NEW DELHI: Anaemia has long been described as India’s silent epidemic—widespread, persistent and devastating in its consequences, yet rarely commanding sustained public attention. For decades, it has quietly undermined maternal health, shaping pregnancy outcomes and infant survival well before a child is born.
Despite years of government programmes and iron supplementation schemes, nearly one in two Indian women of reproductive age remains anaemic, according to national health surveys. Among pregnant women, the risks are even more severe. Anaemia significantly raises the chances of pre-term birth, low birth weight, maternal fatigue, infections and postpartum haemorrhage, one of the leading causes of maternal deaths in the country.
Now, after decades of relying almost exclusively on oral iron tablets, India’s public health system is beginning to shift gears. Several states are increasingly adopting single-dose intravenous (IV) iron infusions as a frontline treatment for moderate to severe anaemia during pregnancy, particularly when oral therapy fails or time is critically short. Public health experts say this change could address one of the most stubborn weaknesses in India’s anaemia control strategy: poor compliance.
THE COMPLIANCE CHALLENGE
Oral iron-folic acid tablets have long been the backbone of maternal anaemia programmes. The logic is straightforward—daily supplementation over several months should gradually improve haemoglobin levels. In practice, however, the approach has often fallen short.
“Oral iron works in theory, but not always in real life,” says Dr Rajnish Sinha, a Delhi-based family physician. “Many women stop taking tablets because of nausea, vomiting, gastritis or constipation. Others miss doses simply because they forget or feel worse after taking them.”
By the time many women seek care in the second or third trimester, correcting anaemia through pills alone becomes difficult. “If a woman comes at 28 or 30 weeks with low haemoglobin, you don’t have months to wait,” Dr Sinha explains. “Missed doses at that stage can directly affect foetal growth.”
This problem is magnified in rural and underserved areas, where late antenatal registration and irregular follow-ups are common.
WHY IV IRON IS GAINING GROUND
IV iron changes the equation by delivering a large, calculated dose of iron directly into the bloodstream, often in a single sitting. This allows haemoglobin levels to rise faster and more predictably than with oral supplements.
“For late pregnancy, that reliability is crucial,” says Dr Sinha. “With IV iron, you know the patient has actually received the treatment. There are no missed doses.”
Newer formulations have made IV iron easier to administer, reducing the need for multiple infusions spread over weeks. This has made it more feasible for public hospitals and maternity centres to adopt the approach. States such as Rajasthan and Karnataka have already begun rolling out IV iron protocols for pregnant women with moderate to severe anaemia.
Health administrators say the shift reflects a broader rethink—from focusing on distributing tablets to ensuring effective treatment.
A FRONTLINE PERSPECTIVE
For community health workers, the appeal of IV iron is immediate. “Compliance has always been the biggest challenge,” says Sunita, an ASHA worker in central India. “We distribute tablets and counsel women, but many stop taking them because of side effects or family pressure.”
A single supervised infusion removes much of that uncertainty. “Once the infusion is done, at least we know the treatment is complete,” she says.
COST VERSUS IMPACT
Critics often cite the higher upfront cost of IV iron compared to oral supplements. But public health experts argue that this view overlooks the long-term savings. Preventing complications such as pre-term births, emergency interventions, blood transfusions and prolonged neonatal care can significantly reduce healthcare costs.
