Percent pregnant women tested for anemia

The proportion of pregnant women who were tested for anemia during their antenatal care (ANC) visit.

This indicator is calculated as:

(# pregnant women who were tested for anemia during pregnancy/Total # of pregnant women attending ANC) x 100

Anemia is tested by measuring blood hemoglobin concentration.  The gold standard for assessing hemoglobin is the direct cyanomethhemoglobin method, which requires access to a laboratory. However, indirect methods using a finger-prick blood sample can be administered as a low technology alternative.  In areas where resources are lacking for the test kits, ANC clinics can screen for anemia by clinical examination using a WHO developed color scale comparing the shade or color shade of blood with defined hues of red(WHO, 2006).

The number of pregnant women attending ANC clinic during a reference period (e.g., one year) and the number who were tested for anemia during the same reference period.

Clinic registries; ANC records and cards.  Health facility exit interviews and provider observations can be useful for evaluation purposes but not for ongoing monitoring. 

This indicator measures the extent to which ANC clients are screened for anemia and can serve as a proxy for the quality of ANC services. Testing for anemia, provision of iron/folate supplements during pregnancy, and treatment for moderate to severe anemia are standard best practices in ANC (USAID/CORE, 2004; CARE/CDC, 2003).  This indicator relates to two of the Millennium Development Goals: #4. Reduce child mortality; and #5. Improve maternal health.

Anemia is a condition in which an inadequate number of red blood cells or an inadequate amount of hemoglobin impairs blood oxygen transport resulting in reduced physical and mental capacity. Among women of reproductive age, adolescent girls and pregnant women are at most risk for anemia: adolescents because of the onset of menstruation and pregnant women because of the increased blood volume associated with pregnancy.  Anemia in pregnant women is defined as a hemoglobin concentration <11 g/dl.  Based on a WHO review of nationally representative samples from 1993 to 2005, 42 percent of pregnant women have anemia, and 60 percent of this anemia is assumed to be due to iron deficiency in non-malarial areas and 50 percent in malarial areas (WHO/CDC, 2008).  In industrialized countries anemia also affects women, especially those of lower socioeconomic status. Iron deficiency is the primary cause of most anemia in low-income environments. Severe anemia among pregnant women resulting from iron deficiency is associated with an increased risk of maternal and fetal mortality and morbidity and of intrauterine growth retardation (WHO, 2000; WHO/CDC, 2008).

Screening for anemia does not indicate if pregnant women are given the universally recommended doses of iron/folate supplements during their ANC visit and more specialized counseling and treatment for cases of moderate to severe anemia. Guidelines for treating severe anemia in pregnant women includes three months of therapeutic supplementation (120 mg iron and 400 ug folic acid) followed by the preventive regimen (60 mg iron and 400 ug folic acid) for the duration of pregnancy and three months postpartum (INACG/WHO/UNICEF, 1998).  Complementary parasite control measures and dietary counseling are also recommended.

Women attending ANC may be a self-selected group and not representative of all pregnant women in an area. They may be more likely to have health problems or to be more affluent, educated, and/or urban.  If data sources are from routine ANC screening, caution should be used in interpreting and generalizing results.

nutrition, malaria, adolescent, quality, safe motherhood (SM), newborn (NB)

CARE/CDC, 2003, The Healthy Newborn: A reference manual for program managers, J. Lawn, B. McCarthy, S.R. Ross. Atlanta, Georgia: CARE/CDC Health Initiative.

International Nutritional Anemia Consultative Group (INACG), WHO, UNICEF, 1998, Guidelines for the Use of Iron Supplements to Prevent and Treat Iron Deficiency Anemia, Ed. Rebecca J. Stoltzfus, Michele L. Dreyfuss.

USAID/CORE, 2004, Maternal and newborn standards and indicators compendium,

WHO, 2006, Reproductive health indicators; guidelines for their generation, interpretation, and analysis, Geneva: WHO.

WHO/CDC. 2008. Worldwide prevalence of anaemia 1993–2005 : WHO global database on anaemia. De Benoist B, McLean E, Egli I, Cogswell M eds. World Health Organization, Geneva. Available at