Researchers in Ethiopia wanted to understand why some pregnant women don’t take their iron and folic acid supplements regularly, even though these vitamins are really important for a healthy pregnancy. They compared 105 pregnant women who weren’t taking their pills regularly with 211 women who were taking them as prescribed. They found that younger women, those who started prenatal care late, and women who didn’t understand why the supplements matter were more likely to skip their pills. The study also showed that women who received fewer pills were less likely to take them consistently. These findings could help doctors and health workers better support pregnant women in taking their supplements.

The Quick Take

  • What they studied: Why pregnant women in Ethiopia don’t take their iron and folic acid supplements regularly, even though doctors recommend them
  • Who participated: 316 pregnant women in Bishoftu Town, Ethiopia who were getting prenatal care at public health clinics. Some were taking their supplements regularly (4+ days per week) and others were not (less than 4 days per week)
  • Key finding: Women aged 15-34 years, those who started prenatal care after 16 weeks of pregnancy, those with limited understanding of why supplements matter, and those who received 30 or fewer pills were significantly more likely to skip their supplements
  • What it means for you: If you’re pregnant or know pregnant women, understanding why supplements matter and having enough pills on hand can help ensure better health for both mom and baby. Healthcare providers may need to do a better job explaining the importance of these supplements and making sure women have adequate supplies

The Research Details

Researchers used a case-control study design, which means they compared two groups of pregnant women: those who weren’t taking their iron and folic acid supplements regularly (the ‘cases’) and those who were taking them as recommended (the ‘controls’). They collected information from 105 women in the first group and 211 in the second group between April and May 2022. A trained health worker asked each woman questions about her age, when she started prenatal care, how many times she visited the clinic, what she knew about supplements, and how many pills she received. The researchers then used statistical analysis to figure out which factors were most strongly connected to women not taking their supplements regularly.

This study design is useful because it allows researchers to look backward and identify specific factors that make women more or less likely to take their supplements. By comparing women who do take supplements with those who don’t, researchers can spot patterns and understand the real-world barriers that pregnant women face. This information is more practical than just knowing that some women don’t take supplements—it tells us exactly what to fix.

The study was conducted in a real healthcare setting with trained health workers collecting the information, which makes the results more realistic. The researchers used a systematic approach to select participants and analyzed the data using proper statistical methods. However, the study only looked at women in one town in Ethiopia, so the results may not apply everywhere. Also, the study relied on women remembering and reporting their own behavior, which could be less accurate than directly observing whether they took their pills.

What the Results Show

The research identified five main factors that made pregnant women less likely to take their iron and folic acid supplements regularly. First, younger women aged 15-24 and 25-34 years were much more likely to skip their supplements compared to older women. Second, women who didn’t start prenatal care until after 16 weeks of pregnancy were more likely to be non-adherent. Third, women who had only two or three prenatal care visits were significantly more likely to skip their supplements than those with more frequent visits. Fourth, women who didn’t understand why iron and folic acid supplements are important were about 3.5 times more likely to skip them. Finally, women who received 30 or fewer tablets were much more likely to not take them regularly compared to those who received more pills.

The study also showed that the timing of prenatal care visits and the frequency of clinic visits were connected to supplement adherence. Women who started prenatal care earlier in their pregnancy and had more frequent check-ups were more likely to take their supplements consistently. This suggests that regular contact with healthcare providers and early engagement in prenatal care may help women understand the importance of supplements and stay motivated to take them.

This study adds to existing research showing that lack of knowledge and inadequate healthcare access are major barriers to taking prenatal supplements in low-income countries. Previous studies have also shown that younger women and those with limited healthcare contact are at higher risk for not following medical recommendations. This Ethiopian study confirms these patterns and adds new information about the specific importance of having enough pills available and starting prenatal care early.

The study only included pregnant women in one town in Ethiopia, so the results may not apply to other regions or countries with different healthcare systems. The information was collected by asking women to remember whether they took their pills, which could be inaccurate—some women might forget or not want to admit they skipped doses. The study didn’t explore all possible reasons why women might skip supplements, such as side effects, cost, or cultural beliefs. Additionally, the study was conducted in 2022, so some information might be outdated.

The Bottom Line

Healthcare providers should make sure pregnant women understand why iron and folic acid supplements are important for their health and their baby’s health (high confidence). Clinics should provide adequate quantities of pills—at least enough for the entire month—to reduce barriers to taking them (high confidence). Healthcare workers should encourage women to start prenatal care early in pregnancy and attend visits regularly (high confidence). Special attention should be paid to younger pregnant women and those starting prenatal care late, as they may need extra support and education (moderate confidence).

Pregnant women, especially those aged 15-34, should pay close attention to this research and make sure they understand why their supplements matter. Healthcare providers, clinic managers, and public health officials in Ethiopia and similar settings should use these findings to improve their prenatal care programs. Women planning to become pregnant should know that starting prenatal care early and maintaining regular visits helps with supplement adherence. This research is less relevant for women in countries with different healthcare systems or those who already have good access to prenatal care and education.

The benefits of taking iron and folic acid supplements during pregnancy develop gradually over weeks and months. Women should expect to see improvements in energy levels and overall health within 4-8 weeks of consistent supplement use. The most important benefits for the baby develop throughout pregnancy, so starting early and staying consistent matters most. If changes are made to improve healthcare provider education and pill distribution, improvements in adherence rates should be visible within 3-6 months.

Want to Apply This Research?

  • Track daily iron and folic acid supplement intake by logging each dose taken. Set a goal of taking supplements at least 4 days per week, and record the actual number of days completed each week. Monitor trends over monthly cycles to identify patterns in adherence.
  • Set a daily reminder on your phone for the same time each day to take your supplement (such as with breakfast). Keep your pills in a visible place where you’ll see them regularly. If you receive a monthly supply, divide them into weekly portions in a pill organizer to make it easier to track whether you’re taking them consistently.
  • Use the app to create a weekly checklist of supplement doses and review your adherence rate monthly. Track any barriers you encounter (such as forgetting, side effects, or running out of pills) and share this information with your healthcare provider. Set monthly goals to gradually improve from your current adherence rate toward the recommended 4+ days per week.

This research describes findings from a specific study in Ethiopia and should not replace personalized medical advice from your healthcare provider. If you are pregnant or planning to become pregnant, consult with your doctor or midwife about whether iron and folic acid supplements are right for you and what dose is appropriate. The findings about barriers to taking supplements are informational and may not apply to all women or all healthcare settings. Always follow your healthcare provider’s recommendations regarding prenatal supplementation, and report any side effects or concerns about taking supplements.