Action - Weekly Iron Folic Acid Supplementation - Nutrition International - India - Iron and folic acid supplementation - Adolescents

Programme: Weekly Iron Folic Acid Supplementation - Nutrition International - India

Programme description

Iron deficiency anaemia is now recognized as the number one cause of lost disability adjusted life years (DALYs) in adolescent girls globally[1]. Anaemia has three major consequences for adolescent girls: (i) decreased school performance (and challenges in concentration); (ii) loss of productivity; and (iii) decreased current and future reproductive health, for those that become pregnant. Related to this, young maternal age increases the risk of maternal anaemia during pregnancy. 

After infancy, adolescence (10-19 years of age) is the most rapid period of development. Adolescents have the highest nutritional needs and provide a second window of opportunity for catch-up growth[2]. While WHO and others formally acknowledge adolescents as a group with specific nutrition needs, until recently, Adolescent Nutrition has been neglected in global and national investment, policy and programming in developing countries. The 2014 WHO report “Health for the World’s Adolescents” notes that progress for adolescents lags behind gains made in maternal and child health programs. 

Improving adolescent anaemia is critical to general anaemia gains. The World Health Assembly has called for a 50% reduction in anaemia in women of reproductive age (15-49 years of age) by 2025[3]. Although adolescent specific data are lacking globally, it is estimated that approximately 30% of adolescents are anaemic[4]. Therefore, to reach this goal, the approximately 600 million adolescent girls living in developing countries must become a prime focus of anaemia reduction efforts. 

The WHO recommends intermittent iron and folic acid supplementation (at least once weekly for three months, twice yearly) as an effective strategy to prevent anaemia in populations where anaemia in women of reproductive age is of public health concern (>20% anaemia)[5]. Despite this WHO recommendation, the policy environment for WIFAS remains a challenge. In coordination with government and other partners, NI aims to improve the health and well-being of girls by reducing anaemia in adolescent girls through Weekly Iron and Folic Acid Supplementation (WIFAS), and contribute to empowering girls through Adolescent Nutrition education. Adolescent boys also benefit from the nutrition education. These Adolescent Nutrition programs are informed by gender-analysis and consider the inequalities in anemia, as well as gendered barriers to attending school and accessing health systems.

There is an existing national policy and plans in India for WIFAS for in- and out-of-school adolescent girls. The Government of India has been implementing the WIFAS program since 2013, which includes government and government-aided schools and outreach (Anganwadi) centres across all states. In this context, where anemia is high for both genders, boys receive the WIFAS in addition to the nutrition education.

Nutrition International contributes to the WIFAS program in India by:

  • Providing technical leadership and support to the government.
  • Engaging and advocating with stakeholders to ensure timely tendering, procurement of supplies, and provision of an adequate budget in the annual plan.
  • Facilitating coordination among departments
  • Developing and implementing of behaviour change intervention strategies.
  • Facilitating joint district visits with senior state officials and undertaking regular meetings with state and district officials for program planning and improvement
  • Providing job aids and communication materials to teachers and Anganwadi workers to improve knowledge and counselling skills to address barriers to consumption of IFA. 
  • Contributing to capacity building of district and state officials, supervisors, and school teachers on skills for appropriate and effective counselling on IFA, use of job aids, and recording and reporting tools
  • Conducting on-the-job trainings for teachers and Anganwadi workers during field visits and monthly meetings of respective departments. 
  • Undertaking monitoring survey and sharing findings with key state and district government officials to make necessary modifications to program strategies. 
  • Conducting process documentation to inform program improvements.

These activities are implemented in partnership with the Department of Health and Family Welfare, Ministry of Women and Child Development, Education departments and Tribal departments at state levels, and UNICEF. NI provides national-level technical assistance to support the government’s ‘Anaemia Free India’ initiative, and works sub-nationally in 64 districts across four states (Chhattisgarh, Gujarat, Madhya Pradesh, and Uttar Pradesh). In 2018, NI has also initiated a new program to support a state-wide WIFAS program in West Bengal. NI started providing support to the Chhattisgarh government for WIFAS in 2010, and expanded its support to other states in 2016; this support is ongoing.

Programme type



  1. WHO, AA-HA! Global Accelerated Action for the Health of Adolescents (AA-HA!) – Guidance to Support Country Implementation – Summary.
  2. Prentice AM, Ward KA, Goldberg GR, Jarjou LM, Moore SE, Fulford AJ, Prentice A. Critical windows for nutritional interventions against stunting. The American journal of clinical nutrition. 2013 May 1;97(5):911-8.
  3. WHO, WHA Global Nutrition Targets 2025: Anaemia Policy Brief. 2014
  4. UNICEF, Progress for Children: A report card on adolescents, 2012.
  5. WHO. Guideline: Intermittent iron and folic acid supplementation in menstruating women. Geneva, World Health Organization, 2011.

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Revision log

Thu, 10/18/2018 - 21:28zillmerkpublishedpublished
Thu, 10/18/2018 - 19:36GINAadminNIAction edited by GINAadminNI.needs_review
Thu, 10/18/2018 - 19:36GINAadminNIAction edited by GINAadminNI.draft
Tue, 10/02/2018 - 16:20engesveenkEdited by GINAadminNI.published
Tue, 09/11/2018 - 15:45GINAadminNIEdited by GINAadminNI.delegated
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