Utilization of iron folic acid tablets among pregnant women in rural Punjab: an interventional study

Geetika Singh, Mohan Lal, Saurav Singh


Background: Anemia in pregnancy remains a public health problem and is an important indirect cause of maternal mortality accounting for 20% of total maternal deaths in India. However, it is largely preventable and easily treatable. Since, decades, the Government of India has recommended iron folic acid (IFA) supplementation as prophylaxis but adherence to IFA tablets is invariably poor. Health education of antenatal women can be an effective tool for improvement in IFA consumption and compliance. Thus, this study was conducted to assess the problem of anemia and its epidemiological determinants among pregnant women in rural field practice area of Punjab as well as to evaluate the compliance and utilization of IFA tablets before and after the health education intervention.

Methods: Author filled in the predesigned and pretested proforma and imparted health education to all the pregnant women who were then followed. Hb was estimated on two different occasions, before and after the intervention.

Results: After intervention, 82.88% of pregnant women took IFA tablets out of which 42.31% consumed more than 90 tablets. Factors like education, socio-economic status, type of family and gravidity were found to be significantly associated with anemia. Although the overall prevalence of anemia reduced slightly from 96.4% to 92.67% after intervention, the mean Hb levels got decreased.

Conclusions: Despite interventions, the desired outcomes were not obtained. Constant motivation of antenatal women by health workers and IEC activities in the community are thus recommended to improve the IFA compliance rates and combat anemia.


Anemia, Health education, Hemoglobin, IFA, Intervention

Full Text:



Khalafallah AA, Dennis AE. Iron deficiency anaemia in pregnancy and postpartum: pathophysiology and effect of oral versus intravenous iron therapy. J Pregnancy. 2012;2012:1-10.

Friedrisch JR, Friedrisch KB. Prophylactic iron supplementation in pregnancy. a controversial issue. Biochem Insights. 2017;10:1178626417737738.

Ahmad N, Kalakoti P, Bano R, Syed MMA. The prevalence of anemia and associated factors in pregnant women in rural Indian community. Hindu. 2010;3(5):276-280.

Ministry of Health and Family Welfare. National Family Health Survey-4 State fact sheet Punjab. Mumbai: International institute for population sciences, Mumbai; 2015;16:6.

WHO. Daily iron and folic acid supplementation in pregnant women. Geneva, World Health Organization, 2012.

Park K. Community nutrition programmes. In: Park's Text book of Preventive and Social Medicine. 23rd ed. Jabalpur: M/s Banarsidas Bhanot Publishers; 2015: 661.

Mithra P, Unnikrishnan B, Rekha T, Nithin K, Mohan K, Kulkarni V, et al. Compliance with iron-folic acid (IFA) therapy among pregnant women in an urban area of south India. Afr Health Sci. 2013;13(4):880-5.

Kishore J. Reproductive and child health program. In: National Health Programs of India. 11th ed. New Delhi: Century Publications; 2014: 223.

WHO. Preventing and controlling iron deficiency anemia through primary healthcare. Geneva, World Health Organization; 1989.

Ministry of Health and Family Welfare. District Level Household and Facility Survey-4 State fact sheet Punjab. Mumbai: International institute for population sciences, Mumbai; 2012;13:8.

Padda P, Devgun S, Gupta V, Chaudhari S, Singh G. Role of ASHA in Improvement of Maternal Health Status in Northern India: an urban rural comparison. Ind J Community Health. 2013;25(4):465-71.

Gautam VP, Bansal Y, Taneja DK, Saha R. Prevalence of anaemia amongst pregnant women and its socio-demographic associates in a rural area of Delhi. Ind J of Community Med. 2002;27(4):157-60.

Jin L, Yeung LF, Cogswell ME, Ye R, Berry RJ, Liu J, et al. Prevalence of anaemia among pregnant women in south-east China, 1993-2005. Public Health Nutr. 2010;13(10):1511-8.

Viveki RG, Halappanavar AB, Viveki PR, Halki SB, Maled VS, Deshpande PS. Prevalence of anaemia and its epidemiological determinants in pregnant women. Al Ameen J Med Sci. 2012;5(3):216-3.

Bisoi S, Haldar D, Majumdar TK, Bhattacharya N, Sarkar NG, Ray KS. Correlates of anaemia among pregnant women in a rural area of West Bengal. J Fam Welf. 2011;57(1):72-8.

Ansari MA, Khan Z. Antenatal care services in rural areas of Aligarh, India: A cross sectional study. J Public Health Epidemiol. 2011;3(5):210-6.

Sarkar S. Lakshminarayanan S. Anaemia in Pregnant women: The invincible scourge? Indian J Maternal Child Health. 2012;14 (2):1-6.