Iron-deficiency anaemia happens when your body does not have enough iron to make haemoglobin, the protein in red blood cells that carries oxygen. It is the most common cause of anaemia in India and worldwide, and it often shows up as tiredness, breathlessness and pale skin. A simple blood test can confirm it, and most people improve with treatment of the cause, iron-rich foods and medical care.
Key takeaways
- According to NFHS-5 (2019–21), about 57% of women aged 15–49 and 67% of children aged 6–59 months in India are anaemic.
- Common signs include fatigue, breathlessness on exertion, pale skin, headaches and a fast heartbeat, but mild anaemia can be silent.
- A complete blood count (CBC) and a serum ferritin test are the usual first steps to confirm anaemia and iron deficiency.
- Pairing iron-rich foods with vitamin C and keeping tea and coffee away from meals helps your body absorb more iron.
- Iron tablets should be taken only as advised by a doctor, because the cause of anaemia must be found and too much iron can be harmful.
What is iron-deficiency anaemia?
Anaemia means your haemoglobin is lower than normal for your age, sex and pregnancy status, so your tissues receive less oxygen. Iron deficiency develops in stages: iron stores run low first, then red cell production slows, and finally haemoglobin falls.
Common causes
- Low dietary iron: a major cause in India.
- Blood loss: heavy periods, bleeding after childbirth, or slow bleeding from the gut (ulcers, piles or, less commonly, cancer).
- Increased need: pregnancy, infancy and the teenage growth spurt.
- Poor absorption: coeliac disease, some stomach surgeries and certain acid-reducing medicines.
- Infections: hookworm and other intestinal worms, and malaria in some regions.
Anaemia can also come from low vitamin B12 or folate, or inherited conditions such as thalassaemia, which is why testing matters before treatment.
How common is anaemia in India?
Anaemia remains one of India's biggest public health problems. The fifth National Family Health Survey (NFHS-5, 2019–21) found that it rose in most groups compared with NFHS-4 (2015–16).
| Group | NFHS-4 (2015–16) | NFHS-5 (2019–21) |
|---|---|---|
| Children aged 6–59 months | 58.6% | 67.1% |
| All women aged 15–49 | 53.1% | 57.0% |
| Pregnant women aged 15–49 | 50.4% | 52.2% |
| Men aged 15–49 | 22.7% | 25.0% |
NFHS-5 also found anaemia in about 59% of adolescent girls and 31% of adolescent boys aged 15–19. Women, children and teenagers are most affected because of menstruation, pregnancy, growth and diet.
Signs and symptoms
Mild anaemia may cause no symptoms. As it worsens, you may notice:
- Tiredness, weakness and low energy
- Shortness of breath, especially on stairs or exertion
- Pale skin, pale inner eyelids or pale nail beds
- Headaches and dizziness
- Fast or pounding heartbeat (palpitations)
- Cold hands and feet
- Brittle or spoon-shaped nails, hair thinning or a sore tongue
- Cravings for non-food items such as ice, clay or chalk (called pica)
In children, iron deficiency can affect growth, attention and learning. In pregnancy, anaemia is linked to a higher risk of preterm birth and low birth weight.
Tests and haemoglobin cut-offs
Complete blood count (CBC)
A CBC measures your haemoglobin and the size and number of your red blood cells. In iron deficiency, red cells are often smaller and paler than normal, shown as a low MCV (mean corpuscular volume) and MCH.
Serum ferritin and iron studies
Ferritin reflects how much iron your body has stored, and a low ferritin strongly suggests iron deficiency. Ferritin can rise during infection or inflammation, so your doctor may also check serum iron, transferrin saturation or a marker of inflammation such as CRP.
WHO haemoglobin cut-offs
In 2024, the World Health Organization updated its haemoglobin thresholds for defining anaemia. The values below apply at sea level in non-smokers; adjustments are made for people living at altitude and for smokers.
| Group | Anaemia if haemoglobin is below |
|---|---|
| Children 6–23 months | 10.5 g/dL |
| Children 24–59 months | 11.0 g/dL |
| Non-pregnant women (15 years and over) | 12.0 g/dL |
| Pregnant women, 1st and 3rd trimester | 11.0 g/dL |
| Pregnant women, 2nd trimester | 10.5 g/dL |
| Men (15 years and over) | 13.0 g/dL |
Severity is graded as mild, moderate or severe; in non-pregnant women, haemoglobin below 8.0 g/dL counts as severe.
Finding the cause
Your doctor will look for the reason, which may include a stool test for hidden blood or worms and sometimes an endoscopy, especially in men and women after menopause.
Iron-rich Indian foods
There are two types of dietary iron. Haem iron, from meat, poultry and fish, is absorbed easily. Non-haem iron, from plant foods, is absorbed less well, so vegetarians need to plan their meals more carefully.
| Food group | Examples |
|---|---|
| Pulses and legumes | Rajma, chana, chole, masoor and moong dal, soybean, lobia |
| Green leafy vegetables | Amaranth (chaulai), drumstick (moringa) leaves, bathua, methi, mustard greens |
| Millets and grains | Bajra, ragi, jowar, poha (flattened rice), whole wheat |
| Seeds and nuts | Garden cress (halim/aliv) seeds, sesame (til), pumpkin seeds, cashews |
| Dried fruit and others | Dates, raisins, dried figs, jaggery (in moderation) |
| Animal foods | Liver, mutton, chicken, eggs, fish |
Cooking in cast-iron kadhais or pans can add a small amount of iron to food. Fortified foods, such as iron-fortified salt or flour where available, also help.
Getting more iron from your meals
Pair iron with vitamin C
Vitamin C helps your body absorb non-haem iron from plant foods. Add a squeeze of lemon to dal or sabzi, eat amla, guava, oranges or tomatoes with your meal, or add kachumber salad to your plate.
Time your tea and coffee
Tea and coffee contain compounds called polyphenols that reduce iron absorption. Try to drink them at least an hour before or after meals rather than with food.
Watch calcium and bran
Milk, curd, calcium supplements and high-bran foods can also reduce iron absorption when eaten at the same time. You do not need to avoid them; simply space them away from your main iron-rich meal and from any iron tablets.
Fermentation and sprouting
Soaking, sprouting and fermenting pulses and grains, as in idli, dosa, dhokla and sprouted moong, can reduce phytates and improve iron availability.
Treatment and national programmes
Treatment depends on the cause and severity. Your doctor may prescribe iron tablets or syrup, or in some cases iron given through a drip. Do not start iron supplements on your own, and keep all iron products out of children's reach, as an overdose can be dangerous for a child.
India's Anemia Mukt Bharat strategy, launched in 2018 under the Ministry of Health and Family Welfare, follows a "6x6x6" approach: six target groups, six interventions and six institutional mechanisms. It covers children, adolescents, women of reproductive age, pregnant women and breastfeeding mothers. Interventions include iron and folic acid supplementation, deworming, anaemia testing and treatment, fortified foods in public programmes and behaviour change communication. Ask at your nearest government health centre about free testing and supplements.
When to see a doctor
See a doctor if you feel constantly tired, breathless on mild exertion, notice pale skin or have heavy periods. Also seek advice if you are pregnant or planning pregnancy and have not had your haemoglobin checked.
Get urgent medical help if you have:
- Chest pain, severe breathlessness or fainting
- A very fast or irregular heartbeat
- Black, tarry stools, vomiting blood or heavy rectal bleeding
- Very heavy bleeding during pregnancy or after childbirth
In an emergency, call 108 or 112 in India.
Frequently asked questions
What is a normal haemoglobin level?
According to WHO, anaemia is defined as haemoglobin below 12 g/dL in non-pregnant women and below 13 g/dL in men. Thresholds differ for children and pregnant women. Your lab report will show its own reference range, so discuss your result with your doctor.
Can I fix anaemia with diet alone?
Mild iron deficiency may improve with diet, but established anaemia usually needs treatment prescribed by a doctor. Diet still helps prevent recurrence, and treating the cause, such as heavy periods or worms, is equally important.
Does drinking tea really affect iron absorption?
Yes. Tea and coffee contain polyphenols that bind non-haem iron and reduce how much your body absorbs. Having them an hour or more away from meals can help.
Is jaggery a good source of iron?
Jaggery contains some iron, but it is mostly sugar, so large amounts are not a healthy way to raise iron. Pulses, green leafy vegetables, millets and, for non-vegetarians, meat and fish are better choices. People with diabetes should be especially careful with jaggery.
How long does it take for haemoglobin to improve?
With appropriate treatment, haemoglobin often starts rising within a few weeks. Rebuilding iron stores takes longer, often a few months. Your doctor will usually repeat blood tests to check progress.
Sources
- Anaemia – WHO fact sheet
- Guideline on haemoglobin cutoffs to define anaemia in individuals and populations (2024) – WHO
- Anemia Mukt Bharat – Ministry of Health and Family Welfare
- Anaemia in women – Press Information Bureau, Government of India
- Iron deficiency anaemia – NHS
- Iron: Fact Sheet for Consumers – NIH Office of Dietary Supplements