The Lift Line
“The barriers are now primarily institutional rather than technical.” (Marthi Venkatesh Mannar, K.J. Alphons, Jaykumar Menon, Dr. Rajiv Tandon and Ruchika Arora, The Hindu, 27 October 2026)
Why This Editorial Matters for Your Exam
In the news: In an op-ed in The Hindu on 27 October 2026, “A ready solution to tackle anaemia”, five public health and nutrition specialists argue that India should scale up double fortified salt (DFS), salt fortified with both iodine and iron, across all States and especially through the Public Distribution System (PDS), as the preventive arm of the revised Anemia Mukt Bharat strategy.
The authors, as the byline reads: Marthi Venkatesh Mannar is former Senior Advisor, Tata Trusts; K.J. Alphons is a former Union Minister for State, Government of India; Jaykumar Menon is Co-Founder and Chair, Open Source Pharma Foundation; Dr. Rajiv Tandon is Executive Director, The Health Continuum, Adjunct Professor of Public Health Practice at the Public Health Foundation of India, Indian Institutes of Public Health, and Ruchika Arora is Technical Specialist, The Health Continuum and former national consultant for child health and Nutrition, Ministry of Health and Family Welfare, Government of India.
For the survey background, see also our pieces on NFHS-6 and the nutrition paradox and the ICMR-Gates Foundation Anaemia Grand Challenge.
UPSC relevance:
- GS Paper 2: issues relating to the development and management of social sector services relating to health; issues relating to poverty and hunger; welfare schemes for vulnerable sections (PDS, PM POSHAN, ICDS).
- GS Paper 3: the Public Distribution System, its objectives, functioning and limitations; food processing (fortification) and food security.
- Prelims: NFHS-5 anaemia figures and the survey’s haemoglobin cut-offs; Anemia Mukt Bharat (6x6x6 to 7x7x7, T4); FSSAI’s fortification regulations and the five fortified staples; double fortified salt; the +F logo.
- Essay and Interview: nutrition as human capital; why sound science stalls at implementation.
The Crux in 60 Words
Anaemia still affects over half of India’s women and about two-thirds of young children. Five specialists argue that double fortified salt, carrying iodine and iron, can prevent it at scale because virtually every household eats salt daily. The science, they say, is settled; what is missing is policy commitment, financing, quality control and a firm place in the PDS.
Double fortified salt is a proven but underused tool against iron-deficiency anaemia, and what now holds it back is institutional, not technical.
- Salt is eaten daily by virtually every household in predictable quantities, so iron delivered through it does not depend on the regular adherence that supplements need.
- It can ride on the supply chain already built for Universal Salt Iodisation, and FSSAI already lists DFS as a fortified staple.
- The authors cite a global review (anaemia down by up to 21 per cent), trials in Bengaluru, Darjeeling and Punjab, a cost of Rs 14 to 20 per person a year and a benefit-cost ratio of 4.2:1.
- DFS reaches the Public Distribution System unevenly because implementation depends on States, so the authors call for a central flagship scheme with financing, quality assurance and consumer awareness.
Anaemia has several causes and iron in salt addresses only one; salt as a carrier must be squared with sodium reduction goals and screening for thalassaemia and sickle cell disease; the column names none of the studies behind its figures; and with no anaemia data in NFHS-6, impact will be hard to measure.
Fold DFS into Anemia Mukt Bharat Abhiyaan as a preventive complement, agree financing and the PDS route with States, test quality against the FSSAI standard, keep haemoglobinopathy screening and sodium policy in step, and judge impact against a comparable venous-blood baseline.
Background and Context
The burden, in NFHS-5 numbers
The fifth National Family Health Survey (NFHS-5) was fielded in two phases between 17 June 2019 and 30 April 2021. Its India fact sheet gives these anaemia figures:
| Group (aged 15-49 unless stated) | Anaemic if haemoglobin is below | NFHS-5 (2019-21) | NFHS-4 |
|---|---|---|---|
| Children, 6-59 months | 11.0 g/dl | 67.1% | 58.6% |
| All women | 12.0 g/dl (11.0 if pregnant) | 57.0% | 53.1% |
| Non-pregnant women | 12.0 g/dl | 57.2% | 53.2% |
| Pregnant women | 11.0 g/dl | 52.2% | 50.4% |
| Men | 13.0 g/dl | 25.0% | 22.7% |
Every group was more anaemic in NFHS-5 than in NFHS-4, and rural rates ran above urban ones: among children, 68.3 per cent in rural areas against 64.2 per cent in urban areas. The authors’ “over half of Indian women” matches the survey. Their “almost three-fourths of children” does not: NFHS-5 puts the share at about two-thirds of children aged 6-59 months.
Where the anaemia data stand now
The sixth round, NFHS-6 (2023-24), whose fact sheets the Union Health Ministry released in May 2026, carries no anaemia figure: it left out 43 NFHS-5 indicators, anaemia prevalence among them. The government gave the background in a Rajya Sabha reply, reported by Business Standard on 4 August 2026: the Ministry, “after due deliberations”, decided to adopt anaemia prevalence figures from “an independent survey conducted by Indian Council of Medical Research utilising the gold standard intravenous method for haemoglobin testing.”
That makes NFHS-5 the most recent NFHS round with anaemia figures. It also raises a measurement point. NFHS tests capillary blood, and its own fact sheet warns that its results “need not be compared with other surveys using venous blood”. Figures from ICMR’s venous-blood survey therefore cannot simply be read as a trend against NFHS-5.
Anemia Mukt Bharat: from 6x6x6 to 7x7x7
The policy background: on 29 June 2026, Union Minister of Health and Family Welfare Jagat Prakash Nadda released the Anemia Mukt Bharat Abhiyaan Operational Guidelines at the 16th meeting of the Central Council of Health and Family Welfare (CCHFW) in New Delhi. This is the “7X7X7” strategy the column refers to. The programme was renamed Anemia Mukt Bharat Abhiyaan, and its scope now “extends beyond supplementation to encompass testing, therapeutic management, eating right and community involvement through ‘Jan Chetna’”. The guidelines aim to shift anaemia management “from prophylactic care to therapeutic care”.
| Before (6x6x6, launched 2018) | Revised guidelines (7x7x7, 2026) | |
|---|---|---|
| Beneficiary groups | Six: pre-school children (6-59 months), children (5-9 years), adolescent girls and boys (10-19 years), pregnant women, lactating women, women of reproductive age (15-49 years) | The six, plus low birth weight (LBW) babies, 0-6 months |
| Interventions | Six, nutritional and non-nutritional | Seven: adds the “Eating Right” approach |
| Institutional mechanisms | Six | Seven: adds a strengthened monitoring and evaluation framework for digital tracking |
| Approach | T3: Test, Treat, Talk | T4: Test, Treat, Talk, Track |
Under the new digital system, haemoglobin records of pregnant women are to be mapped through the JANANI portal and children’s through the RBSK and U-WIN portals, converging into a unified Anemia Mukt Bharat Abhiyaan Portal.
What the rules already say about DFS
FSSAI’s 2018 fortification regulations cover “double fortified salt (with iodine and iron)” as one of five fortified staples, so the column’s statement that “A DFS standard has been issued by the Government of India’s Food Safety and Standards Authority (FSSAI)” stands. On school meals and early childhood services, the column says DFS “is recommended under PM POSHAN and ICDS”.
The Analysis
The authors’ argument, step by step
- The gap. The AMB strategy “rightly recognises the multifactorial nature of anaemia”, the authors write. “Yet, one proven preventive intervention remains significantly underutilised.”
- Why salt. “Salt offers an unparalleled opportunity to address iron deficiency.” It is eaten daily by virtually every household “in predictable quantities regardless of income or geography”. So “DFS also addresses one of the fundamental challenges of anaemia control”, which they name as sustained compliance: unlike iron supplements, “whose effectiveness depends on regular adherence”, salt needs no daily decision.
- A platform already built. Universal Salt Iodisation has put iodised salt into almost every kitchen. DFS would use the same supply chain.
- The evidence they cite. In the authors’ account, DFS already reaches “an estimated 76 million people across four States” through safety-net programmes; a global review found it can cut anaemia “by up to 21%”; and trials in Bengaluru, Darjeeling and Punjab, with large-scale use in Uttar Pradesh, showed better iron status. They add a qualifier: the salt works “when manufactured to validated specifications”.
- The cost. The authors estimate DFS at Rs 14 to 20 per person a year, with “a benefit-cost ratio of 4.2:1 for national DFS introduction”, driven by health and labour productivity gains.
- The obstacle. “The barriers are now primarily institutional rather than technical.” The PDS, which reaches “around 800 million beneficiaries” in their figure, carries DFS unevenly because implementation depends largely on State governments. They want nationwide adoption “through a central flagship scheme”, and list what it needs: “Greater policy commitment, dedicated financing, stronger quality assurance, wider commercial availability and consumer awareness are now needed to accelerate nationwide scale-up.”
- The safeguards. “Like all public health nutrition interventions, DFS should be implemented within a robust regulatory framework.” It should complement AMB, “align with India’s sodium reduction goals” and come with screening for haemoglobinopathies such as thalassaemia and sickle cell disease, lessons the authors draw from the rice fortification programme.
The column’s numbers, and how to use them
| The column says | What to write in an answer |
|---|---|
| Anaemia affects “over half of Indian women” | Matches NFHS-5 (2019-21) for women aged 15-49 |
| ... and “almost three-fourths of children” | Overstated: NFHS-5 gives about two-thirds of children aged 6-59 months |
| “around 95% of households consuming iodised salt” | NFHS-5: 94.3 per cent of households (2019-21) |
| The 7X7X7 strategy, given no date | Guidelines released on 29 June 2026 |
| DFS “is recommended under PM POSHAN and ICDS” (elsewhere the column says the government “mandates” it) | Use “recommended” |
| 76 million people in four States; “up to 21%”; the three trials; Rs 14 to 20 a year; 4.2:1; “around 800 million” PDS beneficiaries | The authors’ figures and estimates: cite them as theirs (“the authors estimate ...”) |
Where the column is strong, and where it stops
- Strong: it picks a delivery route that does not depend on daily adherence, the weak point of tablets; it builds on a platform India already runs; and it names its own safeguards instead of leaving them to critics.
- It cites evidence without naming it. The review, the trials and the 4.2:1 ratio come with no study named, so a reader cannot weigh them. The authors’ own qualifier, “when manufactured to validated specifications”, shows how much rests on quality.
- Iron in salt meets one cause. In the authors’ own words anaemia is multifactorial; DFS acts on iron deficiency, not on the other causes the 7x7x7 framework targets. They present it as a complement, and that is how it should be argued.
- Salt and sodium pull in different directions. If people eat less salt, as sodium reduction asks, they also get less iron from it, so the fortification level and salt policy have to be set together. The column flags the alignment but not the trade-off.
- It is silent on measurement. With no anaemia figure in NFHS-6, a national scale-up would need a comparable baseline, and NFHS-5’s capillary figures are not one for a venous-blood survey.
Way forward
- Place DFS inside Anemia Mukt Bharat Abhiyaan as a preventive complement to supplementation, “Eating Right” and T4, not as a stand-alone fix.
- Settle the PDS route with States: who pays, who procures and who tests, whether through the authors’ central flagship scheme or State programmes.
- Test quality against the FSSAI standard at manufacture and at the ration shop.
- Keep the safeguards in step: screening for thalassaemia and sickle cell disease, and a fortification level set with sodium policy.
- Measure: use the new digital tracking and a venous-blood baseline to judge whether anaemia falls where DFS reaches.
Data and Institutions Vault
Prelims-grade facts:
Anaemia in NFHS-5 (2019-21), India:
- Children aged 6-59 months: 67.1 per cent anaemic (NFHS-4: 58.6), cut-off below 11.0 g/dl
- All women aged 15-49: 57.0 per cent (NFHS-4: 53.1); pregnant women 52.2, non-pregnant 57.2
- Men aged 15-49: 25.0 per cent (NFHS-4: 22.7), cut-off below 13.0 g/dl
- Households using iodised salt: 94.3 per cent (NFHS-4: 93.1)
- NFHS measures anaemia in capillary blood, not comparable with venous-blood surveys
NFHS-6 (2023-24):
- Fact sheets released in May 2026 leave out anaemia prevalence
- The Health Ministry decided to adopt anaemia figures from an ICMR survey using venous blood
Anemia Mukt Bharat (Union Health Ministry):
- Launched in 2018 with a 6x6x6 strategy: six interventions, six beneficiary groups
- Anemia Mukt Bharat Abhiyaan Operational Guidelines released 29 June 2026, at the 16th CCHFW meeting
- 7x7x7 adds LBW babies (0-6 months), the “Eating Right” approach and digital monitoring
- T4: Test, Treat, Talk, Track (earlier T3: Test, Treat, Talk)
Fortification:
- FSSAI: Food Safety and Standards (Fortification of Foods) Regulations, 2018
- Five staples: wheat flour, rice, edible oil, milk and double fortified salt
- DFS = salt with iodine and iron; fortified foods carry the +F logo
⚠️ Watch the trap:
- DFS carries iodine and iron; iron, folic acid and vitamin B12 go into wheat flour and rice
- The seventh 7x7x7 beneficiary group is LBW babies (0-6 months), not adolescents
- NFHS-6 has no anaemia figure; NFHS-5 is the latest NFHS round with one
- DFS under PM POSHAN and ICDS: the column’s word is recommended; avoid “mandatory” without a government order
The Debate
| The case for scaling DFS through the PDS | The case for caution |
|---|---|
| Salt reaches virtually every household daily, with no adherence needed | Anaemia has several causes; iron in salt addresses one |
| It builds on the iodised-salt supply chain and an existing FSSAI standard | Salt is a carrier the country is also trying to cut back |
| The authors put the cost at Rs 14 to 20 per person a year and the benefit-cost ratio at 4.2:1 | The column names none of the studies behind its figures |
| The PDS is the largest safety-net programme, in the authors’ words | PDS integration depends on each State; a central scheme needs their buy-in |
| Quality testing is simpler for salt, the authors argue, given centralised production | Results hold “when manufactured to validated specifications”, so testing must be real |
| Iron fortification calls for screening for thalassaemia and sickle cell disease |
How to Think About This
- Separate the vehicle from the nutrient. The case for salt is about reach and adherence; the case for iron is about cause. Test each on its own.
- Ask who pays and who decides. The Centre designs schemes, but the PDS runs through States, so a national plan is only as good as State uptake.
- Insist on a baseline. Without an anaemia figure in NFHS-6, impact can only be judged against a comparable survey.
- Read advocacy as advocacy. The authors make a case; their numbers are theirs until a named study or an official source confirms them.
Diagram-in-Words
Double fortified salt against anaemia: the authors' case
Covers the burden, why salt, the figures the authors cite, the obstacle they see and what they ask for.
Read the figure from the top: the burden, why salt, the authors’ own figures, the obstacle they see and what they ask for. The middle band holds the authors’ own estimates, not official data.
Despite a national programme since 2018, anaemia remains widespread in India. Examine the case for double fortified salt as a population-level intervention and discuss the safeguards its scale-up through the Public Distribution System would need. (250 words)
Anaemia, caused mainly by iron deficiency, remains one of India’s widest health deficits. NFHS-5 (2019-21) found 57.0 per cent of women aged 15-49 and 67.1 per cent of children aged 6-59 months anaemic, both higher than in NFHS-4.
Because iron supplementation works only with regular adherence, a staple that every household eats daily is an attractive way to deliver iron.
Double fortified salt (DFS) carries iodine and iron. It is one of five staples in FSSAI’s Food Safety and Standards (Fortification of Foods) Regulations, 2018, and it can use the iodised-salt network, which reached 94.3 per cent of households in NFHS-5.
Its case rests on reach and compliance: salt is eaten daily by nearly every household in fairly predictable amounts, so iron reaches people without asking them to change behaviour. The revised Anemia Mukt Bharat Abhiyaan guidelines of 2026 expand the 2018 6x6x6 strategy into 7x7x7, adding low birth weight babies, an ‘Eating Right’ approach and digital tracking under a Test, Treat, Talk, Track (T4) model; DFS would complement these measures, not replace them.
Scale-up raises four issues. First, the Public Distribution System is run largely by States, so coverage turns on State choices and budgets.
Second, quality must be tested against the regulatory standard. Third, iron fortification needs screening for haemoglobinopathies such as thalassaemia and sickle cell disease.
Fourth, the fortification level must fit national goals to cut sodium intake. Evaluation is a further gap: NFHS-6 (2023-24) carries no anaemia figure, and the Health Ministry has decided to adopt figures from an ICMR survey using venous blood, with which NFHS’s capillary-blood estimates cannot be directly compared.
DFS offers a channel for iron that does not depend on adherence, but it works only inside a regulated system: tested quality, State buy-in through the PDS, health safeguards and a sound baseline for evaluation. Placed within Anemia Mukt Bharat Abhiyaan, it can strengthen the preventive side of India’s anaemia response.
Interview Angle
"India asks its people to eat less salt. Is it wise to make salt the carrier of iron against anaemia, and how would you reconcile the two goals?"
Takeaway Box
- The fact base: NFHS-5 (2019-21) is the latest NFHS round with anaemia data; NFHS-6 dropped it, and the Health Ministry has decided to adopt figures from an ICMR venous-blood survey.
- The proposal: DFS (iodine and iron), already an FSSAI fortified staple, scaled through the PDS as a complement to Anemia Mukt Bharat Abhiyaan.
- The test: institutions, not chemistry: financing, State buy-in, quality testing, haemoglobinopathy screening and sodium policy.
- In the exam: quote NFHS-5 and FSSAI as fact; quote the cost, trial and coverage figures as the authors’.
Sources:
- The Hindu, “A ready solution to tackle anaemia”, Marthi Venkatesh Mannar, K.J. Alphons, Jaykumar Menon, Dr. Rajiv Tandon and Ruchika Arora, 27 October 2026
- PIB, Ministry of Health and Family Welfare, release of the Anemia Mukt Bharat Abhiyaan Operational Guidelines, 29 June 2026
- NFHS-5 (2019-21), India Fact Sheet, IIPS and Ministry of Health and Family Welfare
- Ministry of Health and Family Welfare, “India’s Fight Against Anemia: Nourish, Prevent, Protect”, April 2025
- FSSAI, “Fortifying Health”, NuFFooDS Spectrum, January 2021
- Business Standard, “Govt explains why key indicators were missing from NFHS-6 fact sheets”, 4 August 2026
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