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In spite of multiple interventions like health education, nutrition and iron supplementation and de-worming medication, anaemia during pregnancy continues to threaten the well being of women during pregnancy and safety during delivery. It still remains a major direct and indirect cause of maternal morbidity and mortality. It is a well known fact that large percentage of pregnant population is diagnosed as
anaemic at various health care facilities. As per WHO criteria, approximately 70-80 percent may be labelled as anaemic.
Most of the cases of anaemia are due to nutritional deficiency and some small percentage are due to haemo-globinopathies in some specific areas. Anaemia is mostly prevalent in lower socio economic class and in women who are less educated, poor, staying in rural and remote areas or in slum areas ,who are married in teenage and who are multipara and continue to reproduce for want of male child with short interval between pregnancies. Ignorance towards own health and non compliance to advice of the doctor are contributory factors. Non-availability and inaccessibility of health care services, lack of antenatal care and iron supplements also contribute to anaemia during pregnancy. Routine diet that is poor in quantity and quality is the main factor responsible for anaemia,vitamin and mineral deficiencies.
The ill effects of anaemia on pregnant women and her growing fetus are well known. Anaemic women are prone for pre eclampsia ,spontaneous abortions, premature delivery, post partum haemorrhage, inadequate lactation, puerperal infection and thrombo-embolic manifestations. The wellbeing and growth of the intrauterine fetus gets affected adversely, leading to intrauterine growth restriction, low birth weight and its related complications. Obstetric complications like ante-partum and post partum haemorrhage in women, who are severely anaemic, pose risk of maternal death even at tertiary care hospital.
At tertiary care hospitals, these women who are often un-booked, report to labour room with haemoglobin less than 5 grams percent. They create a challenging situation for Obstetrician. These women also have some co morbidities associated with severe anaemia, which further complicates the picture. There are other socio economic issues like non availability of male relatives, who can take responsibility of bringing medicine, blood and blood products as life saving measures. These women are left to the mercy of the doctors on duty and the hospital. If the hospital does not have blood bank or if there is inadequate stock of blood of specific group in the blood bank, the life of the woman is in danger. This is very particular in case of negative blood group.
Even after 70 years of independence, we are still fighting for combating malnutrition and anaemia during pregnancy. It is so disturbing to see a helpless young woman, lying on hospital bed with life threatening complications related to severe nutritional anaemia. Why the prevalence of anaemia still has not come down, in spite of different measures being adopted by the government at various educational and health care facilities, supporting various phases of women’s life is a million dollar question.
Sir Your commentary on anaemia in pregnancy raises a very pertinent issue . Anaemia is not only a deficiency disease but also linked to dietary fads, myths and beliefs . Often ignorance regarding intake of iron rich foods which are available aplenty in rural India 🇮🇳 compounded by worm infestation and menstrual blood loss go a long way in contribution to the problem in expectant mothers . Anaemia is not a problem of the poor or rural areas it is very much prevalent in higher socioeconomic strata of the society as shown in numerous studies . A recent QI initiative in Anji Block of Wardha District by NQOCN with rural ASHA workers led to a startling root cause , most women were averse to taking the hospital supply of Iron Folic Acid Tablets due to myths about its tolerance and acceptability. You have rightly mentioned that the problem is grave and needs immediate attention . In our zeal to focus on more complex issues of healthcare we often forget the basic easily fixable conditions which can be potentially dangerous for the expectant mother and her fetus and newly born baby . Active partnership with community with focus on health education and dietary supplementation would go a long way in addressing this issue using quality improvement methodology . Vikram Datta Director Professor Dept of Neonatology Lady Hardinge Medical College New Delhi , India