Background: Anaemia remains a major global public health concern, particularly among women of reproductive age and during pregnancy. Iron and Folic Acid (IFA) supplementation is a well-established, cost-effective strategy for preventing and reducing maternal anaemia. Despite widespread policy adoption and programme implementation, compliance with IFA supplementation continues to be inconsistent across regions. Emerging evidence suggests that adherence is shaped not only by biomedical factors but also by socioeconomic and cultural influences. This scoping review aimed to map the global evidence on socioeconomic and cultural determinants of IFA compliance.
Methods: A scoping review was conducted following the Arksey and O'Malley framework and reported in accordance with the PRISMA-ScR guidelines. A comprehensive search of PubMed, Scopus, Web of Science, CINAHL, Embase, and Google Scholar was undertaken for studies published between 1995 and 2025. Studies examining socioeconomic and/or cultural determinants of IFA compliance among women of reproductive age were included. Data were charted and synthesised using thematic mapping and narrative analysis.
Results: Fifty-six studies were included. Reported compliance rates varied widely, ranging from low adherence in resource-limited and rural settings to higher compliance in urban and better-resourced populations. Socioeconomic determinants consistently associated with improved adherence included maternal education, household income, urban residence, and access to antenatal care services. Cultural beliefs, misconceptions about IFA, dietary practices, gender norms, and family decision-making dynamics frequently emerged as barriers. Health system factors, particularly supplement availability and counselling quality, further influenced compliance. The findings highlight the multifactorial and context-specific nature of IFA adherence.
Conclusion: IFA compliance is shaped by complex interactions between socioeconomic conditions, cultural contexts, individual perceptions, and health system performance. Strategies to improve adherence must move beyond tablet provision alone and incorporate culturally sensitive education, strengthened health systems, and equity-focused interventions.
Keywords: Iron and Folic Acid, Compliance, Adherence, Anaemia, Socioeconomic Determinants, Cultural Determinants, Pregnancy, Maternal Health.
How to cite this article: Shafqat N, Bairwa R, Verma R, Khan R, Socioeconomic And Cultural Determinants Of Iron And Folic Acid (IFA) Compliance: A Global Scoping Review. Int J Drug Deliv Technol. 2026;16(4s): 537-551; DOI: 10.25258/ijddt.16.4s.64
Source of support: Nil
Conflict of interest: None