Inadequate Iron–Folic Acid Consumption Among Pregnant Mothers in India: A Spatial Analysis

Despite guidelines recommending that every expectant mother take 100 iron–folic acid (IFA) tablets or an equivalent amount of syrup for 100 days, over 70% of Indian mothers do not adhere to this recommendation. Understanding the geographical distribution of insufficient IFA intake and the factors influencing it is crucial for developing targeted prevention and intervention strategies. However, prior to this chapter, research exploring the geographic disparities in IFA consumption and its determinants in India has been limited. Therefore, this chapter aims to address this research gap by examining the spatial patterns of inadequate IFA consumption at the district level and identifying the factors explaining these district-level spatial patterns. This chapter analyzed data from 141,875 married women aged 15–49, using the fourth round of the NFHSs (2019–2021). The dependent variable, inadequate IFA, was defined as consuming fewer than the recommended 100 IFA tablets or equivalent syrup. A district-level prevalence map was prepared to assess the spatial pattern of inadequate IFA consumption. Further, spatial clustering in IFA consumption was evaluated by using Moran’s I statistic and bivariate local indicators for spatial association (BiLISA) maps. Finally, the correlates of inadequate IFA consumption were examined by using ordinary least squares, spatial lag, and spatial error models. The overall prevalence of inadequate IFA consumption in India was 70%, with substantial spatial heterogeneity across different regions, districts, and even socioeconomic groups. The statistically significant spatial autocorrelation value for inadequate IFA consumption indicated the existence of clustering in the distribution of inadequate IFA consumption across the districts of India. Further analysis revealed that several clusters of high values of inadequate IFA were concentrated primarily in the districts of empowered action group (EAG) states—i.e., Bihar, Uttar Pradesh, Madhya Pradesh, Jharkhand, and Rajasthan. BiLISA analysis revealed that the districts with high rates of inadequate IFA consumption also had high rates of poverty and illiteracy, a higher number of Scheduled Caste (SC) and Scheduled Tribe (ST) mothers, high rates of early marriage, the inadequate coverage of antenatal care (ANC), and low levels of mass-media exposure. Among the three regression models applied, the spatial error model was the best. The results of the model suggested that inadequate IFA consumption at the district level was positively associated with ANC visits and negatively associated with a respondent’s education. Considerable spatial heterogeneity exists at the district level in the consumption of inadequate IFA among expectant mothers in India. Redirecting resources to vulnerable subgroups and geographical areas that were identified as lagging in this study would be critical to ensuring equitable progress in reducing IFA deficiency-related anemia among expectant mothers across the country. In addition, appropriate interventions need to be introduced to increase the average number of ANC visits in districts where IFA consumption is substantially low.