A comprehensive review of iron folic acid supplementation among pregnant women: Redefining maternal nutrition

Iron and folic acid (IFA) supplementation remains one of the most widely endorsed strategies in global maternal health, yet its promise is persistently undermined by poor compliance. Pregnancy amplifies nutritional demands, and untreated iron deficiency anemia continues to jeopardize maternal well-being and neonatal outcomes. Despite decades of evidence and strong policy advocacy, including World Health Organization (WHO) guidelines and national programs such as Anemia Mukt Bharat, gaps in adherence reveal a paradox: life-saving interventions often fail to reach or resonate with those most in need. This review interrogates the complex interplay of socioeconomic, cultural, and systemic determinants that shape IFA adherence across contexts, with a particular emphasis on India and comparable low- and middle-income countries (LMICs). The findings expose how financial constraints, fragile health infrastructure, and limited health literacy intersect with cultural beliefs, traditional practices, and family dynamics to create a web of barriers that defy simple solutions. Myths linking supplementation to miscarriage or obstructed labor, alongside dietary inhibitors, side effects, and religious restrictions, reveal that the issue is not merely biomedical but deeply social. Equally, programmatic challenges, such as stock-outs, weak monitoring systems, and fragmented intersectoral coordination, further compromise the potential of supplementation campaigns. Yet, emerging evidence also illuminates pathways. Culturally sensitive education, community-based counselling, and male or family involvement have shown measurable improvements in adherence. Innovative delivery approaches, from fortified foods and micronutrient powders to workplace supplementation, expand access beyond traditional channels. Digital health technologies, particularly SMS reminders and mobile applications, represent scalable tools to enhance daily compliance and strengthen supply-chain accountability. Public-private partnerships further highlight how collaboration can bridge systemic gaps and extend reach. The analysis ultimately argues that IFA compliance must be reframed as more than a clinical prescription: it is a developmental challenge bound to women’s autonomy, education, and equity. Addressing maternal anemia requires integrated interventions that are simultaneously biomedical, behavioral, and political. Unless compliance is treated as both a health system responsibility and a societal priority, the cycle of preventable anemia and poor pregnancy outcomes will persist.