How a New Anaemia Agenda is Leading the Way
By Saskia Osendarp (Micronutrient Forum), Lisa Rogers (World Health Organization), Emily Mates (United Nations Children’s Fund), Sam Macintosh (END Fund), Konstantina Boutsika (Roll Back Malaria Partnership to End Malaria), and Matt Freeman (Stronger Foundations for Nutrition)
Over the last two decades, we’ve made remarkable progress improving global health and nutrition. Under-five mortality fell to 37 deaths per 1,000 live births in 2023—a 16 percent reduction from 2015. Maternal deaths dropped from 228 to 197 deaths per 100,000 live births. Malaria prevention has saved 12.7 million lives and averted 2.2 billion cases since 2000. Fifty-seven countries have eliminated at least one neglected tropical disease as of July 2025.
But catastrophic global aid cuts are threatening these hard-won gains, especially for those most vulnerable to poor health and nutrition: women, adolescents, and young children. Following a 9 percent drop in official development assistance in 2024, the Organisation for Economic Cooperation and Development (OECD) projects an additional 9 to 17 percent decline, with several major donors scaling back support in the coming years.
The human cost of these cuts, estimated as 44 percent of the $1.6 billion provided in 2022 to support the World Health Assembly global nutrition targets, is cataclysmic. Recent projections suggest that the dismantling of the U.S. Agency for International Development (USAID) alone could result in more than 14 million additional deaths by 2030, including 4.5 million deaths among children younger than five.
Integration Is Not Just Smart—It’s Essential
To maintain momentum—and reach the Sustainable Development Goals and global nutrition targets—we must prioritise proven, integrated, and cost-effective strategies that deliver multiple health and development outcomes simultaneously. Many critical public health issues—anaemia, wasting, stunting, and low birth weight—share root causes: gender inequality, food insecurity, inadequate access to care, and poverty. Tackling these challenges in isolation is inefficient and ineffective because the populations we support are likely vulnerable to many of them.
Anaemia is a prime example. The lack of progress toward the Sustainable Development Goal indicator and global nutrition target to reduce anaemia in women of reproductive age by 50 percent exemplifies the urgent need for context-specific integration. We know what works to reduce anaemia but need to purposely coordinate and integrate delivery of nutrition, deworming, malaria prevention, and reproductive health integration to safeguard futures and save lives.
Why Anaemia Demands Collective and Integrated Action
Anaemia affects 604.8 million women and 269 million young children globally. Without enough healthy red blood cells to carry oxygen to the heart, brain, and muscles, attention and productivity fall, vulnerability to infection increases, and pregnancy and childbirth become more dangerous for both mother and baby.
Despite decades of research and investment, anaemia levels have remained largely unchanged. Anaemia’s causes and risk factors are varied and context-specific, but the global community has failed to prioritise multi-sectoral programming and investments. While iron deficiency accounts for about half of all cases globally, the other half is caused by a combination of other nutritional deficiencies (e.g., vitamin A, B12, folate); infections (notably malaria, which accounts for up to 25 percent of severe anaemia in pregnant women and up to 15 percent of all anaemia cases), inflammation, and chronic diseases; inherited red blood cell disorders; and obstetric and gynaecological conditions.
Anaemia’s largely invisible consequences mean families and policymakers often misjudge its devastating impact. Women and girls’ reproductive roles make them more biologically vulnerable and social norms and structural barriers—including unequal access to food and healthcare and limited decision-making power—compound this risk. Antenatal care services may offer iron and folic acid containing supplements, but attendance, supplies and coverage, and adherence rates remain far too low for progress.
Joint service delivery of interventions by community and facility health workers acknowledges that individuals face multiple health risks at once (e.g., malaria and parasitic worms) that often influence each other (e.g., parasitic worms and undernutrition)—and offers a strategic, cost-effective way to protect health, strengthen systems, and accelerate progress. To meet the urgency of the moment, we need integration of evidence-based interventions supported by strong coordination and collaboration.
An Agenda for Integrated Anaemia Action
Led by the World Health Organization and UNICEF, the Anaemia Action Alliance introduced a bold new approach in 2023 to mobilise national governments, United Nations agencies, donors, and civil society to prevent and treat anaemia more effectively. The Alliance supports the development of national plans that implement multi-sectoral and integrated programmes and policies to accelerate anaemia reduction while encouraging additional investment in key research.
The tools to fight anaemia are already in our hands—iron-containing supplements, fortified foods, deworming, insecticide-treated nets and indoor residual spraying, reducing unnecessary caesarean sections, treating heavy menstrual bleeding, and infection prevention. What’s needed now is coordinated planning, delivery, and surveillance at scale. The Alliance calls for the integration of essential context-specific interventions to increase treatment coverage, improve quality of care and health outcomes, and reduce inequity and delivery costs. Key platforms include:
🩸 For children and adolescents, schools can deliver nutritious, fortified meals, deworming, and nutrition education.
🩸 Antenatal and postnatal care for pregnant and postpartum women should provide anaemia screening, iron-containing supplements, and malaria prevention and treatment.
🩸 Community-based platforms can offer older adolescents and women nutrition education, treatment for heavy menstrual bleeding, and family planning.
Integration Works: The Philippines
The Philippines shows what coordinated action can do. Between 2000 and 2017, anaemia among women of reproductive age fell from 33 to 22 percent—thanks to integrated interventions that improved access to family planning counselling, nutrition education, and micronutrient supplementation via antenatal care. To address underlying risk factors, efforts to reduce income inequity and improve access to clean water and sanitation complemented this.
An Urgent Call for Bold, Accelerated Action
Anaemia reduction is foundational to good health and development. Now more than ever, we need to prioritise approaches that recognise the varied causes and risk factors to boost learning, increase productivity, reduce maternal mortality, and strengthen economies.
Partners in the Anaemia Action Alliance call for action and are committed to support countries to:
🩸 Use data and diagnostics to drive action. We must identify who is most affected, why, and where interventions are needed, and strengthen use of diagnostics and routine information systems to guide decisions and track progress.
🩸 Coordinate across sectors and systems. We must integrate diagnosis, prevention, and treatment into health; nutrition; education; water, sanitation, and hygiene; and social protection plans and platforms. We need to align efforts and resources across governments, civil society, donors, and technical partners to deliver change.
🩸 Deliver effective interventions at scale. We must strengthen the capacity of health workers and optimise service delivery platforms to reach those most affected.
🩸 Mobilise investment and innovation. We must increase financial commitments and support implementation research to improve the design and delivery of integrated care.
Meeting women, adolescents, and children where they are, with the services they need, will reduce the deleterious impact of ill health on education, opportunities, and wages.
We must act now before anaemia, coupled with aid cuts, rob millions of their future.
An event at the United Nations General Assembly on Monday, 22 September in Elsie Rooftop from 3–5 pm explores this topic. To join the guest list, please email info@stronger-foundations.org.
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