Abstract
Objectives This study aimed to determine the level of compliance with iron and folic acid supplementation (IFAS) and identify factors influencing compliance among pregnant women attending tertiary care hospitals in District Peshawar. Methods This cross-sectional study was conducted over a period of two months, from January 15, 2022, to April 30, 2022, among pregnant women visiting tertiary care hospitals in district Peshawar for antenatal checkups. A nonprobability-purposive sampling technique was used to collect the data. Pregnant women in their second and third trimesters were included, while those in the first trimester or with comorbidities were excluded. Data were collected using a validated and reliable questionnaire. Statistical analyses included the Chi-square test, independent t-test, and Fisher's exact test, where appropriate, with a significance level set at p < 0.05. Results The mean age of the study participants was 26.87 ± 6.80 years, with 24% residing in nuclear families. The majority of participants had attained at least a basic level of education. Obstetric history revealed an average of four pregnancies and two deliveries per participant, with 28.61% reporting previous abortions and 21.67% experiencing stillbirths. Antenatal care utilization was high, with 98% receiving prenatal care, while 52.78% had a documented history of anemia. Regarding IFAS compliance, only 34.4% of the participants met the adherence criteria. The primary motivators for compliance included encouragement from healthcare workers and fear of pregnancy-related complications. Conversely, forgetfulness and concerns about potential side effects were the most commonly cited barriers to adherence. Demographic factors associated with IFAS compliance included age, place of residence, family structure, participant's education, spouse's education, and median monthly income. In addition, pregnancy-related factors such as parity, total number of prenatal visits, gestational age at the initial visit, and the duration of supplement use during the current pregnancy were significantly associated with compliance. Multivariate logistic regression identified nuclear family structure as a significant predictor of lower compliance (OR = 0.513, 95% CI: 0.30-0.878, p = 0.015). Similarly, participants who took IFAS for only one month during pregnancy were significantly less likely to comply (OR = 0.246, 95% CI: 0.082-0.736, p = 0.012). Conclusion Low levels of compliance with iron and folic acid supplements were noted, highlighting a significant challenge. Family structure and the duration of IFAS intake during pregnancy play crucial roles in predicting compliance among pregnant women. Healthcare worker encouragement and addressing concerns about negative effects may enhance compliance. Interventions should be tailored to address these factors, which require immediate attention and resolution.