Maternal Anemia Prevalence and Associated Risk Factors During Pregnancy in Pakistan: A Mixed-Methods Study
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Background: Maternal anemia remains a major public health concern in Pakistan and is shaped by nutritional deficiency, poverty, reproductive burden, cultural dietary practices, and limitations in antenatal healthcare access. Objective: To determine the prevalence pattern of maternal anemia during pregnancy and explore the biological, socioeconomic, behavioral, cultural, and health-system factors associated with anemia among pregnant women attending antenatal services in urban and semi-urban Pakistani settings. Methods: A mixed-methods study was conducted using a quantitative cross-sectional assessment and qualitative interviews and focus group discussions. Pregnant women attending antenatal care were assessed for hemoglobin status and completed structured questionnaires addressing sociodemographic characteristics, dietary practices, obstetric history, antenatal attendance, and iron and folic acid supplementation. Qualitative data were collected from pregnant women and healthcare providers to explore anemia awareness, dietary beliefs, supplement adherence, healthcare access, and service-delivery barriers. Quantitative findings were summarized descriptively, and qualitative data were analyzed thematically, followed by integrated mixed-methods interpretation. Results: Maternal anemia was highly prevalent, with most affected women having mild-to-moderate anemia and a greater burden observed in semi-urban settings. Reported risk factors included poor dietary diversity, low socioeconomic status, high parity, short interpregnancy intervals, inadequate antenatal attendance, and poor supplement adherence. Qualitative themes included limited awareness of anemia, cultural food restrictions, barriers to healthcare access, provider-related constraints, and systemic limitations. Conclusion: Maternal anemia during pregnancy in Pakistan is a multifactorial condition requiring integrated nutritional, behavioral, reproductive, community-based, and health-system interventions
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