India’s maternal health gains are real and so is anaemia risk

This article is authored by Dr Sunita Tandulwadkar, president, Federation of Obstetric and Gynaecological Societies of India (FOGSI).

India’s maternal health story has witnessed extraordinary progress. Our Maternal Mortality Ratio (MMR) has declined to 88 deaths per one lakh live births in 2020-22, an impressive drop from 130 just a few years earlier (2014-16). Today, more women deliver in hospitals, receive regular antenatal care, and benefit from improved obstetric services, as a result of a concerted drive toward better maternal health outcomes.

Pregnancy (Representational image)

With these gains firmly in place, the next big crisis we must confront to further reduce maternal deaths is anaemia. Caused by poor intake of micronutrients like iron, folic acid and vitamin c, anaemia can cause irreversible harm to both mothers and children. In India, one in every two pregnant women is anaemic, of which over 30% cases are either moderate or severe (9.9 g/dl and lower) and require urgent medical attention. One of the most dangerous effects of anaemia during pregnancy is postpartum haemorrhage (PPH), the leading cause of maternal deaths worldwide. Studies show that anaemic women are over 11 times more likely to suffer from PPH, escalating what should be a moment of joy to a potentially life-threatening emergency.

Preventing anaemia starts at the table. First and foremost, girls’ and women’s diets must be prioritised. In many households, women eat last—and least—leaving diets chronically low in iron and vitamin C. Alongside better diets, tools available in the public domain must be adopted for timely testing and treatment. National guidelines recommend haemoglobin screening once per trimester, but in practice, many women are tested only once or not at all, meaning anaemia often goes undiagnosed until it is too late. Today, testing has been made quick, safe, and easy with minimally invasive digital screening tools that deliver results in minutes. By fully integrating these, we can ensure early detection, track treatment, and flag high-risk cases before complications arise.

Once anaemia is detected, iron and folic acid (IFA) supplement consumption is critical. However, even when oral IFA supplements are available, adherence remains a challenge. While the government recommends a 180-day course during pregnancy, completion rates remain alarmingly low. Side effects and lack of follow-up are common barriers.

A true lifecycle approach must begin well before conception, ensuring girls enter pregnancy with adequate iron stores. For moderate-to-severe cases or those intolerant of oral iron, intravenous Ferric Carboxymaltose (IV FCM) offers a rapid, single-dose alternative. A promising newer tool in our arsenal, IV FCM, unlike oral iron supplements that require months of adherence and are often poorly tolerated, offers an effective solution that rapidly restores iron levels. Even when administered in the preconception phase, it can reduce fatigue, improve energy, lower the risk of complications, and build a stronger foundation for pregnancy and childbirth.

Despite its proven benefits, IV FCM remains underutilised. Many women, especially in rural and underserved areas, are never informed of this option. Awareness is low, and access is uneven. Encouragingly, the Government of India issued guidelines last year recommending the use of IV FCM for pregnant women with moderate to severe anaemia, an important and much-needed measure. The focus must now shift to implementation. It is critical to ensure that this life-saving intervention reaches every woman who needs it, and without delay. For women with moderate to severe anaemia, or those unable to tolerate oral iron, IV FCM should be a standard part of preconception and antenatal care.

To ensure healthier pregnancies, we must adopt a lifecycle approach to women’s health, one that strengthens the body long before childbirth. While nation-wide efforts have been in place for decades, irregular testing and low adherence to treatments such as oral iron and folic acid (IFA) supplementation, have left pregnant women across the country at severe risk. By the time a woman arrives at the delivery room, it is often too late for the simple, preventive interventions that could have made all the difference. The real work of safeguarding maternal health begins months, sometimes years, before pregnancy, and there is a real need for a shift in how we define and deliver maternal health care.

In my decades of practice, I have seen anaemia routinely under-recognised. It is treated as an almost inevitable condition of pregnancy rather than the serious clinical and public health issue it is. This complacency must end. Anaemia is anything but routine. When half of India’s women are affected, it is a public health emergency. When it undermines a woman’s health in pregnancy, heightens her risk of haemorrhage, sepsis, and death, it becomes life-threatening. And when its effects carry forward to the next generation—manifesting in low birth weight, stunting, and cognitive deficits—it becomes a multigenerational burden

Also, if we are to maintain a steady, linear decline in MMR, anaemia must be addressed with urgency, accountability and focus.

I reiterate, no woman should have to navigate pregnancy in a state of depletion, and every child deserves to begin life on strong footing. We have the knowledge, the tools, and increasingly, the political will. Recent initiatives like the Government of India’s Swasth Nari, Sashakt Parivar Abhiyan—launched to prioritise women’s health as the foundation of stronger families—reflect this growing recognition at the highest levels. Now we need unwavering execution.

This article is authored by Dr Sunita Tandulwadkar, president, Federation of Obstetric and Gynaecological Societies of India (FOGSI).