Levels of adherence, barriers and facilitators to antenatal supplementation of iron-containing supplements in sixty-nine low- and middle-income countries: a secondary analysis of demographic and health surveys data

Fe-deficiency anaemia is common during pregnancy and can lead to serious health consequences for mothers and babies. Antenatal Fe supplementation is associated with lower anaemia prevalence and improved pregnancy outcomes, and the WHO recommends daily oral Fe (30-60 mg) with folic acid (0·4 mg) during pregnancy. However, data on uptake and adherence in many low- and middle-income countries remain fragmented and outdated. We conducted a secondary analysis of Demographic and Health Surveys from sixty-nine low- and middle-income countries to assess uptake and adherence to Fe-containing supplements and explore associations with socio-demographic characteristics and antenatal care (ANC). Overall, 86 % of respondents reported receiving Fe supplements during pregnancy. Among these women, 46·1 % consumed ninety or more supplements, 23·3 % consumed 120 or more, and only 7·1 % consumed 180 or more. Higher education, wealth, and media access were strongly associated with increased odds of initiating supplementation (OR: 1·32; 95 % CI: 1·25, 1·38; OR: 1·29; 95 % CI: 1·20, 1·38; OR: 1·15; 95 % CI: 1·05, 1·26, respectively) and adhering to the regimen (OR: 1·16; 95 % CI: 1·12, 1·21; OR: 1·21; 95 % CI: 1·13, 1·30; OR: 1·14; 95 % CI: 1·08, 1·20, respectively). Early ANC attendance was also associated with higher supplement consumption. Country-specific ANC guidelines are needed to provide clear guidance on the timing and frequency of ANC attendance and supplementation.