Systemic Intervention Needed to Address Anemia Among Adolescent Girls and Women

Health is the foundation of our wellbeing, which is why we should not treat any health problems lightly, including anemia. Anemia is most prevalent among adolescent girls and women, and also the root cause of high maternal mortality rates and cases of stunting among children below age five. Therefore, stronger interventions are needed in the prevention and management of anemia among adolescent girls and women as a systemic health problem.

Understanding Anemia

Anemia is a condition characterized by lower-than-normal hemoglobin levels. The World Health Organization (WHO) states that anemia in adult males occurs when the hemoglobin levels are below 13 grams/deciliter (g/dl), adult females and adolescent girls (12-14 years) below 12 g/dl, and pregnant women below 11 g/dl. Meanwhile, the clinical limit commonly used to diagnose anemia is a hemoglobin level below 10 g/dl.

Anemia is not a disease diagnosis, but rather a series of symptoms we must look out for. The most common symptoms of anemia are feeling weak, lethargic, tired, exhausted, and absentminded. It is also often accompanied by headaches, blurred vision, and drowsiness, as well as reduced concentration and productivity. In acute conditions, anemia can cause a faster heartbeat, shortness of breath, chest pain, and even organ dysfunction.

Treating anemia requires knowing what causes it.Three main factors that cause anemia are: reduced red blood cell production by the bone marrow; bleeding (due to menstruation, childbirth, digestive tract bleeding, and accidents); and blood disorders (thalassemia). In developing countries, cases occur where parasitic infections (hookworms) can cause anemia.

Anemia Among Adolescent Girls and Women

More than 2 billion people suffer from anemia, contributing to three-quarters of the 1 million deaths per year in Africa and Southeast Asia. For instance, Indonesia recorded 26.8% of children aged 5-14 years and 32% of young people aged 15-24 years suffered from anemia in 2018. In other words, three to four out of 10 teenagers suffer from anemia.

The good news is that a study revealed that global cases of anemia are declining in men. Unfortunately, anemia among adolescent girls and women remains prevalent.

The largest groups experiencing anemia are women of productive age and pregnant women. Adolescent girls are susceptible to anemia because their hemoglobin levels are naturally lower than men’s. The menstrual cycle is also a cause of the high rate of anemia in women and adolescent girls.

The impact of anemia on adolescent girls will be carried over into adulthood, especially during pregnancy. Anemia can cause pregnant women to experience bleeding before and during childbirth, which will threaten the safety of the mother and child. According to the Centers for Disease Control and Prevention (CDC), anemia causes about 800,000 emergency room visits for mothers each year and causes nearly 6,000 maternal deaths.

Moreover, babies conceived by women with anemia can experience miscarriage, premature birth, low birth weight, and growth disorders such as stunting, wasting, and neurocognitive disorders.

Inadequate Actions

The issue of anemia is not without action. Since the 1970s, WHO has recommended iron and folic acid supplementation programs and published guidelines and recommendations for controlling anemia in countries worldwide. However, progress in reducing the prevalence of anemia remains very slow.

Across the globe, national governments have launched policies, frameworks, and guidelines to address this issue. There are also various programs and initiatives by governments and civil society to tackle anemia among adolescent girls and women.

However, existing actions remain insufficient. Some common contributing factors include incomplete government planning, inadequate and uneven access to health facilities in rural areas, minimal human resources and budget, complicated supplement distribution, and a weak monitoring and control system of current programs.

Systemic Interventions in Anemia Management

Anemia is often misunderstood as ordinary fatigue and ends up dismissed as trivial. In reality, it is one of the root causes of high maternal mortality rates.

Worse, anemia is often seen as merely a personal health problem instead of a broad, systemic public health problem that cannot be addressed with a partial approach. In reality, anemia is closely related to poverty and socio-economic inequality, which makes it difficult for many people to meet their nutritional needs and, in many cases, also causes them to lack adequate information and knowledge about nutrition and health risks.

The issue is also inseparable from the problem of limited access to affordable nutritious food, lack of access to quality education, inequality in access to health services in many areas, and lack of access to employment and broader economic opportunities, which are structurally and culturally faced mainly by girls and women.

Therefore, systemic interventions are needed to prevent and overcome anemia at the national level, which go beyond specific nutritional interventions and improved health services. Addressing anemia among adolescent girls and women must be done with a comprehensive, coherent, and integrated approach that considers the various aspects of needs that determine the health and wellbeing of each person. Governments and all key stakeholders must increase their commitment and work together.

Editor: Nazalea Kusuma

Translator: Kresentia Madina

The original version of this article is published in Indonesian at Green Network Asia – Indonesia.

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