August 28, 2025
THIMPHU – A silent health crisis is affecting a significant portion of the country’s population, with nearly half of all children and women suffering from anaemia.
According to data, 44.7 percent of children aged 6–59 months are affected.
Figures show that 40.9 percent of non-pregnant women (15–49 years), 36.5 percent of adolescents (10–19 years), and 33.3 percent of pregnant women (15–49 years) suffer from anaemia.
Globally, this blood disorder affects half a billion women aged 15-49 and 269 million children aged 6-59 months, primarily in low- and lower-middle-income countries due to a lack of proper nutrition.
This blood disorder, caused by a deficiency of red blood cells, prevents the body from carrying enough oxygen to its organs and tissues. Some types of anaemia are inherited, but people may also acquire or develop the condition during their lifetimes.
The symptoms of anaemia can include fatigue, dizziness, and shortness of breath. If left untreated, it can lead to severe health complications, such as poor growth in children, complications in pregnancy, heart problems, learning difficulties, and a weakened immune system.
The 65th session of the World Health Assembly in 2012 also endorsed anaemia as the second global nutrition target for 2025, with the goal of achieving a 50 percent reduction of anaemia in women of reproductive age.
Dual threat: Nutrition and lead poisoning
Experts from the World Health Organisation (WHO) and the Ministry of Health (MoH) said nutrient deficiencies and the presence of high blood lead levels are the two major causes.
High lead levels in the body can make bone marrow toxic, shorten red blood cell survival, and lead to microcytic hypochromic anaemia.
Over three-quarters (76 percent) of Bhutanese children between the ages of one and six have blood lead levels at or above 3.5 micrograms per deciliter, a concentration considered harmful to health. The average blood lead level in this age group is 5.3 micrograms per deciliter, which is significantly higher than the safe limit.
Moreover, three out of every five pregnant or breastfeeding women in Bhutan have blood lead levels at or above 3.5 micrograms per deciliter, which is higher than the safe limit.
In addition, monastic children under the age of 13 have an average blood lead level of 5.9 micrograms per deciliter.
National efforts
Diverse interventions are in place by the government. For pregnant and lactating women, preconception care was implemented through folic acid supplementation and nutrition counselling.
The government also introduced a Conditional Cash Transfer programme to incentivise and support pregnant women to attend antenatal check-ups and adhere to nutritional supplementation.
Multiple micronutrient supplements, such as iron-folic acid supplementation, and deworming programmes were started in schools.
For children, micronutrient powder has been supplied since 2019, Vitamin A supplements since 1984, and deworming since 1988. Infant and Young Child Feeding care at all hospitals and primary health centres, along with growth monitoring and nutrition counselling, was also facilitated.
For adolescents, fortified rice and oil have been provided in all public schools since 2017, tea has been replaced with fortified milk, and the one child–one egg programme was also started, among others.
Challenges
Despite these efforts, challenges remain. According to health experts, challenges in battling anaemia include ensuring patients comply with treatments like Micronutrient Powder (MNP), Multiple Micronutrient Supplements (MMS), and Iron and Folic Acid (IFA).
In addition, challenges also include a lack of dietary diversity, high blood lead levels, and autoimmune hemolytic anaemia.
Bhutan is an import-driven country, and imported food items also pose a major risk for causing anaemia. Nutrient deficiencies are prevalent in rural areas and monastic institutions.
The majority of citizens still have minimal knowledge of lead poisoning, and proper monitoring is also a challenge.
Way forward
The National Nutrition Strategy and Action Plan (NNSAP) for 2026–2030 will be implemented to review and update anaemia control programmes, improve partnerships across different sectors, and strengthen existing health initiatives.
Moreover, NNSAP will assess and improve compliance rates of MNP, MMS, and IFA across all target groups and promote dietary diversity and healthy eating habits.
Anaemia reduction is also part of the Sustainable Development Goals (SDGs) of the United Nations. SDG 2 states that by 2030, all forms of malnutrition should be ended, including achieving, by 2025, the internationally agreed targets on stunting and wasting in children under 5 years of age, and addressing the nutritional needs of adolescent girls, pregnant and lactating women, and older persons.