Women who feel constantly tired are rarely the first to suspect that something may be medically wrong.
She adjusts, pushes through, and assumes it is the pace of life.
For many women, this may be anemia.
Anemia occurs when the body does not have sufficient healthy red blood cells to carry oxygen to its organs and tissues. As the oxygen levels decrease, the body feels constantly low on energy.
It is a worldwide health issue. In India, more than 50% of women are estimated to have anemia. However, Indian women are more affected, often due to poor nutrition, higher iron needs, and lifestyle factors.
According to the National Family Health Survey (NFHS-5), approximately 57% of Indian women aged 15-49 years are anemic.
Awareness has grown, programs have run, and supplements have been distributed, yet the numbers remain the same for over a decade.
For over a decade, anemia in Indian women has stayed high. The treatments exist, but it is still persisting because the circumstances that drive it - poor nutrition, gender inequality, and limited healthcare access have remained largely unchanged.
Women are more affected than men due to higher iron needs.
According to the World Health Organization (WHO), anemia affects:
40% of children between 6–59 months of age
30% of women between ages 15–49
37% of pregnant women globally
Anemia in Indian women is not completely a medical condition. It is shaped by what women eat, how their health is prioritized, and whether they can access care, alongside the physical demands of menstruation and repeated pregnancies.
The groups most affected are adolescent girls, pregnant women, and women after childbirth - they share one thing in common. Their nutritional needs are highest at the stages when those needs are least likely to be met.
Iron, Vitamin B12, and folate are all essential for the production of healthy red blood cells. A deficiency in any one or in combination can cause or worsen anemia.
Many Indian women consume enough food but not enough of the required nutrients.
Plant-based diets, which are predominant across India, provide non-heme iron, which is absorbed less efficiently by the body than iron from animal sources.
Without proper dietary planning, this gap is easy to miss and harder to correct.
In an interaction with MedBound Times, clinical dietitian Nithisha Komaraboina, HCPC Registered (UK), Critical Care & Pediatric Nutrition, shared that anemia in Indian women is driven by both diet and lifestyle factors.
“Nutritional deficiencies in Indian women often come from diets low in iron, B12 & protein, compounded by irregular meals, excess tea/coffee & poor absorption.
Many women prioritize family over their own nutrition, while chronic stress and workload further deplete reserves, increasing vulnerability to anemia.”
The problem is not always food scarcity. More often, it is about who eats first, what they eat, and how much priority is given to their nutritional needs specifically.
Women lose blood through menstruation every month. Over years, when dietary intake does not adequately compensate for this loss, the depletion accumulates. Heavy or prolonged periods accelerate this significantly.
Pregnancy places further demands on the body. Blood volume increases, iron requirements nearly double, and nutritional needs rise across multiple nutrients simultaneously.
If pregnancies occur with no proper gap, the body will have no sufficient time to rebuild depleted stores before the next cycle of demand begins.
Understanding these categories is important because symptoms and treatment needs vary depending on the severity of the condition.
In an interaction with MedBound Times, Dr. Mekhala Iyengar, a gynecologist and IVF specialist, shared
"Repeated physiological demands like recurrent pregnancies, menstrual blood loss, and poor spacing between births further deplete iron stores, and social neglect impacts detection."
By the time a woman presents with symptoms, the deficiency is rarely recent. It has typically been building over months or years of unmet nutritional needs.
Access to nutritious food, healthcare, and supplementation is uneven across India. But beyond access, the social dynamics within households shape women's health in ways that are harder to measure and harder to address.
Dr. Banisha Sulthana, MBBS, MD, a public health expert, shared with MedBound Times that she identified the key socioeconomic constraints from her clinical and community experience:
The main socio-economic constraints among Indian women that I have observed during my clinical and community exposure are poor dietary diversity.
In India, we always have a custom of prioritizing men and children when it comes to quality and nutritious food; women settle for the leftover diet and frequent intake of chai, which interferes with iron absorption, and recurrent infections like worm infestations, which are very prevalent in India.
Early marriage & repeated pregnancies, and even though iron supplements are distributed free of cost by the government, many pregnant women are not taking them regularly. Some are not even aware of it. Limited autonomy and low health literacy among Indian women are also significant causes.
Dr. Banisha Sulthana, MBBS, MD, Public Health Expert
This is echoed by Dr. Pooja Nilgar, public health expert and PhD scholar, who shared with MedBound Times in an interaction,
In India, the risk of anemia is higher among women mainly due to poverty, poor diet, and gender inequality, with food served to the male members of the house before the female members.
Low awareness and limited access to healthcare facilities, as women are dependent on male family members to take them to hospitals. We can call patriarchy an indirect determinant of the health of women in India.
Nutrition is the most common driver of anemia in Indian women, but infections and underlying diseases are significant contributors that are frequently underestimated.
In addition to infections such as HIV and malaria, several other medical conditions can contribute to anemia.
Hookworm infestation remains an important cause in some regions because chronic intestinal blood loss can gradually deplete iron stores.
Chronic kidney disease may reduce the production of erythropoietin, a hormone necessary for red blood cell formation.
Genetic blood disorders such as thalassemia and sickle cell disease can also cause anemia, while conditions like hypothyroidism and celiac disease may contribute through impaired nutrient absorption or altered red blood cell production.
Adding a clinical perspective, MedBound Times spoke with Dr. Ashwin Panikar, a general physician, who explained the mechanisms clearly:
Some infections, like HIV and malaria, not only destroy currently circulating red blood cells (hemolysis) but can also suppress bone marrow, reducing the production of new red blood cells.
Infections in kidneys directly affect production of red blood cells, as the kidneys release erythropoietin (EPO), which signals the bone marrow to produce red cells.
Chronic infections can also indirectly cause anemia by creating micronutrient deficiencies in iron and folic acid, the key components in red cell production.It is important to identify and treat the underlying cause, not just the low iron levels.
Dr. Ashwin Panikar, General Physician
It is important to understand that supplementing iron in the presence of an untreated infection will produce limited results.
Anemia secondary to infection requires treatment of the infection itself.
Symptoms like fatigue, weakness, dizziness, and pale skin are easy to overlook. They are the same symptoms women attribute to a busy day, poor sleep, or simply not eating on time.
This is exactly why anemia goes unnoticed for so long.
When any woman in the family mentions tiredness, we often tell her to take rest. Even sometimes, when she mentions it to a doctor, she is told the same. The symptom is acknowledged but rarely investigated.
A complete blood count is a routine, inexpensive blood test that can confirm or rule out anemia within hours, which is widely available. Yet it is rarely done proactively.
Most women find out they have anemia during a pregnancy checkup or before a surgical procedure, not because someone thought to screen for it earlier.
By the time a diagnosis is made, the deficiency is often moderate to severe. At that stage, dietary changes alone are not enough.
And the complications that could have been prevented with an earlier test are already in play.
Because anemia affects such a large proportion of the population, India has adopted a nationwide strategy known as Anaemia Mukt Bharat (AMB) to address the problem systematically.
The Government of India launched Anaemia Mukt Bharat (AMB) as a national strategy to reduce anemia prevalence systematically.
Its framework addresses anemia across six population groups through six interventions supported by six institutional mechanisms.
Children between 6-59 months, children between 5-9 years, adolescent girls and boys, pregnant women, lactating mothers, and women of reproductive age.
These groups represent the full range of vulnerability, from early childhood through the reproductive years.
Iron and folic acid supplementation, deworming, behavior change communication campaigns, regular testing and treatment, food fortification, and addressing non-nutritional causes of anemia.
Including non-nutritional causes is significant as it acknowledges that iron tablets alone cannot resolve anemia, which is driven by infection, chronic illness, or absorption disorders.
A reliable supply chain, monitoring and evaluation systems, coordinated action across ministries, training of frontline health workers, community engagement, and investment in research and innovation.
The framework's strength lies in recognizing anemia as a multi-cause problem requiring simultaneous action across nutrition, healthcare delivery, education, and systemic support.
Whether implementation consistently matches this ambition varies by state and region, but the strategy represents the most comprehensive national approach to the problem to date.
Anemia, if left untreated, does not stay mild. Over time, low hemoglobin means the body's muscles and organs receive less oxygen than they need, affecting energy, concentration, and physical capacity in ways that accumulate quietly.
In pregnant women, the consequences are more serious. Severe anemia during pregnancy is linked with a higher risk of heavy bleeding during childbirth, preterm birth, and low birth weight.
Babies born to anemic mothers are also more likely to have low iron stores at birth, putting them at risk for delayed development in the early years.
The impact reaches beyond the individual woman. Across a population, chronic anemia means lost productivity, complicated pregnancies, and children who begin life already at a nutritional disadvantage.
Diet is the first and most accessible step for women with mild iron deficiency. The good news is that many of the right foods are already part of the Indian kitchen.
They just need to be eaten consistently and in the right combinations.
Leafy greens like palak, methi, drumstick leaves (moringa)
Pulses like rajma, chana, masoor dal, moong
Millets like ragi and bajra are particularly iron-dense
Jaggery, a small daily quantity provides usable iron
Dates, raisins, figs in moderate amounts
Sesame seeds (til), which are iron-dense and easy to add to daily cooking
Iron from plant sources is absorbed more effectively when consumed alongside vitamin C.
A squeeze of lemon over dal, raw amla, or tomato alongside a meal supports absorption. Tea and coffee consumed immediately after meals significantly reduce iron absorption - a habit worth reconsidering, particularly for women who already have low iron stores.
Cooking in iron vessels, a traditional practice in many Indian homes, has shown modest benefit in increasing the iron content of cooked food.
These dietary measures support iron levels over time. They are not a substitute for medical treatment where anemia has already developed.
Diet helps, but only up to a point. When symptoms have been present for more than a few weeks, or when they are getting worse rather than better, a blood test is the right next step, not a dietary adjustment.
If these symptoms are persistent, then immediate medical attention is needed.
Persistent fatigue that does not improve with rest
Breathlessness on minimal exertion
Frequent dizziness or fainting
Pale skin or pale inner eyelids
Fast or irregular heartbeat
Unusually heavy menstrual periods
A complete blood count is the standard first test. It is simple, affordable, and available at most diagnostic centers. Depending on results, further tests like serum ferritin, vitamin B12, or folate levels may be needed to identify the exact cause.
This actually matters because the treatment depends entirely on the cause.
Iron deficiency, B12 deficiency, and anemia from chronic illness or infection are managed differently. Treating one when the other is the actual problem will not help.
An important caution: Iron supplements should not be taken without a confirmed diagnosis. Excess iron has its own health risks. A blood test takes the guesswork out.
Anemia affects more than half of Indian women. The causes are understood, the interventions exist, and the condition is treatable, usually with straightforward measures when caught early.
What delays it is not a lack of solutions. It is the normalization of symptoms that should not be normal.
Fatigue, breathlessness, and dizziness are not simply the cost of a busy life. They are worth investigating.
A hemoglobin test is simple, inexpensive, and available at most diagnostic centers.
For adolescent girls, women with heavy periods, pregnant women, and new mothers, getting tested is not an overcaution. It is basic, overdue preventive care.
Anemia does not resolve on its own. Early detection and the right treatment make the difference.
Anemia is one of India's most common health problems, yet it is also one of the most preventable and treatable.
Recognizing persistent fatigue as a warning sign rather than a normal part of life may be the first step toward breaking a cycle that affects millions of women across generations.
World Health Organization. Anemia. Available from https://www.who.int/health-topics/anaemia
Ministry of Health and Family Welfare, Government of India. Anemia Mukt Bharat Strategy. Available from: https://anemiamuktbharat.info/programme/about
Baird-Gunning J, Bromley J. Correcting iron deficiency. Nutrients. 2024. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11174870/
National Family Health Survey (NFHS-5). National Family Health Survey (NFHS-5), 2019-21: India Fact Sheet. Mumbai: International Institute for Population Sciences (IIPS) and ICF, 2021. https://dhsprogram.com/pubs/pdf/FR375/FR375.pdf
