Under National Rural Health Mission (NRHM), a flagship program of the Central Government, Janani Suraksha Yojana (JSY) was launched in 2005 to improve maternal health in the state. Improving the levels of antenatal and delivery care were among the main objectives of the scheme. Although Uttar Pradesh (UP) has made considerable progress in terms of institutional deliveries, antenatal care has been severely hit by the apparent lack of supplies of Iron Folic Acid (IFA) in the state. 

Iron Folic Acid deficiency during pregnancy can negatively impact the health of the woman during pregnancy as well as fetal development. An additional amount of IFA is required to meet pregnant woman's (and also of the featus in the womb) nutritional needs. The deficiency of iron causes anemia. The consequences of anemia in pregnant mothers include maternal mortality, higher risk of preterm births and low birth weight. Hence providing adequate quantity to IFA can contribute significantly to achieving health related Millennium Development Goals. According to NFHS-3, more than half of the pregnant women in UP suffered from anemia in 2005-06.

The government has been asking ANMs to buy blood pressure instrument, blood and urine test kits etc. from the untied fund provided to them under NRHM so that the aim of providing 'full' antenatal care to all pregnant women can be fulfilled. However, it has not paid any attention to the apparent lack of IFA - a major component of antenatal care. It is surprising that a government so desperate to cut down the maternal mortality, focuses only on measuring weight, height, blood pressure and hemoglobin of pregnant women rather than providing them adequate quantity of IFA which could actually reduce maternal mortality to a considerable extent.

The state has not been able to procure any IFA since last one year or so. Hence, Auxiliary Nurse Midwife (ANM) and Accredited Social Health Activist (ASHA) are devoid of any IFA since then. Most of the women in rural areas especially poor and uneducated mainly depend on ASHAs and ANMs for IFA tablets and syrup. Since government has been providing IFA tablets for free in the past, people are not ready to buy them from the market where it is available but a higher price.

I don't know why government is not able to procure IFA despite the fact that it is available in the market in ample amount. However, a district level health department official revealed the story behind this shortage. The company which was given the tender to provide IFA to the health system in UP to has not been able to deliver it. The main problem has something to do with the pricing of the IFA.  The government has neither taken any action against the company nor made any short term arrangements to procure IFA from other sources. It has been almost a year since when the last stock was distributed across the system.