Climate crisis and food insecurity are driving anemia in India

Shalini Sonavane collapsed late last year while cleaning the floor of her house in the early hours. The 36-year-old farmworker from Bhadole village in India’s Maharashtra state had suffered a sudden fall in blood pressure, and her hemoglobin was just 4 grams per deciliter, a level considered severely anemic. Her medical tests revealed anemia, a condition in which the blood has lower red cells and hemoglobin. Other symptoms include headache, irregular heartbeat, swelling of hands and feet, tiredness, and loss of appetite. During that November, she spent 12,000 Indian rupees ($144) on 14 intravenous iron sucrose and medicines, after which her hemoglobin increased to 5.5 grams per deciliter, still quite low. “Every day I would feel tired, but still was unable to sleep for three months and didn’t feel like eating anything, which made me weaker,” Sonavane, who earns the equivalent of just $36 a month, told Devex. When her hemoglobin failed to rise as anticipated, the local doctor asked her to stop eating hybrid wheat and rice and suggested replacing it with native sorghum varieties, which she says helped to a certain extent. A 2017 Harvard study published in GeoHealth journal that analyzed diets from 152 countries found that wheat, rice, barley, maize, and legumes have lower iron concentrations of 4%-10% when grown under increased carbon dioxide concentration. This puts 57% of children under age 5 — a staggering 354 million —- and 1.06 billion women of childbearing age, at risk of anemia. “The majority of answers to our health problems lie in the food plate.” --— Kamal Kore, a community health care worker in India Governments worldwide are pushing farmers to adopt genetically modified hybrid varieties to combat food insecurity and feed the rapidly growing population. These varieties are easy to grow and have a higher yield than native ones, but they require intensive use of chemical fertilizers and pesticides, the overuse of which impacts the soil and its nutrients, leading to a decline in essential nutrients in the crops. Native varieties, on the other hand, are more resilient to climate change and don’t require chemical fertilizers and pesticides, making them more nutritious. As per the World Health Organization, 29.9% of women of reproductive age (15-49 years) were anemic, which is over half a billion women within this age group. Globally, most people derive their dietary iron from the consumption of plants. The researchers found that countries with high anemia rates derived iron from the fewest foods, and over half of the global anemia cases can be attributed to a lack of adequate iron. This can be devastating because the Food and Agriculture Organization’s 2023 report on the state of global food security and nutrition shows that over a billion people in India, roughly 74% of the population, can’t afford a healthy diet. India’s food problem is so widespread that in 2020, Prime Minister Narendra Modi launched the Pradhan Mantri Garib Kalyan Anna Yojana scheme. This scheme provides over 810 million people with 5 kilograms of free hybrid wheat and rice monthly. Sonavane relies on wheat and rice from this scheme to meet her nutritional needs. However, a study by the Indian Council of Agricultural Research scientists found that hybrid rice and wheat have lost up to 45% of their food value in the past five decades. These grains meet over 50% of daily energy requirements, but the researchers estimate that the grains “will become impoverished for human consumption by 2040.” Vulnerable to anemia Like Sonavane, 21-year-old Sanika Kamble from Maharashtra’s Jambhali village relies on the scheme. At four months pregnant, her hemoglobin level was 7.3 grams per deciliter. Community health care worker Kamal Kore immediately took her to the public health center, where she was administered intravenous iron sucrose six times. This helped, but within a month, her hemoglobin fell again. She is now prescribed a folic acid vial. “The culprit was the food she was eating,” shares Kore, who spent months investigating the falling hemoglobin levels. She found that recurring crop losses caused by changes in climatic patterns forced farmers to tremendously increase the use of harmful chemical fertilizers and pesticides, lowering the iron content of these grains. In the book “Microbiota and Biofertilizers,Vol 2,” the authors warn, “The overuse of chemical fertilizers hardens the soil, reduces soil fertility, pollutes air, water, and soil, and lessens important nutrients of soil and minerals, thereby bringing hazards to the environment.” To protect crops from recurring climate disasters, especially floods and heat waves, and improve yield, farmers are forced to increase the use of chemical fertilizers inadvertently to harvest the crops before the disasters strike. However, climate change is barely considered while researching anemia, which might lead to underestimating the burden caused by the condition, as is evident from homemaker Arti Jadhav’s story. After walking barely 100 steps, Jadhav feels tired and nauseous. She has to sit down and rest for at least 30 minutes as she experiences breathlessness. But whenever she complains about it, people just dismiss it as a common symptom of pregnancy. Only after experiencing dizziness and shortness of breath for three months did 25-year-old Jadhav get medical tests that mentioned anemia. Jadhav’s hemoglobin levels fell to as low as 6 grams per deciliter during her seventh month of pregnancy, way below the 12-16 grams per deciliter that’s normal for pregnant women. Community health care worker Ranjana Gavade found more and more women complaining of similar symptoms in her village, Ganeshwadi, on the border of India’s Karnataka and Maharashtra states. “I never saw such a frequent rise in anemia cases,” she shares. Gavade began drawing the connection between rising temperatures and anemia and found that more pregnant women became anemic as the thermometer topped 39 degrees Celsius. She isn’t alone in reaching this conclusion. A 2024 paper published in the Science of The Total Environment journal found that high temperatures may increase the risk of anemia in pregnant women, with the strongest effects reported in the second month of pregnancy. This study conducted in Xi’an, China, concluded that pregnant women are vulnerable to anemia in the first and second trimesters. A paper published in Plos Medicine journal in 2018 mentioned, “Globally, women suffer from higher rates of anemia and malnutrition and are sensitive to climate-driven food insecurity due to increased nutritional needs during menstruation and childbirth.” This is because climate change reduces agricultural production, thereby impacting food security. With diets lacking the essential nutrients, many pregnant women become vulnerable to anemia. Apart from iron-deficient diets, malaria is another cause of anemia in pregnant women. Climate change-induced high temperatures speed up the growth cycle of malaria parasites that rupture red blood cells, spreading anemia in women of reproductive age. WHO’s World Malaria Report 2023 mentions, “Climate change is also responsible for more extreme and frequent weather events, such as flooding (which can result in malaria epidemics).” Risk mounts Jadhav, who is now eight months pregnant and considered high risk, worries that her child will be born anemic — which leads to poor cognitive and motor development in children. To swiftly increase her hemoglobin, she was prescribed intravenous iron sucrose and folic acid, and iron supplements. “With just a month left for childbirth, every day, I fear that my poor hemoglobin can lead to complications during birth and also affect my child," says Jadhav, who is visited every couple of days by Gavade. Anemia in pregnancy can lead to depression, stillbirth, low birth weight, postpartum hemorrhage, and early labor. Rising cases of anemia in pregnant women are concerning. India’s 2019-2021 National Family Health Survey found 52.2% of pregnant women were anemic, a steady increase from 50.4% during 2015-2016. India has 378 million women of childbearing age. According to WHO, in 2019, the world lost 50 million years of healthy life due to disabilities caused by anemia. Long-term anemia can lead to an abnormally fast heartbeat, known as tachycardia, and heart failure. It can also affect the lungs. UNICEF’s advocacy brief, Climate Change: Impact on Adolescent Girls, published in October 2023, mentioned that climate change might contribute to high anemia rates for adolescents in the Middle East and North Africa by increasing food insecurity. Phil Evans, who contributed to the report and is the director of policy and communications at Karama, a network organization of women’s rights groups based in Egypt, says that climate change is fueling a rise in extreme weather phenomena that will irreversibly harm food security. “A 1.5-2 degrees [Celsius] rise in the average temperature exacerbates pressure on food production and security, which is where we see a real threat in the increase of anemia,” he explains. With the rising climate disasters, he says it’s inevitable that anemia will increase. “The trends of food security, increase in drought, extreme weather events are pointing that anemia is going to be a greater problem, and ultimately, it’s going to be women and girls, who are more vulnerable to anemia, who will suffer.” Efforts to curb anemia To curb the rising anemia, India launched the Anaemia Mukt Bharat program in 2018, targeting children, adolescents, pregnant and lactating women, and women of reproductive age groups. As part of this, over a million community health care workers provide iron and folic acid tablets daily from the second trimester, continuing throughout the pregnancy and 180 days postpartum. Moreover, efforts are being made to identify vulnerable groups, like pregnant women, in the earlier stages of anemia. In public health care centers, they are offered free blood tests in the first trimester to start timely anemia treatment and are also given intravenous iron sucrose. Alongside these programs, Evans suggests, “Women and girls need to be a part of the policy process, where issues like anemia can be raised, and the gender impacts of climate change come into focus.” He also advocates for gender-focused loss and damage funding, increasing access to affordable and nutritious meals, and putting diet on the social protection agenda. However, with the rising temperature, access to nutritious food is becoming increasingly difficult for Jadhav, Sonavane, Kamble, and millions of women. Kore, who has spent 15 years helping people recover from anemia, says, “The majority of answers to our health problems lie in the food plate.”