Compliance With Iron–Folic Acid Supplementation and Iron‐Deficiency Anemia Among Pregnant Women in Kathmandu

Background: Iron‐deficiency anemia (IDA) during pregnancy is a major public health concern, leading to adverse maternal and fetal health outcomes such as premature birth and low birth weight. This study aimed to identify factors associated with compliance with iron–folic acid supplementation (IFAS) and the prevalence of IDA among pregnant. Methods: A cross‐sectional study using face‐to‐face interviews with structured questionnaires was conducted among 270 pregnant women attending a private hospital in Kathmandu, Nepal in 2023. Respondents were selected consecutively. Descriptive analysis was performed for categorical variables. Multivariate logistic regression analysis identified factors associated with compliance and anemia ( p < 0.05). Results: Most respondents were young adults (mean age: 30.09 ± 4.40 years) with secondary level education (57.8%) and homemaker occupations (57.4%). Over half (56.3%) demonstrated good knowledge of anemia, and slightly more than half (50.0%) had good knowledge of iron–folic acid (IFA). Compliance with IFAS was 63.0%, while 28.5% of women had IDA. Compliance was positively associated with occupation (adjusted odds ratio (AOR) = 2.6 and 95% confidence interval (CI) = 1.1–6.0), receiving IFA in the 2nd trimester (AOR = 2.2 and 95% CI = 1.1–5.0), and knowledge of IFA (AOR = 2.4 and 95% CI = 1.2–4.8). Higher education level (AOR = 5.1 and 95% CI = 1.7–15.2) and being employed (AOR = 0.3 and 95% CI = 0.1–0.8) were associated with lower IDA prevalence, while a history of medical illness was associated with higher IDA prevalence (AOR = 4.0 and 95% CI = 1.5–10.6). Conclusion: Despite IFA compliance rates within the national coverage range, forgetfulness, side effects, and inadequate counseling remain barriers. The persistence of anemia, even at a slightly lower rate than national data, remains a significant public health concern. Public health interventions are needed to improve IFA adherence, reduce anemia, and optimize maternal and fetal health outcomes in this population.