International Women’s Day 2018 marks the 109th year of the event. Starting in New York on February 28, 1909 (the date was changed to March 8th the following year), the day historically has been one of both celebration of progress made towards gender equality, as well as an opportunity to highlight areas of change for the following year. This has especially been the case recently, as since 2010 the United Nations has attached an official theme to each International Women’s Day (IWD), with issues ranging from Empower Rural Women: End Hunger and Poverty to Women in the Changing World of Work: Planet 50-50 by 2030. 2018’s theme has been designated #PressforProgress, in an effort to build on the momentum generated by the previous year’s events such as #MeToo and #TimesUp, among others. The idea behind #PressforProgress is to continue to push for gender equality in all available avenues, in all countries.
One such avenue for progress lies in the field of health. An area that, on the surface, would appear to be the same between men and women would be that of nutrition. This, however, is far from the case as data from all over the globe has revealed the startling truth that Iron Deficiency Anaemia (IDA) affects women at a vastly higher rate than it does men. Physiological differences between men and women lead to women being more predisposed to developing iron deficiency anaemia, however, given that IDA is often preventable and curable, it is startling to see how disproportionately women are still affected by this debilitating condition.
Prevalence of Anaemia in Women
A 2016 paper discussing the prevalence of anaemia and moderate-severe anaemia in the US population observed that, on average, non-pregnant women suffered from anaemia more than twice as often as men (7.6% vs. 3.5%, p<0.0001). Regarding severity, moderate-severe anemia was 5 times more common in non-pregnant women in comparison to men (2.5% vs. 0.5%, p<0.0001) (Le 2016). This discrepancy is exacerbated in developing countries; the prevalence of anemia in developing and developed countries is estimated to be 43% and 9%, respectively (Gebre 2015). The research article published by Gebre, noted causes for this disparity include various socio cultural problems like illiteracy, poverty, lack of awareness, cultural and religious taboos, poor dietary habits, and high prevalence of parasitic infestation. This research was conducted in the north western zone of Tigray, northern Ethiopia, but we also see in a research article published in the Asia-Pacific Journal of Public Health in 2008 that the tendencies observed in eastern Africa hold true for the women of India. The study found that women who had a lower standard of living, women who lived in rural areas, women of lower education, and women who observed a religion with dietary restrictions all manifested anaemia at a significantly higher percentage than those in other economic or biosocial factions (Bharati et al 2008).
What causes IDA?
Causes of anaemia stemming from iron deficiency can be that the person isn’t consuming enough iron, they aren’t absorbing enough of the iron they are ingesting, or they have excessive blood loss (parasites, menstruation, ulcers) that puts a strain on the body’s ability to produce adequate red blood cells (Gebre 2015). Because anaemia is defined by having a reduced haemoglobin or red blood cell count, a combination of the above factors is often what leads someone to becoming anaemic. Iron deficiency represents the largest micronutrient deficiency group in the world; about two billion people (Viteri 1998). As iron is essential for haemoglobin production, iron deficiency accounts for 30%-50% of anaemia worldwide (World Health Organization 2007) (global anaemia population is 2 billion (World Health Organization 2015). Anaemia symptoms generally include:
tiredness and lack of energy
shortness of breath
noticeable heartbeats (heart palpitations)
hearing ringing, buzzing or hissing noises inside your head (tinnitus)
food tasting strange
a sore tongue
hair loss – you notice more hair coming out when brushing or washing it
wanting to eat non-food items (for example, paper or ice) – called pica
finding it hard to swallow (dysphagia)
painful open sores (ulcers) in the corners of the mouth
Impact of Anaemia on Women
So, we have established that anaemia is more prevalent in women than men by a significant margin, and that the occurrence rate is over four times greater in developing countries as opposed to developed countries. We have previously written about the potential mental health problems in people who had IDA during childhood and adolescence.
We now come to the overall impact of this pervasive issue.
With no visible illness for women exhibiting these symptoms while being exposed to the same environments as the men, the lack of education about anaemia would almost certainly attribute the weakness from the unknown, undiagnosed anaemia to an inherent weakness in the main observable difference, that being the difference in the sex. This has been discussed by Kriya Iron, noting on cultural influences both contributing to anaemia and attributing its symptoms as the fault of the afflicted.
It is doubtless that women today face a multitude of complex issues in the pursuit of gender equality. As is evident at debate tables across the globe, the exact causes and effects of these issues, be it women’s health, the wage gap, double standards in workplace behaviour, social expectations of beauty, or more grave issues, such as domestic violence, human rights, or exploitation. All of these topics warrant a place in #PressforProgess, and the IDA epidemic that is present in women in developed nations and that plagues the women of the developing world belongs in this discussion. IDA is not uniquely a women's issue, but the rate at which it affects women and the damage it causes to them both physically and socially is.
Viteri FE 1998. A new concept in the control of iron deficiency: Community-based preventive supplementation of at-risk groups by the weekly intake of iron supplements. Biomed Environ Sci 11: 46–60
Miller J.L. Iron deficiency anemia: A common and curable disease. Cold Spring Harb. Perspect. Med. 2013;3:a011866. doi: 10.1101/cshperspect.a011866.
McLean E, Cogswell M, Egli I, Wojdyla D, de Benoist B 2009. Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993–2005. Public Health Nutr 12: 444–454
World Health Organization 2007. Conclusions and recommendations of the WHO consultation on prevention and control of iron deficiency in infants and young children in malaria-endemic areas. Food Nutr Bull 28: S621–S627
Le CHH (2016) The Prevalence of Anemia and Moderate-Severe Anemia in the US Population (NHANES 2003-2012). PLoS ONE 11(11): e0166635.
World Health Organization, Micronutrient Deficiencies: Prevention and Control Guidelines, World Health Organization, Geneva, Switzerland, 2015
Gebre A, Mulugeta A. Prevalence of Anemia and Associated Factors among Pregnant Women in North Western Zone of Tigray, Northern Ethiopia: A Cross-Sectional Study, Journal of Nutrition and Metabolism, Volume 2015 (2015), Article ID 165430
Bharati P, Som S, Chakrabarty S, Bharati S, Pal M. Prevalence of Anemia and Its Determinants Among Nonpregnant and Pregnant Women in India, Asia-Pacific Journal of Public Health, 2008 20: 347