Researchers reviewed 61 studies from 23 countries to understand why pregnant women develop anemia (low iron in the blood) and why prevention programs aren’t working well. They found that women’s ability to manage anemia depends on their family situation, cultural beliefs, and access to affordable food. Many women struggle to take iron supplements because of side effects and forgetfulness, while doctors face challenges testing for anemia and treating it effectively. The study suggests that future programs need to consider these real-world barriers and involve families and communities to help pregnant women stay healthy.
The Quick Take
- What they studied: Why pregnant women develop low iron levels (anemia) and what stops them from preventing or treating it
- Who participated: The review analyzed 61 research studies involving pregnant women, healthcare workers, and community leaders from 23 different countries, mostly in low- and middle-income areas
- Key finding: Pregnant women’s ability to manage low iron is heavily influenced by family support, cultural beliefs, cost of healthy food, and side effects from iron supplements—not just medical factors
- What it means for you: If you’re pregnant or planning to be, understanding these barriers can help you work with your doctor to find solutions that fit your life, such as taking supplements with food to reduce side effects or getting family support to remember doses
The Research Details
This was a qualitative evidence synthesis, which means researchers carefully reviewed and combined findings from 61 existing studies rather than conducting one new study. They searched medical databases for research published up to November 2024 and included studies from around the world with no language restrictions. The researchers organized all the findings into four main themes: how culture affects anemia management, ways to prevent and treat anemia through diet and medicine, how anemia is tested, and what challenges healthcare workers face. They used a special method called thematic synthesis to identify patterns across all the studies and assessed the strength of their conclusions using the GRADE-CERQual approach, which is a scientific way to rate how confident we should be in the findings.
By reviewing many studies together rather than looking at just one, researchers can see the bigger picture of what’s really happening in pregnant women’s lives across different countries and cultures. This approach is especially valuable for understanding complex, real-world problems like anemia prevention, where personal experiences and cultural factors matter just as much as medical treatments. The findings can guide doctors and public health officials in creating programs that actually work for the women they serve.
This review is strong because it included 61 studies from 23 countries, giving a broad perspective. The researchers used established scientific methods to analyze the data and assess confidence in their findings. However, the quality depends partly on the quality of the original studies reviewed. The findings reflect what women and healthcare workers reported about their experiences, which is valuable but different from measuring exact medical outcomes. Readers should know this captures perceptions and barriers rather than proving which treatments work best.
What the Results Show
The research revealed that pregnant women’s experience with anemia is shaped far more by their life circumstances than by medical knowledge alone. Women’s limited decision-making power in their families and communities significantly affected their ability to prevent or treat anemia. Many women understood that eating nutritious food was important for managing anemia, but the high cost of healthy foods created a major barrier that medical advice couldn’t overcome. Family support emerged as a critical factor—women were much more likely to take iron supplements regularly when family members helped remind them and encouraged them. Side effects from iron supplements, particularly stomach upset and constipation, were common reasons women stopped taking them, even when they understood the supplements were necessary. Healthcare workers reported that testing pregnant women for anemia was difficult due to lack of equipment, training, or time in their clinics.
Women viewed blood transfusions as the main treatment for severe anemia, while intravenous iron (iron given through a needle into the vein) was seen as an option for women who couldn’t take pills, came to prenatal care late, or couldn’t receive transfusions. Healthcare workers faced significant structural problems in their health systems that prevented them from properly managing anemia, including insufficient resources, unclear guidelines, and competing priorities. The research showed that cultural beliefs about pregnancy, food, and medicine varied across regions and influenced how women approached anemia prevention and treatment. Community and family attitudes toward anemia prevention programs affected whether women participated and followed recommendations.
This review builds on decades of research showing that anemia in pregnancy remains a major health problem, especially in low- and middle-income countries. Previous studies have documented that anemia rates haven’t improved much despite many programs and interventions. This research goes deeper by explaining why—it shows that the problem isn’t just lack of medicine or supplements, but rather the complex mix of social, cultural, and economic factors that affect whether women can actually use these tools. The findings align with growing recognition in global health that programs must address real-world barriers, not just provide medical solutions.
This review synthesizes qualitative research (studies based on interviews and observations) rather than measuring exact medical outcomes, so it tells us about experiences and perceptions rather than proving which treatments work best. The studies reviewed came from different countries with different healthcare systems, so findings may not apply equally everywhere. Some regions and populations may be better represented in the research than others. The review captures what people reported about their experiences, which may differ from what actually happens in practice. Future research using these findings alongside implementation science (the study of how to make programs work in real settings) would be needed to develop and test solutions.
The Bottom Line
Healthcare providers should assess each pregnant woman’s individual barriers to managing anemia—including family support, access to affordable food, and tolerance of supplements—rather than assuming one approach works for everyone (moderate confidence). Programs should involve families and communities in anemia prevention efforts, as family support significantly improves adherence to supplements (moderate confidence). Healthcare systems should invest in training, equipment, and time for healthcare workers to properly test and manage anemia in pregnant women (moderate confidence). Women should discuss side effects with their doctor, as taking supplements with food or adjusting timing may help, and family members should be involved in supporting adherence (practical recommendation).
Pregnant women and those planning pregnancy should care about this research because it validates that barriers to managing anemia are real and not just about willpower or understanding. Healthcare workers, doctors, and midwives should use these findings to design programs that address actual barriers rather than assuming women simply need more education. Public health officials and policymakers in low- and middle-income countries should prioritize addressing the structural barriers healthcare workers face. Family members of pregnant women should understand their important role in supporting anemia prevention. This research is less relevant for pregnant women in wealthy countries with robust healthcare systems, though some barriers like supplement side effects apply universally.
Improvements in anemia prevention would likely take several months to a year to show up in blood tests, as iron stores build gradually. However, women may feel better (less tired, better energy) within weeks of successfully managing anemia. Systemic changes to healthcare programs and family support systems would take longer—typically 6 months to 2 years to implement and show population-level results. Individual women who address their specific barriers with healthcare provider support may see improvements in their next blood test (usually 4-8 weeks after starting or adjusting treatment).
Want to Apply This Research?
- Track iron supplement adherence daily by logging when you take your supplement and any side effects experienced, plus weekly energy levels (1-10 scale) and monthly blood test results if available. Note which family members provided support on days you took supplements.
- Set up a daily reminder on your phone for taking iron supplements at the same time each day, preferably with food to reduce stomach upset. Share your supplement schedule with a family member and ask them to check in with you daily. If you experience side effects, use the app to note them and discuss with your doctor rather than stopping the supplement.
- Use the app to track patterns over 3 months: which days/times you successfully take supplements, what side effects occur, and how your energy levels change. Share this data with your healthcare provider at prenatal visits to adjust your treatment plan. Monitor whether family support improves your consistency, and adjust your support system if needed.
This research summarizes women’s and healthcare workers’ experiences and perceptions about anemia in pregnancy—it does not provide medical advice or prove which treatments work best. Pregnant women should always consult with their doctor or midwife about anemia screening, prevention, and treatment. If you are pregnant and experience symptoms like extreme fatigue, shortness of breath, or dizziness, seek immediate medical care. The findings primarily reflect experiences in low- and middle-income countries and may not apply to all healthcare settings. Individual medical decisions should be made with qualified healthcare providers who know your complete health history.