Anaemia has long been one of India’s most stubborn public health challenges, particularly among pregnant women.
Despite decades of iron supplementation programmes, the condition continues to affect nearly one in two women of reproductive age, increasing the risk of pre-term births, low birth weight babies, and maternal complications.
Now, a shift in strategy is quietly gaining ground across states: single-dose intravenous (IV) iron infusion as a frontline intervention for moderate to severe anaemia in pregnancy. Public health experts believe this could address one of the biggest gaps in India’s anaemia control programmes, that of poor treatment compliance.
“Oral iron works in theory, but not always in real life,” says Dr Ramesh Shah, a family physician based in Mumbai. “Many pregnant women stop taking tablets because of nausea, gastritis, or constipation. By the time they reach us in the second or third trimester, there is very little time left to correct anaemia through daily pills.”
Unlike oral supplements that need to be taken daily for months, IV iron delivers a large dose in a single sitting, allowing haemoglobin levels to rise faster. This is especially critical for women diagnosed with anaemia after 24–28 weeks of pregnancy, when delays can directly affect foetal growth.
“Single-dose IV iron can raise haemoglobin levels more predictably,” Dr Shah explains. “In late pregnancy, that reliability matters. You cannot afford missed doses.”
Newer formulations of IV iron have also reduced the need for multiple infusions, making it easier to integrate into public health facilities. Several states, including Rajasthan and Karnataka, have begun rolling out IV iron protocols through government hospitals and maternity centres.
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Health administrators say the move reflects a growing recognition that programme success cannot depend solely on patient adherence. “Compliance has been the Achilles’ heel of anaemia control in India. When treatment requires daily intake over several months, dropout rates are high,” says Amita Tai, an ASHA worker who is responsible for ensuring pregnant women consume iron tablets as per requirement, in the tribal regions of Palghar district, ahead of Mumbai.
A single supervised infusion ensures the woman actually receives the iron she needs, according to doctors.
Experts explain that while IV iron appears more expensive upfront, it may be cost-effective in the long run, as preventing pre-term births, emergency interventions, and blood transfusions reduces the burden on the health system. The economic and health gains go beyond the pregnancy itself.
Anaemia during pregnancy is closely linked to low birth weight, developmental delays, and higher neonatal morbidity. For mothers, it increases the risk of fatigue, infections, and postpartum haemorrhage.
Emphasising the scale of the crisis, Abhinav Manish notes in his paper “Anaemia in pregnancy: Global burden and urgent call for action” published in the International Journal of Clinical Biochemistry and Research that, “Anaemia in pregnancy remains one of the most persistent and under-addressed public health challenges worldwide, despite decades of research and policy frameworks aimed at its prevention.”
The consequences of maternal anaemia are severe and extend well beyond pregnancy, increasing the risk of postpartum haemorrhage, maternal death, preterm birth and low birth weight, while also compromising long-term cognitive development and immunity in children.
Despite being both preventable and treatable through iron–folic acid supplementation, improved antenatal care, and nutritional interventions, implementation gaps continue due to poor screening, inconsistent supply of supplements, and socio-cultural barriers.
Pointing to the urgency of coordinated global action, Manish writes that “the continued global burden of anaemia in pregnancy reflects not biological inevitability but systemic inadequacies in health systems, nutrition, and gender equity,” underscoring the need to treat anaemia as a broader development challenge rather than a standalone medical condition.
“Correcting anaemia is not just about improving a lab value,” say nutritionists involved in maternal health programmes. “It directly affects the survival and health of both mother and child. If IV iron helps us reach women who would otherwise fall through the cracks, that’s a significant advance.”
Doctors point out that IV iron is particularly useful for women who have poor absorption, severe nausea, or late antenatal registration, a common issue in underserved areas.
Experts caution that IV iron is not meant to replace oral supplementation entirely. It requires trained staff, monitoring for adverse reactions, and proper screening. Women with certain conditions, including active infections or specific blood disorders, may not be eligible.
Anaemia in India, say experts, is rooted in poor diet diversity, repeated pregnancies, infections, and social inequality. IV iron works best when it is targeted and combined with broader nutrition and maternal health interventions.
What makes the growing acceptance of IV iron significant is the shift in thinking it represents, from blanket supplementation to context-specific treatment. For years, anaemia programmes focused on scale. Now, there is greater emphasis on effectiveness and outcomes.
“If we can reduce low birth weight and pre-term deliveries by intervening decisively during pregnancy, the benefits extend well into childhood,” Dr Shah says. “That is how you begin to break the intergenerational cycle of anaemia.”
Anaemia may not grab headlines, but the consequences are far-reaching. A single iron infusion may not solve the problem entirely, but for millions of pregnant women navigating late diagnoses and fragile health systems, it could make a life-changing difference.