Regional variations in the trend of iron supplementation during pregnancy and its multi- level predictors: Evidence from Pakistan Demographic and Health Surveys

Abstract Background Iron supplementation during pregnancy is a key intervention preventing and treating iron deficiency anemia with its efficacy and benefits well-documented. Despite this, a comprehensive understanding of the trends and predictors of iron supplementation across different regions remains limited. This study aims to assess the temporal trends in iron supplementation among pregnant women and identify its multi-level predictors. Methods This research utilizes data from four waves of the Pakistan Demographic and Health Survey (PDHS; 2006–07 to 2019) to analyze trends in iron supplementation, calculating rates and percentage changes with Microsoft Excel version 365. The data from PDHS 2019 is examined to identify predictors of iron supplementation during pregnancy using SPSS version 22 employing binary regression models. The dependent variable is the response to the question on “supplementation of iron tablets during pregnancy”, with various individual, community, and institutional level factors as independent variables. Results There has been a 44.1% increase in iron supplementation among pregnant women nationwide, with regional increases of 61.7% in rural areas and 19.9% in urban areas, leading to a current national supplementation rate of 65.4%. Factors such as older age, rural residency, living in Sindh or Baluchistan, smoking history, higher number of pregnancies and losses, and more children born or deceased were associated with lower odds of iron supplementation(p < 0.005). Conversely, higher education, residency in Gilgit Baltistan, Azad Jammu and Kashmi, as well as Khyber Pakhtunkhwa, and lady health worker’s advice regarding antenatal care were the significant factors with antenatal care utilization as the strongest predictor of supplementation in both unadjusted (OR = 30.07; 95% CI: 23.55–38.40) and adjusted models (AOR = 31.29; 95% CI: 14.37–68.11). Conclusion Although over half of pregnant women in the study population take iron supplements, the rate is still lower compared to many other countries. Significant regional disparities suggest the need for targeted efforts to increase supplementation rates and improve maternal health outcomes.