Reducing Iron-Deficiency Anemia and Changing Dietary Behaviors among Adolescent Girls in Maharashtra, India

This research brief explores and evaluates communication strategies developed to address India's high prevalence of iron-deficiency anemia among women. Between 60% and 70% of Indian adolescent girls are anemic, a condition that can result in adverse pregnancy outcomes or even maternal death, as well as reduced work productivity and impaired physical capabilities. Adolescence, as a period of growth and development, is considered the most appropriate time to intervene.

In this context, the Institute of Health Management-Pachod (IHMP), in collaboration with the International Center for Research on Women (ICRW), conducted a 3-year community intervention trial in Maharashtra, India among unmarried adolescent girls aged 10 to 19. Baseline data indicated that anemia is significantly more likely among girls who eat two or fewer meals in a day, have been sick in the past year, and consume few iron-rich foods. Thus, the intervention focused on changing dietary behaviour.

Conducted in 16 slums of Pune city (10 of them intervention slums - 1000 girls - and 6 of them control slums - 752 girls), the study involved providing participants with weekly iron and folic acid tablets in the first 3 months; conducting ongoing nutrition education through home visits and meetings by community health workers; carrying out participatory activities such as food fairs; undertaking a community project through IHMP's life skills programme; and creating audiovisual materials such as flash cards and posters developed by the participants.

Endline comparisons of the intervention and control sites show that the intervention was effective. Specifically, 28.4% of the intervention group ate 3 or more meals per day at the end of the study, compared to 3.8% of the control group. 31.1% of girls exposed to the intervention ate fruit more than 3 times a week versus 22.6% of the control group. Furthermore, between baseline and endline, mean haemogloblin (Hb) levels increased from 5.8 to 9.5 gm/dl for severely anemic participants, and from 8.9 to 11.2 gm/dl for moderately anemic participants.

The research brief concludes by proposing the following policy implications:

• "The government's anemia prevention and control programme should focus on adolescents
• Participatory nutrition education can influence adolescent girls' anemia and dietary behavior
• Iron supplementation programs need to include nutrition education programs to be effective
• Key dietary behavior messages for girls include: eating more than 3 meals a day, eating with family so as to eat enough, eating green vegetables daily, and eating lemon or amla with meals.
• More effective methods need to be devised for community-based Hb testing."