Encouragement Mechanisms for Take-up & Adherence of Iron Tablets to Address Anemia


Building Holistic Health


Rural Karnataka


19 factories, ~18000 women


University of Michigan, Shahi Exports







The WHO’s worldwide prevalence of anemia (2011) report finds that a quarter of the world’s population is affected by anemia. India is ranked as severely anemic in all groups for which national survey data is available. More than 60% of women (pregnant and non-pregnant) in the age group of 15-49 years were found to be anemic. Iron deficiency is the primary cause of anemia but despite making iron tablets available and accessible, why is the take-up and adherence so low? What can be done to change this?


Can we increase take-up of and adherence to iron supplementation among anemic women in garment factories, through daily reminders and other encouragement designs like peer learning?


The objective of Project Ironwoman is to incentivize anemic women working in the garment supply chain of Shahi factories to start taking iron tablets and continue using them regularly.

Our study focuses on interventions affecting patients’ behavioral factors that can lead to non-adherence despite strong program support and service delivery. Because the symptoms of anemia are often insidious for moderately and mildly anemic patients, individuals may not regularly or correctly follow their prescriptions for iron supplementation. Hence, we are approaching the study as follows: In order to investigate whether learning (through the experience of peers) about the benefits of iron supplementation can increase adherence, we plan to implement a “peer feedback” treatment to a subset of women. This treatment encourages women to evaluate the health benefits they might be experiencing and informs them of any benefits their peers are experiencing. In addition, when it comes to self-administering long term medication, people are often forgetful which results in low adherence. Therefore, we also study the impact of receiving daily reminders (text message on phones or in person reminders) on adherence to the treatment.

In all this, we also want to determine whether iron supplementation improves workplace productivity. Given the wide body of evidence on the positive effects of iron supplements on various measures of health, we expect to see significant improvements in self-reported health and work productivity for workers who took the supplementation regularly.


We have completed this project across 19 factories, covering 18000 women in rural Karnataka, India. Preliminary results show a marked improvement in haemoglobin levels thus addressing anemia. Detailed results will be updated soon.

Image credits: Nayantara Parikh