Antenatal iron supplementation

What does this indicator tell us?

This indicator reflects the percentage of women who consumed any iron-containing supplements during their current or previous pregnancy within the past 2 years. It provides information about the quality and coverage of perinatal medical services.

Daily iron and folic acid supplementation is currently recommended by WHO as part of antenatal care, to reduce the risk of low birth weight, maternal anaemia and iron deficiency. It is suggested that the supplement contains 30-60 mg of iron, with the higher dose preferred in settings where anaemia in pregnant women is a severe public health problem (≥40%), along with 400 µg of folic acid. Daily supplementation throughout pregnancy, beginning as early as possible after conception, is recommended in all settings. Despite its proven efficacy and wide inclusion in antenatal care programmes, the use of iron and folic acid supplementation has been limited in programme settings. Possible reasons for this include a lack of compliance, concerns about the safety of the intervention among women with an adequate iron intake, and variable availability of the supplements at community level. Intermittent use of iron and folic acid supplements by non-anaemic women is a recommended alternative to prevent anaemia and improve gestational outcomes in areas where the prevalence of anaemia among pregnant women is lower than 20%. The suggested dose is 120 mg elemental iron and 2800 µg (2.8 mg) folic acid provided weekly throughout the pregnancy, beginning as early as possible after conception.

This indicator is included as a process indicator in the core set of indicators for the Global Nutrition Monitoring Framework.

How is it defined?

This indicator is defined as the proportion of women who consumed any iron-containing supplements during their current or previous pregnancy within the past 2 years. Data can be reported on any iron-containing supplement, including iron and folic acid tablets, multiple micronutrient tablets or powders, or iron-only tablets (which will vary, depending on the country policy).

What are the consequences and implications?

Improving the intake of iron and folic acid by women of reproductive age could improve pregnancy outcomes, and improve maternal and infant health. Iron and folic acid supplementation is used to improve the iron and folate status of women before and during pregnancy, in communities where food-based strategies are not yet fully implemented or effective. Folic acid supplementation (with or without iron) provided before conception and during the first trimester of pregnancy is also recommended for decreasing the risk of neural tube defects.

Anaemia during pregnancy places women at risk for poor pregnancy outcomes, including maternal mortality; it also increases the risks for perinatal mortality, premature birth and low birth weight. Infants born to anaemic mothers have less than one half the normal iron reserves. Morbidity from infectious diseases is increased in iron-deficient populations, owing to the adverse effect of iron deficiency on the immune system. Iron deficiency is also associated with reduced work capacity and reduced neurocognitive development.

Source of data

Demographic and health surveys (DHS) program STATcompiler (http://www.statcompiler.com/).

Further reading

WHO. Developing and validating an iron and folic acid supplementation indicator for tracking progress towards global nutrition monitoring framework targets. Final report - June 2018. Geneva: World Health Organization; 2018 (https://www.who.int/nutrition/publications/iron-folic-indicator-GNMF/en/).

WHO. Weekly iron and folic acid supplementation as an anaemia-prevention strategy in women and adolescent girls. Lessons learnt from implementation of programmes among non-pregnant women of reproductive age. Geneva: World Health Organization; 2018 (https://www.who.int/nutrition/publications/micronutrients/WIFS-anaemia-prevention-women-adolescent-girls/en/).

WHO. Weekly iron-folic acid supplementation (WIFs) in women of reproductive age: its role in promoting optimal maternal and child health. Geneva: World Health Organization; 2009 (http://www.who.int/nutrition/publications/micronutrients/weekly_iron_folicacid.pdf).

WHO, UNICEF. Global Nutrition Monitoring Framework: operational guidance for tracking progress in meeting targets for 2025. Geneva: World Health Organization; 2017 (http://www.who.int/nutrition/publications/operational-guidance-GNMF-indicators/en/).

Internet resources

WHO. Global targets 2025 to improve maternal, infant and young child nutrition. (http://who.int/nutrition/global-target-2025/en/).

WHO. e-Library of Evidence for Nutrition Actions (eLENA)

• Daily iron and folic acid daily supplementation during pregnancy (http://www.who.int/entity/elena/titles/daily_iron_pregnancy/en).
• Intermittent iron and folic supplementation in non-anaemic pregnant women (http://www.who.int/elena/titles/guidance_summaries/intermittent_iron_pregnancy/en/)