Anaemia and micronutrient deficiencies remain pressing public health concerns in developing countries. In India, the prevalence of anaemia among women of reproductive age rose from 53.1% to 57% between 2015–16 and 2019–21, as reported by the National Family Health Survey (NFHS-V). In response, the Government of India launched a pilot scheme in 2019–20 to distribute rice fortified with iron, folic acid, and vitamin B12 through the Targeted Public Distribution System (TPDS) in selected districts. This study evaluates the impact of the pilot scheme after about 20 months of implementation in Malkangiri (Odisha), and 30 months in Chandauli (Uttar Pradesh), using data from a cross-sectional household survey conducted between April and August 2023.

Focusing on non-pregnant women aged 15–49 years, the study aims to: (i) assess changes in anaemia prevalence post-intervention; (ii) examine associations between anaemia and socio-demographic, household, and individual factors; and (iii) identify the most vulnerable groups using Classification and Regression Tree (CART) analysis. NFHS-V data serve as the baseline, and the 2023 survey as the endline. Changes in anaemia prevalence were assessed through descriptive comparisons, while correlates were identified using bivariate statistics and multivariable binary logistic regression. CART analysis was applied to explore pathways to vulnerability.

The findings show a reduction in anaemia prevalence among non-pregnant women in both districts— from 48.5% to 40.9% in Chandauli and 71.8% to 65.7% in Malkangiri. Higher odds of anaemia were observed among scheduled tribe women, those with unimproved sanitation, those not practicing water-tight rice cooking, and those not consuming pulses daily. CART analysis highlighted scheduled tribe women with poor sanitation as the most at-risk group. The study concludes that rice fortification, when combined with improved sanitation and behavioural interventions, offers a promising strategy for reducing anaemia among women of reproductive age in India.

The authors have declared no competing interest.

The author(s) received no specific funding for this work.

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Ethical approval for this study was granted by the Institutional Review Board (IRB) of TRIOs, New Delhi, India, a body registered with the Office for Human Research Protections (OHRP) under the U.S. Department of Health and Human Services (HHS). The reference number of the approval is IRB-TRIOS 101/2023/018/I/WFP.

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