Factors Associated With Uptake of Iron Supplement During Pregnancy Among Women of Reproductive Age in Somaliland: A Cross‐Sectional Study

ABSTRACT Background Anemia in pregnancy is a severe public health problem in low‐ and middle‐income countries, yet the uptake of recommended iron supplementation remains critically low. In a post‐conflict and resource‐constrained setting like Somaliland, there is a significant evidence gap regarding the factors that determine whether pregnant women use these essential supplements. This study aimed to identify the individual and community‐level factors associated with the uptake of iron supplements during pregnancy in Somaliland. Methods We conducted a cross‐sectional analysis of data from the 2020 Somaliland Demographic and Health Survey (SLDHS), including a nationally representative weighted sample of 2577 women aged 15–49 years who had a live birth in the 5 years preceding the survey. A multilevel binary logistic regression model was used to identify determinants of iron supplement uptake while accounting for the hierarchical data structure. Results The uptake of iron supplements was alarmingly low, with only 37.08% of women reporting use during their most recent pregnancy. The strongest predictor was attending four or more antenatal care (ANC) visits (adjusted odds ratio [AOR] = 6.20; 95% confidence interval [CI]: 4.70–8.19). Other significant positive determinants included belonging to a rich household (AOR = 1.93; 95% CI: 1.43–2.60), having a husband in paid employment (AOR = 2.13; 95% CI: 1.71–2.66), and exposure to television. Conversely, women whose husbands had no formal education had significantly lower odds of uptake (AOR = 0.68; 95% CI: 0.51–0.91). Significant regional disparities were observed, with markedly lower uptake in the Sool and Sanaag regions. Conclusion Iron supplement uptake in Somaliland is critically deficient and driven by profound inequities in healthcare access and socioeconomic status. A multipronged strategy is urgently needed, focusing on strengthening ANC services, leveraging mass media and mHealth for targeted health promotion, addressing socioeconomic barriers, and engaging male partners to improve maternal and child health outcomes.