Neelam MohanI Ensuring Healthy Start to Life: Why Fixing Adolescent Anaemia Is Urgent

The Government of India’s flagship “Anaemia Mukt Bharat Abhiyaan” recently added low birth weight babies, born under 2.5 kg, to the programme’s ambit for the first time.

Nearly one in five babies born in India are born with low birth weight. This puts babies at high risk of developing anaemia within the first few months of life, which can affect a child’s cognitive development and performance at school. Beyond the immediate risks of infection and malnutrition in infancy, research increasingly links low birth weight to a higher lifetime risk of non-communicable diseases such as heart disease, chronic kidney disease and metabolic disorders. These conditions often surface only decades later but can severely impact the quality of life. Given the severe impact of anaemia, addressing the issue in these infants early is, therefore, an investment that pays off well into adulthood.

Iron deficiency and severe anaemia in women, before and during pregnancy, can restrict oxygen and nutrient delivery to the foetus. This frequently leads to preterm delivery or intrauterine growth restriction, resulting in a low birth-weight baby. The fact that one in every two pregnant women in India is anaemic means addressing this is an absolutely critical issue that impact future generations. Correcting anaemia before pregnancy ensures a healthy start for newborn.

It is in this context that the release of the Anaemia Mukt Bharat (AMB) Abhiyaan operational guidelines, in June 2026, by Union health and family welfare minister J.P. Nadda, assumes particular significance. Given the urgent need to address anaemia before pregnancy, the new guidelines’ strengthened focus, among the many important advancements, on addressing anaemic in adolescents stands out as one of the most consequential.

Anaemia lies at the intersection of child health and maternal health, with adolescence serving as the critical bridge between them. With nearly six in ten adolescent girls and one in three adolescent boys affected by anaemia, the challenge extends across the adolescent population.

The revised guidelines rightly recognise that anaemia during adolescence is not simply a concern for the present. It is a determinant of future maternal health, birth outcomes and the well-being of the next generation. Addressing it early creates benefits that extend across the life course and starting during adolescence is pivotal.

As a paediatrician, I rarely encounter adolescent anaemia as a medical emergency. Rather, it looks like a slipping report card. A teenager who used to excel at sports, now sits out the games. Or a once eager learner often loses focus during classes. Fatigue is mistaken, time and again, for laziness or a difficult phase. Left unrecognised, these seemingly ordinary symptoms can affect learning, physical development, productivity and long-term health.

The revised guidelines respond to this reality by embedding adolescent anaemia within the broader framework of the National Health Mission. Rather than treating it as an isolated condition, they integrate prevention, screening, treatment and counselling into existing school health services, adolescent health programmes and community-based platforms. This life-course approach acknowledges that improving adolescent health requires sustained engagement, not one-time interventions. The programme itself reflects a welcome evolution.

The 6x6x6 strategy now becomes 7x7x7, with the addition of a new beneficiary group, a new intervention, and an additional institutional mechanism. Equally significant is the expansion of the T3 approach of Test, Treat and Talk into a T4 approach that adds Track, placing sustained follow-up on par with counselling, diagnosis and treatment.

The operational protocol laid out for adolescents is comprehensive and field-ready. Going forward, annual screening will take place through Rashtriya Bal Swasthya Karyakram (RBSK) Mobile Health Teams in schools and anganwadi centres, and opportunistic screening will be conducted by frontline health workers. A structured treatment pathway using the IFA Blue tablet has been advised as well as defined timelines for retesting. Most importantly, a clear referral pathway that ensures every adolescent completes their treatment successfully will also be implemented. The line-listing of anaemic adolescents, shared with ANMs and school teachers, will further strengthen the continuum of care.

Another welcome addition is the introduction of “Eating Right” as a dedicated intervention.

Iron supplementation alone cannot solve anaemia if dietary habits remain unchanged. By combining treatment with sustained nutrition counselling and promoting iron-rich diets during adolescence, the guidelines acknowledge that lasting improvements require behaviour change alongside clinical care.

In addition, the Abhiyaan’s emphasis on Jan Bhagidari, or community participation, will encourage active involvement of parents during parent-teacher meetings, the vigilance of school teachers, and the reinforcement of healthy nutrition practices at the community level.

These are all important steps toward translating this clinical protocol into sustained, everyday practice.

The Indian Academy of Paediatrics warmly welcomes these revised operational guidelines and reaffirms its commitment to supporting the government’s efforts to strengthen adolescent, maternal and child health. As part of this commitment, the Indian Academy of Paediatrics is working to strengthen awareness and preventive action on adolescent health through its network of paediatricians across the country. Through this, we hope to complement the government’s efforts by encouraging healthier practices at the community level.

Breaking the cycle of anaemia requires us to intervene before young girls become mothers. By placing adolescents at the centre of India’s anaemia strategy and combining testing, treatment, nutrition counselling and sustained tracking, the revised AMB Abhiyaan offers an opportunity to improve not only the health of today’s adolescents, but also that of the generations that will follow. Few investments in public health have the potential to deliver such enduring returns.

Dr Neelam Mohan is the president of the Indian Academy of Paediatrics