New Data Uncover Alarming Drop in Iron and Folic Acid Use Among Indian Pregnant Women: Study

Why, in a country with some of the world's highest anemia rates, do so many pregnant women stop taking iron and folic acid even after receiving them? This question is at the heart of a new study published in BMC Pregnancy and Childbirth, which leverages data from over 170,000 pregnancies across India to illuminate critical gaps in iron and folic acid (IFA) supplementation adherence.

Study Design: National Survey Uncovers Adherence Patterns

Researchers analyzed data from the National Family Health Survey-5 (2019–21), focusing on 174,947 women who obtained IFA supplements during pregnancy. The team examined both initiation (starting IFA) and continuation (taking IFA for at least 100 and 180 days), along with the impact of socioeconomic status, education, antenatal care (ANC) visits, and partner involvement.

Key Findings: Initiation Is High, But Continuation Plummets

Initiation rates are promising: Most women (84%) took at least one dose of IFA once supplements were available.

Adherence quickly drops: Only 44% consumed IFA for the recommended 100 days, and just 40% reached the 180-day mark.

Socioeconomic status makes a difference: The poorest women were over 60% more likely than the richest to be non-adherent for 100 days (OR 1.61) and nearly twice as likely for 180 days (OR 1.96).

Education matters: Women with no education had a 73% higher chance of non-adherence for 100 days compared to those with higher education.

ANC and partner support are crucial: Women with fewer than four ANC visits or whose husbands did not accompany them to visits were significantly more likely to miss IFA milestones.

Socioeconomic and Geographic Disparities

Rural, less educated, and poorer women showed the highest non-adherence, with some states (e.g., Uttar Pradesh, Bihar, Ladakh) reporting over 60% non-compliance. In contrast, southern and urban states, as well as women with higher education and wealth, fared much better.

Why This Matters: Clinical and Public Health Implications

Anemia remains a leading cause of maternal morbidity and adverse outcomes in India. The study found a positive correlation between state-level anemia prevalence and IFA non-adherence, underscoring the public health significance. Despite good IFA availability, adherence remains the bottleneck—especially among vulnerable groups. Improving education, ensuring at least four ANC visits, and involving partners in prenatal care are practical steps clinicians can champion to close these gaps.

Technical note: Odds ratios (OR) from logistic regression quantify how much more (or less) likely a group is to be non-adherent compared to the reference (e.g., poorest vs. richest). Four ANC visits are defined as per national guidelines.

Conclusion

Ensuring that IFA supplements simply reach pregnant women is not enough. Targeted interventions focusing on education, ANC utilization, and family involvement are essential to boost adherence, reduce anemia, and improve pregnancy outcomes in India.

Key points

Most pregnant women in India receive iron and folic acid, but less than half complete 100 days of supplementation.

Poorer, less educated, and rural women face the highest risk for non-adherence.

At least four ANC visits and partner involvement significantly improve IFA adherence rates.

There is a direct link between state anemia prevalence and IFA non-adherence.

Community health workers play a vital role in monitoring, education, and follow-up for sustained IFA consumption.

Citation:

Sengupta A., Prakash M., Dutta T. Non-adherence to iron and folic acid consumption among Indian pregnant women: evidences from national family health survey-5 data (2019-21). BMC Pregnancy Childbirth. 2026. https://doi.org/10.1186/s12884-026-09639-4