Researchers in Ethiopia discovered that only 45% of pregnant women in rural areas are taking their iron and folic acid supplements as recommended—far below the 80% goal set by the World Health Organization. Iron and folic acid are crucial vitamins that prevent anemia (low blood counts) during pregnancy, which can harm both mother and baby. The study of 406 pregnant women found that women who received counseling about why these supplements matter, attended more prenatal checkups, understood the importance of the vitamins, and had anemia were more likely to take their pills regularly. The findings suggest that better education and more frequent doctor visits could help more pregnant women protect their health and their babies’ health.
The Quick Take
- What they studied: How many pregnant women in rural Ethiopia actually take their iron and folic acid supplements as prescribed, and what helps or stops them from taking these important vitamins
- Who participated: 406 pregnant women with an average age of 28 years old who received care at rural health clinics in the Waghimra zone of Northern Ethiopia between February and June 2024
- Key finding: Only 45 out of every 100 pregnant women (45%) were taking their iron and folic acid supplements regularly, which is much lower than the 80% that health experts recommend. Women who received counseling, had more prenatal visits, understood why the supplements matter, and had anemia were 2 to 4 times more likely to take their pills
- What it means for you: If you’re pregnant or planning pregnancy in a rural area, ask your doctor about iron and folic acid supplements and why they’re important. If you’re a healthcare provider, spending time explaining these supplements and seeing patients more often could help many more women protect themselves and their babies from anemia
The Research Details
Researchers conducted a cross-sectional study, which is like taking a snapshot in time rather than following people over months or years. They visited rural health facilities in Ethiopia and randomly selected 406 pregnant women to interview between February and June 2024. They asked women questions about whether they were taking their iron and folic acid supplements, how many prenatal checkups they’d attended, what they knew about these vitamins, and whether they had anemia. The researchers also reviewed medical records to confirm information.
The study used a method called systematic random sampling, which means they picked every nth woman from a list to make sure the selection was fair and unbiased. They collected information through face-to-face interviews using structured questionnaires, which means they asked the same questions in the same way to every woman. This approach helps ensure the information is consistent and comparable across all participants.
After collecting all the data, researchers entered it into computer programs and used statistical tests to figure out which factors were most strongly connected to whether women took their supplements. They looked at the strength of these connections and determined which ones were statistically significant, meaning they were unlikely to have happened by chance.
This research approach is important because it provides a real-world picture of what’s actually happening in rural health facilities where many pregnant women receive care. Rather than studying the supplements in a laboratory, the researchers looked at actual women in their communities, which makes the findings more relevant to real life. The cross-sectional design is efficient for identifying which factors are associated with taking supplements, even though it can’t prove that one thing directly causes another. By understanding these barriers and helpful factors, health programs can design better strategies to help pregnant women stay healthy.
This study has several strengths: it included a reasonable sample size of 406 women, used systematic sampling to reduce bias, and collected data through multiple methods (interviews and medical records). However, readers should know that this is a snapshot study from one region of Ethiopia, so the results may not apply everywhere. The study shows associations between factors and supplement use, but cannot prove that one thing directly causes another. The study relied partly on women’s self-reports about taking supplements, which could be inaccurate if women don’t remember correctly or feel embarrassed to admit they didn’t take them. The research was published in a reputable journal (BMC Pregnancy and Childbirth), which suggests it met quality standards for publication.
What the Results Show
The main finding was that only 45.1% of pregnant women were adhering to their iron and folic acid supplements—meaning they were taking them as prescribed. This is significantly lower than the World Health Organization’s recommendation of more than 80% adherence. The researchers identified four key factors that made women more likely to take their supplements consistently.
First, women who received counseling about why iron and folic acid supplements are important were 2.3 times more likely to take them regularly. This suggests that simple education and explanation from healthcare workers can make a real difference. Second, women who had more prenatal care visits were 3.5 times more likely to take their supplements, possibly because they had more opportunities to receive reminders and support from their doctors.
Third, women who had good knowledge and understanding of what iron and folic acid do were 4.2 times more likely to take their supplements—the strongest factor identified. This shows that when women truly understand how these vitamins protect them and their babies, they’re much more motivated to take them. Finally, women who already had anemia were 3.1 times more likely to take their supplements, possibly because they experienced symptoms or their doctor emphasized the importance after diagnosis.
While the study focused primarily on adherence rates and the four main factors, the research also highlighted that the problem of low supplement use is widespread in rural Ethiopia. The fact that more than half of pregnant women are not taking these protective vitamins suggests a significant public health concern. The study also showed that the average age of participants was 28 years old, indicating that women across their reproductive years are affected by this issue, not just teenagers or older women.
This research fits into a larger body of evidence showing that iron and folic acid supplement adherence is a challenge in many low-resource countries, particularly in rural areas. Previous studies have identified similar barriers, including lack of knowledge, side effects, and limited access to healthcare. However, this study adds important local evidence from Ethiopia and confirms that counseling and education are effective strategies, which aligns with recommendations from global health organizations. The 45% adherence rate is consistent with other studies from similar settings in Africa, suggesting this is a widespread problem rather than unique to this region.
This study has several important limitations that readers should understand. First, it was conducted in only one zone of Ethiopia, so the results may not apply to other regions with different healthcare systems or populations. Second, the study relied on women’s self-reports about taking supplements, which can be inaccurate—some women might not remember correctly, or might say they took supplements when they didn’t because they feel embarrassed. Third, the study is a snapshot in time and cannot prove that counseling directly causes better adherence; it only shows that these factors are associated. Fourth, the study didn’t explore some important barriers like cost, side effects, or supply shortages that might prevent women from taking supplements. Finally, the study didn’t follow women over time to see if those who took supplements actually had better pregnancy outcomes.
The Bottom Line
Based on this research, healthcare providers should: (1) Provide clear counseling to every pregnant woman about why iron and folic acid supplements are important for her health and her baby’s health—this appears to be one of the most effective interventions; (2) Schedule more frequent prenatal checkups, especially for women at risk of anemia, to provide more opportunities for support and reminders; (3) Focus on educating pregnant women about what these supplements do in their bodies so they understand the benefits; (4) Screen for anemia early and discuss results with women to motivate them to take supplements. For pregnant women: take your iron and folic acid supplements as prescribed, ask your doctor why they’re important, and mention any side effects so your doctor can help. These recommendations have moderate to strong evidence support from this study.
This research is most relevant to pregnant women in rural areas of low-income countries, particularly in Africa, where anemia rates are highest and healthcare resources are limited. Healthcare workers, midwives, and doctors who care for pregnant women should pay special attention to these findings. Public health officials and program planners in Ethiopia and similar countries should use this information to improve their prenatal care programs. Pregnant women in developed countries with good healthcare access may have different barriers and higher supplement adherence rates, so these specific findings may not apply to them. However, the general principle that counseling and education improve adherence is likely universal.
If a pregnant woman starts taking iron and folic acid supplements regularly after receiving counseling, she may begin to feel better within 2-4 weeks if she has anemia (more energy, less shortness of breath). However, the real benefits—preventing severe anemia and protecting the baby’s development—develop over weeks and months of consistent use. The most important time for these supplements is throughout pregnancy, but especially during the second and third trimesters when the baby’s iron needs increase. Women should expect to take these supplements for the entire duration of their pregnancy and possibly for a few months after delivery if they’re breastfeeding.
Want to Apply This Research?
- Track daily iron and folic acid supplement intake with a simple yes/no checklist in the app. Set a daily reminder at the same time each day (for example, with breakfast) to take the supplement. Record any side effects like nausea or constipation so you can discuss them with your healthcare provider. Monitor your energy levels weekly on a scale of 1-10 to see if supplements help you feel better.
- Use the app to set a daily alarm reminder to take your iron and folic acid supplement at the same time every day. Create a simple habit by linking supplement intake to an existing daily routine (like after breakfast or before bed). Share your adherence progress with your healthcare provider during prenatal visits by showing them your app data. If you experience side effects, use the app to log them and get tips for managing them (like taking supplements with food or at different times).
- Track supplement adherence weekly and review your consistency each month with your healthcare provider. Monitor energy levels, shortness of breath, and other anemia symptoms monthly. If adherence drops below 80%, use the app to identify barriers (forgetting, side effects, access issues) and adjust your strategy. Schedule check-ins with your healthcare provider every 2-4 weeks to discuss your supplement use and any concerns. Use the app to record counseling sessions or educational information from your doctor so you can review why these supplements matter when motivation is low.
This research describes a study conducted in rural Ethiopia and may not apply to all populations or healthcare settings. The findings show associations between factors and supplement use but do not prove direct cause-and-effect relationships. This information is educational and should not replace advice from your healthcare provider. If you are pregnant or planning pregnancy, consult with your doctor or midwife about whether iron and folic acid supplements are appropriate for you, what dose you should take, and how to manage any side effects. Do not start, stop, or change any supplements without discussing it with your healthcare provider first. This study was published in October 2025 and reflects research conducted in 2024; newer information may be available.