Ruby^1*, Anil¹, Lalit Sharma²

¹Research Scholars, Department of Economics, Guru Jambheshwar University of Science & Technology, Hisar, Haryana, India

²Assistant Professor, Department of Economics, Guru Jambheshwar University of Science & Technology, Hisar, Haryana, India

Corresponding Author: Ruby, Research Scholars, Department of Economics, Guru Jambheshwar University of Science and Technology, Hisar, Haryana.

Received: 25 February 2025; Accepted: 27 February 2025; Published: 10 March 2026

Article Information

Citation: Ruby, Anil, Lalit Sharma. The Burden of Anemia: A Study of SC Women's Health in Haryana. Journal of Women’s Health and Development. 9 (2026): 18-22.

DOI: 10.26502/fjwhd.2644-288400146

Abstract

Keywords

Anemia; Women; Nutritional status; Health; etc

Article Details

Introduction

Anemia is a major public health issue, especially among women in Haryana, India. At its core, anemia occurs when the body lacks enough red blood cells or hemoglobin, which reduces the blood’s ability to carry oxygen. When hemoglobin is below normal, not just health but also productivity and well-being are impacted [1]. Anemia is still a worldwide problem, and the most vulnerable groups are childbearing women of reproductive age and young children [2]. Its impact does not stop at personal well-being; socioeconomic development may be hampered, and quality of life decreased by anemia. Nutritional anemia is one of the most prevalent health disorders among Indian women [3]. It is a result of a combination of factors like improper diet, recurrent infection, chronic disease, and deficiency of rare genetic elements. Among them, the biggest culprit is iron deficiency, which occurs most frequently due to inadequate intake of iron-containing food or defective utilisation of dietary iron. Other deficiencies of vitamins and minerals like folate, vitamin B12, and vitamin A are also an important contributory factor for the this [4].

The World Health Organization (WHO) categorizes anemia on the basis of hemoglobin and physiological status, age, and sex [5]. Pregnancy is of most significance in the context of anemia because it increases preterm labour, low birth weight, and maternal death risks [6]. The symptoms are very common, such as tiredness, dizziness, and breathlessness which can affect the way of life and health of a woman significantly. Anemia affects nearly one-quarter of the population worldwide, and it affects women and children disproportionately [7, 1,8]. In developing countries, 35% to 75% of pregnant women suffer from anemia [9]. Anemia is directly responsible for over 115,000 deaths at childbirth and nearly 600,000 antenatal deaths every year worldwide [10]. The consequences of anemia extend far beyond a matter of health. Anemia weakens women physically and mentally, lowers their resistance to disease, and diminishes their capacity to learn, earn, and care for their families. Anemia is a poverty trap and ill health passed from generation to generation. Eradication of anemia among women is not only required to improve the health and well-being of individuals as well as women's equity, family welfare, and India's sustainable development.

Anemia is a significant public health problem in India, which is driven by low diet diversity, poverty, gender inequality, and limited access to care. National initiatives such as Anemia Mukt Bharat, which focuses on the prevention of anemia through supplementation and mass education, have been accompanied by uneven gains. In Haryana and other places, women's health remains bad with a high prevalence of pregnancies, short birth intervals, malnutrition, and parasitic diseases [11]. These add to the widespread prevalence of anemia, especially in marginalized and poor groups. Inter-caste inequality characterized early childbearing. The most disadvantaged were Scheduled caste women, although this gap was narrow [12]. Prevalence of anemia in poor and poorest of the general women were lower than the women belonging to richer and richest categories of SC&ST, OBC [13]. The poorly educated and poor women and socially disadvantaged groups were most affected by anemia during the last two decades [14]. Anemia in women elevates maternal morbidity and pregnancy complications like stillbirth, low birth weight and preterm labour and high maternal mortality [15]. Maternal anemia also impacts children in the generations to come through stunting and delayed intellectual development [16]. It has been found that the principal determinants of the high morbidities and mortality among Indian women of reproductive age are perinatal and nutritional [17]. Despite policy actions conventionally targeting iron and folic acid supplementation, recent studies underscore the need to address a palette of micronutrient deficiencies and determinants of anemia holistically [18,19]. Recent evidence suggests that anemia is established by a sophisticated interaction of dietary and non-dietary factors, such as poverty, hemoglobinopathies, and infections, that simultaneously inform dietary iron intake's impact on the prevalence of anemia [20, 21]. Beyond its contribution to health, anemia is extremely costly, incurring losses in productivity and costing the public health systems [22]. Since it realized its significance globally, the World Health Organization (WHO) was actively in pursuit of decreasing the occurrence of anemia among women of reproductive age by 50% by the year 2025 [23].

In India, there have been various government schemes implemented for the treatment of anemia, like Anemia Mukt Bharat scheme that addresses iron and folic acid supplementation, deworming, and the creation of awareness. Although Integrated Child Development Services (ICDS) program is also targeted towards women and adolescent girls by providing supplementary nutrition, health education, and supplementation on a regular schedule. Despite all such efforts, the speed has remained slow and jerky on account of implementation gaps, social disparities, and poor coverage among weaker sections like the Scheduled Castes (SCs) and the Scheduled Tribes (STs). There is evidence to show that anemia-correcting interventions are most effective when nutrition interventions are followed by all-around social and economic interventions like education, women's empowerment, and vocational training schemes. Such multidimensional interventions address not just the biological causes of anemia but also the support systems on which it thrives and provide a longer-term solution to women's better health and the eradication of caste discrimination in India. This exercise presents anemia prevalence in 15-49-year-old women by caste (SC, ST, OBC, others). The STs are not present in Haryana, and hence the three categories, i.e., SC, OBC, and Others, have been taken into consideration for the study.

Methodology

The present study is based on secondary data taken from the National Family Health Survey (NFHS) editions 4^th and 5^th, which were conducted by the Ministry of Health and Family Welfare (MoHFW) with support from the International Institute for Population Sciences (IIPS), which gives nationally representative data on different health and socioeconomic indicators. These surveys are helpful in estimating the incidence and trends of anemia among various population groups, including SC women. The research focuses on women of reproductive age, specifically SC women in Haryana.  According to the WHO, when the amount of hemoglobin in red blood cells is lower than normal or when there are fewer red blood cells than typical, it causes anemia. Hemoglobin is necessary for the blood to transfer oxygen to the body's tissues; if a person has too few red blood cells or not enough hemoglobin, the capability of blood to transfer oxygen would be diminished. The study used four categories, such as any anemia, mild, moderate and severe, suggested by the World Health Organisation. When a woman's haemoglobin is less than 12 gm per 100 ml of blood, the woman is considered anemic.

The study used cross-tabulation to examine the percentage incidence of anemia among women of reproductive age (15-49). This allows the study to explore patterns and disparities in anemia among women based on caste. The study used ArcGIS software to map the disparities among women of different caste categories. The study does not consider Scheduled Tribes because these do not exist in Haryana.

Results

Table 1: Anemia in SC Women (15-49).

This table examines the prevalence of anemia among Scheduled Caste (SC) women across 22 districts of Haryana, using data from the National Family Health Surveys NFHS-4 (2015–16) and NFHS-5 (2019–21). The indicators categorize anemia into four levels of severity: severe, moderate, mild, and any anemia. Comparison between the two survey rounds is to identify in which way the status has improved or worsened and where there has been improvement or decline. On a quick glance, any anemia among SC women would appear to have altered very marginally. While 65.91% were anemic in NFHS-4, in NFHS-5, it was 64.99%. But a second glance puts a darker shade to the story. Though no variation was observed in the prevalence of any anemia, the severity of anemia is greater. The incidence of women with mild anemia dropped to as high as 43.9% to 25.02%. Meanwhile, cases of medium anemia have surged from 20.27% to 35.14%, while severe anemia has nearly doubled from 1.72% to nearly 4.83%. This would indicate that although fewer women are currently under treatment for mild anemia, more women are currently under treatment for the severe types of anemia. Even inequalities at the district level are seen to be evident. Charkhi Dadri, Rohtak and Gurgaon show the maximum anemia rates in the latest survey, with over 75% of the women falling prey to it. These are the sectors that need to be put in the limelight most urgently in the sector of health and nutrition schemes. But Ambala and Panchkula have the lowest percentages of 51% to 57% which show that intervention in these sectors can be more motivational or women can be easily reached by healthcare and nutrition. Severe and moderate anemia increased exponentially in Hisar and Sirsa, while modest increases in total are noted by Ambala and Panchkula while minimal increases are seen in severe ones. Overall, the figures reflect a multifaceted picture. Haryana is not seeing a sudden decline in the overall number of SC women with anemia, but does see a transformed nature to the problem. A decrease in mild anemia may proof that better treatment and earlier detection are happening, but indicates that further advanced health and nutrition issues are yet to be addressed. For actual progress to happen, a district-specific plan of action, specifically, high-burden districts such as Karnal, Kaithal, and Sirsa, incorporating treatment as well as prevention, must be developed. Successful anemia control will ultimately include not only medical management but also improved overall diet quality, knowledge, and social support systems for women.

Table 2: Anemia in OBC Women (15-49).

The table explores anemia prevalence amongst OBC women in 22 Haryana districts using two NFHS rounds — NFHS-4 (2015–16) and NFHS-5 (2019–21). Anemia prevalence overall amongst OBC women appears fairly consistent at a glance since it goes up steadily from 61.71% for NFHS-4 to 59.67% for NFHS-5. But such a small discrepancy covers up a far greater issue. Mild anemia declined from 42.62% to 24.88%, though this decline has been offset by a vast rise in moderate anemia (17.73% to 31.35%) and nearly a three-fold rise in severe anemia (1.36% to 3.44%). These are trends that have produced a situation where fewer women of today are suffering from the mildest disease, but many more women are surviving anemia in its most lethal phases. Particularly, the issue has not declined but increased. There are differences between districts as well. NFHS-5 from Panipat, Charkhi Dadri, and Gurgaon show the highest rates of anemia, indicating endemic nutrition and health issues within these districts. Ambala and Faridabad show two of the lowest rates of anemia at 49.14% and 54.05%, which may be due to improved settings or improved coverage of nutrition. All the remaining districts, such as Panipat, Sirsa, and Bhiwani, however, have demonstrated a serious rise in moderate and severe anemia, suggesting local determinants like availability of food, availability of health centres, or level of awareness affecting trends. Overall, the results prove that total prevalence among anemic OBC women of Haryana has not increased considerably, but severity of the disorder has solidified.

Table 3: Anemia in Other Women (15-49).

The table considers the prevalence and the changing trends of anemia in women belonging to social groups which fall under the "Others" category i.e., they are not SC, and neither are they OBC. Overall, in total, the prevalence of anemia among such women has declined by a margin, decreasing from 59.25% in NFHS-4 to 57.36% during NFHS-5. On initial glance, this could seem to be a fine trend, but on closer observation, there is a sterner trend. The percentage of women with mild anemia has dropped, from 42.72% to 24.77%, but moderate anemia rose from 15.59% to 29.27%, and severe anemia has nearly four-fold, from 0.94% to 3.31%. In effect, though fewer women are anemic in total today, more women who still suffer from anemia are at more severe levels. There can also be district variations. Bhiwani and Charkhi Dadri have the highest NFHS-5 anemia rates of 66.21 and 68.92%, respectively, and these indicate ongoing nutrition and health issues. Conversely, Sonipat and Ambala showed one of the lowest, i.e., 40% to 50%, rates, showing relatively healthier systems or better access to health care and nutrition. A few of the other districts, for example, Sirsa and Rohtak, continue to show high rates of moderate and severe anemia, showing that despite policy interventions, reasons such as poverty, food insecurity, and a lack of grassroots-level awareness still remain a leading causative factor. Nutrition education to strengthen women, increasing the availability of iron-containing foods, and integrating anemia prevention within broader maternal programs have the potential together to breed genuine, sustained change. Finally, the results indicate that although Haryana has made some behind-the-scenes gains in lowering overall anemia among women within 'Other' social segments, the severity of the issue has deepened. The issue now is not merely about reducing numbers, but how to deal with the harsher and more cumulative realities behind the numbers so that women are no longer merely surviving anemia, but living healthier, stronger lives.

Figure 1: Mild Anemia among Women (15-49) in Various Social Groups (NFHS-4).

Geographical trends in NFHS-4 data show that mild anemia among women widely differ by location and caste. The issue is worse for central and western districts SC women in Hisar, Kaithal, and Sirsa, and OBC women in Karnal, Jind, and Kurukshetra. Meanwhile, districts such as Palwal and Gurugram are less common with respect to mild anemia. Women from Other groups have a more uniform pattern, but they too have fairly high rates in certain regions. Anemia in general is very common in the state as a whole, but has extremely debilitating effects on SC and OBC women, indicating the persistent consequences of social and economic disparities. Such results indicate the need for special, region-specific health programs that not only enhance nutrition but also attempt to deal with the underlying structural determinants of these differentials. (Data were not available for Charkhi Dadri at the time of the survey)

Figure 2: Moderate Anemia among Women (15-49) in Various Social Groups (NFHS-4).

NFHS-4 maps indicate distinct geographical and caste-wise patterns of women's moderate anemia in Haryana. The ailment is largest in the western and southern regions of the state, i.e., Bhiwani, Mahendergarh, Rewari, and Hisar districts, where over one-fifth of women are affected by moderate anemia. The ailment is the largest among Scheduled Caste (SC) and Other Backward Class (OBC) women. Contrarily, the northern regions, such as Panchkula and Ambala, have very low rates, reflecting improved nutrition and health care. Women of the Other social group have a more evenly distributed incidence, although moderate anemia is prevalent in some southern and western regions. Overall, the maps indicate that moderate anemia is a significant issue, closely associated with local disadvantage and social inequality. To put an end to this problem, there will have to be interventionist public health action on high-burden blocks and better nutrition and care access for poor women. (Charkhi Dadri data was unavailable at the time of the survey)

Figure 3: Severe Anemia among Women (15-49) in Various Social Groups (NFHS-4).

The NFHS-4 maps show sharp regional and caste-wise differences in severe anemia among women of Haryana. While the overall prevalence is low, severe anemia prevails in the southern and western districts, namely Rewari, Bhiwani, Mahendergarh, and Sirsa, and also in Scheduled Caste (SC) and Other Backward Class (OBC) women. Conversely, northern regions like Panchkula, Ambala, and Karnal have extremely low prevalence levels, typically below 1%, reflecting improved nutrition and health. Women from Other social classes are having the lowest severe anemia, with hardly any districts reporting more than 2.5%. The maps typically note that severe anemia continues to be geographically and socially clustered, and this reflects the long-term effects of caste-based socioeconomic inequities. These high-burden areas and risk groups need special programs of nutrition, health care access, and social equality. (No data were available for Charkhi Dadri at the time of the survey).

Figure 4: Mild Anemia among Women (15-49) in Various Social Groups (NFHS-5).

The map indicates the extent to which mild anemia is prevalent among women of all social groups, although the severity of this varies across states. NFHS-5 statistics indicate that SC and OBC women still report slightly higher cases of mild anemia, particularly from central and southern districts, where prevalence is largely above 27 percent. In comparison, the north and northeast regions of the state report lower proportions. Although mild anemia is a lesser condition than others, the prevalence shows that a high percentage of women still experience underlying malnutrition. The persisting regional patterns at all social levels imply that geography and local environmental conditions are significant determinants of women's health outcomes, and this indicates the need for area-based and socially targeted nutrition interventions.

Figure 5: Moderate Anemia among Women (15-49) in Various Social Groups (NFHS-5).

The map indicates that moderate degree anemia is a common health condition among women from every social group, according to NFHS-5 figures. It prevails among SC and OBC women, with all the central and most of the state's southern districts reporting above 40 percent. Moderate anemia rates are not prevalent in northern women and certain eastern districts. Though variation within patterns for populations is subtle, the cross-sectional perspective delineates clear social and geographical differentials. Consequences are that women's health remains influenced by living conditions and access to nutrition, and interventions are necessary to be supplied where risky settings and socially disadvantaged groups are found.

Figure 6: Severe Anemia among women (15-49) in Various Social Groups (NFHS-5).

The map shows where women frequently suffer from severe anemia in districts and classes in the state according to NFHS-5 findings. Indeed, their place of residence and class do seem to matter. SC women have the highest proportion of severe anemia in central and south districts, where it is most common. For OBC and Other women, the numbers are lower in number but the regional patterns are similar — lower rates in northeast and north regions. Generally, the map is picking up social and regional variations, and some communities and regions have much larger effects than others. They illustrate the requirement of targeted health interventions and nutrition programs with special emphasis on socially disadvantaged groups and high-risk areas.

Table 4: Anemia Trends, CADR, and 2025 projection.

Figure 7: Anemia Trends and 2025 projection.

The following figure and table indicate the trend of women's anemia rate in NFHS-4 and NFHS-5 based on compound annual decrement rate (CADR). Ambala, Hisar, Rohtak, and Jhajjar districts indicate phenomenal progress, indicating a comparatively superior programme and better health outcomes. But districts such as Panchkula, Kurukshetra, Kaithal, and Sonipat indicate the decline in performance, indicating upcoming gaps and issues in the health facilities, community mobilisation and policy implementation. Disparity in the difference of prevalence and CADR values indicates unequal improvement across districts in Haryana. Even though some districts are progressive but several districts remain far from achieving the 2025 targets, which were set to reduce anemia by half. The findings suggest that there are intrastate disparities, needs region region-specific policies to reduce anemia prevalence to ensure equal and sustained progress.

Conclusion

In Haryana, according to NFHS-4 (2015–16) and NFHS-5 (2019–21) estimates, Anemia in women is a tale of successive increase with intergenerational piling up of concern. Although the percentage of anemic women overall has gone down slightly by caste groups — from 66.1% to 65.0% among Scheduled Caste (SC) women, 61.3% to 59.9% among Other Backward Class (OBC) women, and 59.5% to 57.9% among women belonging to Other social groups — its severity has gone up in almost all groups. Fewer women are being labelled as mildly anemic, and more have moderate and severe anemia, which indicates that although there is some improvement in detection and initial management, the causes of anemia are not yet being well-addressed. Geographically, the issue is not even. All such districts as Karnal, Kaithal, Hisar, and Jind still have the highest anemia prevalence, sometimes reaching 68–70%, whereas Ambala and Panchkula always record the lowest. These discrepancies are the result not so much of differences in geography as it applies to diet and access to healthcare but of the social inequality upon which women's health also rests. Throughout the state, SC women suffer the most, followed by OBC and Other categories, a reminder of how economic class and caste continue to exert pressure on health. Although there have been national initiatives such as Anemia Mukt Bharat that have enhanced the coverage of treatment and information, these have not been universal for all strata of people. Women from poor and socially and economically weaker sections of people continue to be exposed to restriction in the quality of diet, poverty, and restricted access to health care. In all these gaps, Haryana must extend more targeted, locally tailored interventions beyond the administration of iron supplements. Prevention of anemia would thus involve spending on women's nutrition, the intensification of health outreach at a mass level, and the correction of the structural inequities that are perpetuating ill health among poorer segments. Briefly, while there has been some betterment on the part of Haryana in reducing the incidence of anemia, the issue has now surfaced as one of equity rather than prevalence and one of severity. Control of anemia in the coming years is not so much a question of improved statistics as it is of guaranteeing all women, class or caste, an equal right to a healthy and well-fed existence.

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