Anemia is a major public health challenge globally which affects over 1 billion people. The most common cause of anemia is iron deficiency (IDA) which can occur due to nutritional deficiency secondary to decreased iron intake, increased iron loss from the body and increased iron requirement. IDA is defined as individual hemoglobin levels that are 2 SDs below the distribution mean or >5% of a given population has hemoglobin levels that are 2 SD below the distribution mean in an otherwise normal population of individuals from same sex and age groups, living at the same altitude. Factors like dietary deficiency, iron inhibitors in diet, poor iron stores in childhood and adolescence, iron losses during post-partum hemorrhage, teenage pregnancy, repeated pregnancies with inadequate spacing and poor sanitary conditions increases the burden of iron deficiency anemia especially among women undergoing pregnancy in the developing world. Pregnancy is a physiological state characterized by increased iron demand which increases the risk of iron-deficiency anemia. According to the classification of World Health Organization (WHO), pregnant women with hemoglobin levels less than 11.0 g/dl in the first and third trimesters and less than 10.5 g/dl in the second trimester are considered anemic. A large scale cross-sectional survey, the Indian National Family Healthy Survey-4 found 58% of pregnant women in India are anemic. It is well-established that IDA is associated with multiple adverse outcomes for both mother and infant, including an increased risk of hemorrhage, sepsis, maternal mortality, perinatal mortality, and low birth weight. Furthermore, anemia  in pregnant women is  estimated  to  contribute  to  more  than  115,000  maternal  deaths  and  591,000 perinatal deaths globally per year. Anemia is considered as the underlying cause for 20–40 per cent of maternal deaths in India. India also contributes to 15% of the global burden of maternal deaths.

Current prevention and control strategies for IDA for women in India are focused upon iron folic acid supplementation beginning from childhood and continuing during pregnancy and lactation. Nevertheless, these strategies have been either ineffective or inadequate in controlling IDA in India. Moreover poor adherence to IFA is a major challenge in Indian health settings. Findings from the NFHS-4 reveal that only 52% women took 100 IFA pills during their pregnancy.

LACUNAE IN PREVIOUS STUDIES: There is a paucity of Indian studies which have assessed factors associated with poor IFA intake and perspectives on preventing anemia through a life-cycle programmatic intervention approach.