Free IFA Tablets, Yet Widespread Anaemia: A Public Health Paradox

Sharing laughs during health sessions

Remember how our mothers would encourage us as kids, saying, “Mera bahadur baccha jaldi se dawa kha lega! (My brave child will take medicine quickly!)” whenever we refused to take medicine? Their gentle encouragement and warm reassurance made all the difference. Recently, in Triveniganj, I have seen this happen often—but with women, not children. Many women avoid Iron Folic Acid (IFA) tablets, even though they are crucial during pregnancy and lactation.

For instance, during my community visits, I was interacting with Neelu (name changed), a nine-month pregnant woman. During the conversation, she shared that she has been experiencing tiredness, dizziness, and shortness of breath. The yellow tinge in her eyes was also clearly noticeable. All these were a clear sign of anaemia. I asked Neelu if she was taking the IFA tablets that were freely available at the Anganwadi centre. She hesitated, then admitted, “I took one or two of them, then stopped. Who would consume such big tablets?” 

I didn’t react immediately. I knew if I told Neelu, “You must take these tablets,” she would nod and forget about it the next moment. Instead, I sat down with her and explained why the tablets were necessary, especially in the last month of her pregnancy. I offered her some easy tips on how to take them without discomfort, like not consuming IFA on an empty stomach. I also suggested drinking lemon water instead of tea to help with iron absorption. I explained that the symptoms she was experiencing were a result of low iron levels and that this could harm both her and her baby. What she said next was not so surprising to me: “Didi, no one told me this before; otherwise, I would have taken the tablets.”

She had the tablets but didn’t know why they mattered. And she wasn’t alone and lacked awareness and practice.

Glimpse from the field

I kept meeting women with similar stories. Some stopped taking the tablets because of nausea. Others mentioned side effects like constipation or dark stool. These all are temporary discomforts that typically fade in a week. But for them, these minor issues were enough to stop them from consuming them. Is it because no nutritional supplement is worth any discomfort?

However, some of them did consume them. They proudly told me they never missed a single dose. One woman confidently said, “Didi, I haven’t missed a single tablet. I have been taking them daily for a month.” Relieved, I asked how she took them. “I take one tablet in the morning with tea and biscuits,” she replied.

And there it was—the catch! Why? Components like tannins present in tea and coffee hinder iron absorption, rendering the tablets far less effective. She was diligent yet unaware that timing and pairing mattered as much as consistency.

I also heard myths that left me speechless. Many women said, “Didi, I don’t take them because my mother-in-law says they will make the baby dark.” I smiled and replied that by this logic, shouldn’t eating greens turn the baby green? Or does drinking milk make the baby fair? They laughed and understood what I meant.

These conversations made me realise that the problem wasn’t access. Public healthcare centres offer IFA tablets for free, yet anaemia remains prevalent. Data says only 13.2% of women in the Supaul district consumed IFA tablets during pregnancy, and just 8% continued for 180 days postpartum (Source: NFHS-5).

The reasons are many. One-to-one counselling is missing from the service provider’s side, and there are existing myths and misconceptions. For many, their health felt secondary to daily survival—cooking, cleaning, and caring for children and family members. I have seen women work in fields until the day they deliver, eat last at every meal, and normalise their exhaustion as ‘just how life is.’ Moreover, this is because most of the women around us fail to understand the importance of their own health. This is where community engagement and social behaviour change shine.

Distributing IFA tablets is only one part. What’s missing is someone to sit down, listen, and explain—someone to make health feel personal and a priority. Women should take IFA tablets because they understand their importance, not just because they are told to. They should know why. They should feel empowered to act, not pressured to comply.

Behaviour change takes time, but it lasts. Behaviour change begins with questioning myths and understanding facts. When people gain the right knowledge, their practices shift.  As practice changes, health outcomes improve—not just for one woman but for entire families and communities.