it is therefore necessary to reach mothers-in-law, since they are often in a position to decide who eats what, and migrant husbands should also be targeted since they are never present in the room.
India is now carrying out a more ambitious programme than before to combat anaemia, and has no current figures with which to evaluate it. Until the data is available, we are facing a problem for which records have been discontinued, and the women who are affected most may be the last to find out whether or not any change has taken place.
(Anurag Telang is a researcher in public health. dranurag225@gmail.com; Karan Babbar is an assistant professor of Economics at XLRI, Jamshedpur. phd17karanb@iima.ac.in)