COUNTRY EXAMPLE

EXPANDING ANEMIA PREVENTION

AND CONTROL IN INDONESIA
Anemia prevalence is high in a number of groups throughout Indonesia. After initiating
efforts to reduce anemia in pregnant women in 1985, Indonesia has since expanded its anemia prevention and control strategies and is addressing anemia prevalence in other vulnerable groups through a number of measures.
As the table below indicates, the 1995 National Household Survey (NHHS) found prevalence highest among adolescent girls, followed by pregnant women, school-age children, children less than 5 years old, and all women of reproductive age.

Vulnerable Group

% Anemic

Pregnant women

50.9

All women of reproductive age (15-44 yrs.)

39.5

Young children (0-5)

40.5

School-age children (5-11)

47.2

Adolescent girls (10-14)

57.3

Source: 1995 NHHS.

Taking Action:
Developing a Strategy

Anemia Prevalence in Vulnerable Populations in Indonesia

National survey data show that anemia prevalence in pregnant women decreased from 73.7
percent in 1985 to 50.9 percent in 1995, a 31 percent decline. This suggests that progress
had indeed occurred by the mid-1990s. As seen in the figure below, anemia prevalence in
preschool children (0 to 5 years of age) also decreased from 55.5 to 40.5 percent between
1992 and 1995.
Prevalence of Anemia (%) in Pregnant Women and Preschool Children, 1985-1995

The change in anemia prevalence in pregnant women accompanied increased attention to

anemia prevention and control in antenatal care (ANC) services. Several good practices
were identified as responsible for the improvements in this program:

Chapter II Taking Action: Developing a Strategy

27

 High commitment from the Indonesian government to control anemia

Monitoring systems for anemia and iron-folic acid (IFA) supplement use
Improved packaging to protect IFA supplements from humidity and make them more
attractive to consumers
A change to a red, film-coated supplement that did not have the fishy taste of the previous supplements
Messages about when and how to take IFA supplements to mitigate side effects
Increased supply and availability of IFA supplements at each level of the health system,
including distribution by community health workers (village midwives and traditional birth
attendants) and private sector sales by drug vendors and small shops
Availability of program guidelines and protocols on how many IFA supplements to give
These improvements have increased the number of pregnant women receiving and taking IFA
supplements. Demographic Health Surveys in 1994 and 1997 indicated a 36 percent decline
in pregnant women receiving no IFA supplements (from 26.4 to 16.9 percent) and a 69 percent increase in pregnant women receiving 90 or more IFA supplements (from 14.4 to 24.4
percent). There were not commensurate increases in the number of women receiving ANC
from a trained provider or in the number of women receiving four or more ANC visits. The
increase in coverage for IFA supplements thus was not due to an increase in ANC use but to
specific actions taken to improve IFA supplement distribution.
Indonesia has also developed protocols for giving iron supplements to children ages 6 to 60
months, but these recommendations have not been extensively implemented. Nonetheless,
anemia prevalence also declined for this group between 1992 and 1995. This decline may
have been due to improvements in overall nutritional status or in maternal iron status,
resulting in better iron stores in newborn infants.
In addition, the Directorate of Nutrition in Indonesias Ministry of Health has collaborated
with a number of other ministries to address anemia and introduce IFA supplementation to
various population groups. Collaborating ministries include the Ministry of Religious Affairs to
work with engaged or newly married women and children attending Islamic schools; the
Ministry of Education to reach other school-age children; the Ministry of Manpower to introduce IFA in workplaces; and the Ministry of Industry and Trade to introduce iron-fortified
flour.The Government has worked with parastatal and private sector pharmaceutical companies to sell IFA supplements in retail shops throughout the country. While the commitment
of these various sectors needs strengthening, as do behavior change communications,
Indonesia has made important steps in improving anemia prevention and control provided by
ANC services and in expanding activities beyond those targeted at pregnant women.

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Anemia Prevention and Control:What Works

Part I : Program Guidance