Maternal iron-folic acid supplementation programs

Evidence of impact and implementation

Tina G. Sanghvi, Philip W J Harvey, Emily Wainwright

Research output: Contribution to journalArticle

Abstract

Background. According to a World Health Organization (WHO) review of nationally representative surveys from 1993 to 2005, 42% of pregnant women have anemia worldwide. Almost 90% of anemic women reside in Africa or Asia. Most countries have policies and programs for prenatal iron-folic acid supplementation, but coverage remains low and little emphasis is placed on this intervention within efforts to strengthen antenatal care services. The evidence of the public health impact of iron-folic acid supplementation and documentation of the potential for scaling up have not been reviewed recently. Objective. The purpose of this review is to examine the evidence regarding the impact on maternal mortality of iron-folic acid supplementation and the evidence for the effectiveness of this intervention in supplementation trials and large-scale programs. Methods. The impact on mortality is reviewed from observational studies that were analyzed for the Global Burden of Disease Analysis in 2004. Reviews of ironfolic acid supplementation trials were analyzed by other researchers and are summarized. Data on anemia reduction from two large-scale national programs are presented, and factors responsible for high coverage with iron-folic acid supplementation are discussed. Results. Iron-deficiency anemia underlies 115,000 maternal deaths per year. In Asia, anemia is the second highest cause of maternal mortality. Even mild and moderate anemia increase the risk of death in pregnant women. Iron-folic acid supplementation of pregnant women increases hemoglobin by 1.17 g/dL in developed countries and 1.13 g/dL in developing countries. The prevalence of maternal anemia can be reduced by one-third to one-half over a decade if action is taken to launch focused, large-scale programs that are based on lessons learned from countries with successful programs, such as Thailand and Nicaragua. Conclusions. Iron-folic acid supplementation is an under-resourced, affordable intervention with substantial potential for contributing to Millennium Development Goal 5 (maternal mortality reduction) in countries where iron intakes among pregnant women are low and anemia prevalence is high. This can be achieved in the near term, as policies are already in place in most countries and iron-folic acid supplements are already in lists of essential drugs. What is needed is to systematically adopt lessons about how to strengthen demand and supply systems from successful programs.

Original languageEnglish (US)
JournalFood and Nutrition Bulletin
Volume31
Issue number2 SUPPL.
StatePublished - Jun 2010
Externally publishedYes

Fingerprint

Folic Acid
folic acid
anemia
Iron
Mothers
iron
Anemia
maternal mortality
acid
pregnant women
evidence
Maternal Mortality
Pregnant Women
coverage
death
Nicaragua
Essential Drugs
prenatal care
WHO
scaling

Keywords

  • Anemia
  • Hemoglobin
  • Iron deficiency
  • Maternal health programs
  • Maternal mortality
  • Neonatal health programs
  • Perinatal mortality
  • Pregnancy

ASJC Scopus subject areas

  • Geography, Planning and Development
  • Nutrition and Dietetics
  • Food Science
  • Medicine(all)

Cite this

Sanghvi, T. G., Harvey, P. W. J., & Wainwright, E. (2010). Maternal iron-folic acid supplementation programs: Evidence of impact and implementation. Food and Nutrition Bulletin, 31(2 SUPPL.).

Maternal iron-folic acid supplementation programs : Evidence of impact and implementation. / Sanghvi, Tina G.; Harvey, Philip W J; Wainwright, Emily.

In: Food and Nutrition Bulletin, Vol. 31, No. 2 SUPPL., 06.2010.

Research output: Contribution to journalArticle

Sanghvi, Tina G. ; Harvey, Philip W J ; Wainwright, Emily. / Maternal iron-folic acid supplementation programs : Evidence of impact and implementation. In: Food and Nutrition Bulletin. 2010 ; Vol. 31, No. 2 SUPPL.
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