October 25, 2006


What do you know about IFA (iron and folic acid) tablets? Me, I knew nothing. Then one day I learned that pregnant women take them to stave off anaemia, common during pregnancy. In our cities, women can buy them easily, but they are not so easily available in rural areas.

So a few years ago, the Central Government had in place a scheme to supply rural pregnant women with IFA tablets. Already anaemic women were eligible for 200, normal ones for 100.

In the late 1990s, there was an apparent shortage of these tablets, at least to the extent that the Centre was unable to procure enough supplies to supply all the states with enough. So instructions went out to the states that their respective Departments of Health and Family Welfare (H&FW) should buy the tablets on their own and claim reimbursement, under this scheme, from the Centre.

Orissa (among other states) could not do so. A doctor I know who was working in rural Orissa at the time wrote me a letter about this. Here are some lines from that letter:
    "Orissa is unable to buy IFA supplies: firstly they have few resources; secondly GOI [Government of India] already owes the state about Rs 17 lakh for health supplies bought a few years ago which GOI promised to reimburse and has not yet done. State Treasury is thus unwilling to advance Department [of H&FW] any more funds for spending.

    [H&FW] approached UNICEF for assistance, which UNICEF was willing to extend. However, Secretary, H&FW in Delhi has refused to allow state Government to take UNICEF assistance -- they say the state has to find its own resources. A case of dog in the manger attitude -- GOI will not supply tablets, will not allow state to procure from donor.

    The bottom line is that women in Orissa (and MP, UP, etc.) continue to die of anaemia. ... Our district hospitals are full of anaemic women in heart failure giving birth to low birth-weight babies. The women die of anaemia if they cannot get blood at this late stage -- and as their husbands [and] relatives are anaemic too, the district medical officer is at his wits' end trying to find blood donors in an anaemic community."

    All this makes me mad."
(May be of interest to read this in conjunction with What Malnutrition means).


Neela said...

Chilling article.

Btw, folic acid is essential not just for anemia but also to prevent birth defects in the baby's brain and spine (neural tube defects).

Also, tangentially, i think anemia is a common problem among most Indian women, regardless of economic situation. At least that's what my doc told me.


Anonymous said...

However, Secretary, H&FW in Delhi has refused to allow state Government to take UNICEF assistance

Is there any law that says the government in Delhi can stop the state government from taking UNICEF help? Where is our Supreme Court when we need them? They are the de-facto rulers of Delhi, dictating pollution norms and closing shops in allegedly "residential" areas. But the rest of India doesn't seem to exist.

wise donkey said...

just why cant the states take help from unicef??

the maternal mortality rate is worse (5.4 per 1000) than Bangladesh (3.8 per 1000) or Sri Lanka (0.92 per 100)
thats 140,000 mothers each year in India due to childbirth, thats just one every 5 minutes.

the infant mortality rate is worse (63 per 1000)than that of Bangladesh (46 per 1000) or Sri Lanka (13 per 1000), forget China (30 per 1000).

and reading about stuff attitudes like this from officials just makes one sick.

pregnancy is supposed to be about life, not death..

Sidhusaaheb said...

I guess this is what 'red tape' is all about.