Anaemia in pregnancy: how it is found and what brings the blood back up
Anaemia means the blood is carrying less oxygen than it should, which leaves a mother tired, breathless and pale, and makes bleeding at delivery far more dangerous than it would otherwise be. The antenatal clinic finds it with a finger-prick blood test and by looking at the inside of your lower eyelid, your palms and your tongue. It is treated with what the clinic gives you, by dealing with the causes such as malaria and worms, and by eating iron-rich food regularly, with a repeat test to confirm it is improving.
- Anaemia is common in pregnancy and often has no obvious symptoms until it is well advanced.
- It is found with a simple finger-prick test at the antenatal clinic, which is one of the reasons the visits matter.
- Malaria and hookworm are two of the usual causes here, and treating them is part of treating the anaemia.
- Iron from beans, silverfish, offal and dark greens is absorbed better when a sour fruit is eaten with the meal, and worse with tea.
- The repeat test is the point. Feeling better is not proof the blood has come back up.
General information, not medical advice. If you are worried about a mother or a child, go to your nearest health facility or speak to your village health team.
What anaemia actually is, in plain terms
Blood carries oxygen around the body using a substance in the red cells. When there is too little of it, everything the body does costs more effort. That is why the first sign is usually tiredness that does not lift with sleep, and breathlessness climbing the hill to the garden that never used to be a hill.
In pregnancy the body is supplying two people, and later on it has to withstand losing blood at delivery. A mother who starts labour with low blood has much less to spare if she bleeds. That is the reason antenatal clinics take it seriously well before it feels serious to the mother.
Why pregnancy makes it more likely
Pregnancy increases the amount of blood in the body and increases the demand for iron at the same time. A diet that was just about enough before pregnancy is often not enough during it.
Pregnancies close together compound it, because the body has not rebuilt its stores from the last one before the next begins. So does a heavy load of malaria or worms, and so does a diet built mostly on matoke, cassava or posho with little beans, fish or greens.
None of that is the mother's fault, and none of it is unusual. It is why the test is routine rather than reserved for women who look unwell.
How the clinic finds it
The main test is a finger prick. A drop of blood is taken and read on a small machine or a test strip, and the result is written on your antenatal card as a number. Ask what your number was and ask the midwife to tell you whether it is low, borderline or fine.
The midwife will also pull down your lower eyelid and look at the colour inside, look at your palms, your tongue and your nail beds. Very pale means low, and it is a useful check when a testing machine is out of reagents, which happens.
If your number is low you should be tested again later in the pregnancy. Write the date of the repeat on your card yourself, because a missed repeat test is the commonest way anaemia goes untreated all the way to labour.
What causes it in our districts
Four causes come up over and over in the households our field officers visit, and most mothers who are anaemic have more than one of them at once.
This matters because giving a mother iron while she still has untreated malaria or a hookworm load is like filling a jerrycan with a hole in it. The cause has to be dealt with alongside.
- Malaria, which destroys red cells and is more common and more severe in pregnancy
- Hookworm and other intestinal worms, picked up through the feet, which cause slow blood loss from the gut
- A diet low in iron-rich foods, particularly in the months before harvest when the sauce thins out
- Pregnancies spaced closely together, or heavy bleeding in a previous birth that was never made up
What the clinic will do about it
Antenatal care includes supplements taken through pregnancy, and treatment for worms and for malaria at the points set out in national guidance. The midwife decides what you get and when. Do not buy tablets from a shop on a neighbour's advice, and do not stop what the clinic gave you because a friend said it upset her stomach. Tell the midwife instead, because there is usually something to be done about that.
If the anaemia is severe, or found late in pregnancy, you may be referred to a facility that can manage it and that has blood available for delivery. Take that referral seriously and go early. It is much easier to arrange in the eighth month than in labour.
Ask, at the visit, where you are expected to deliver given your result. A mother with low blood should not be planning a home delivery, and she should not be planning a facility two hours away with no transport arrangement.
What to eat, using food you already grow
The most useful iron in a rural diet comes from animal foods: silverfish dried and pounded into the sauce, offal and liver when the household kills or buys, eggs, and small fish eaten whole with the bones. Silverfish is often the cheapest of these and the easiest to keep.
Plant sources matter too and are what most households actually eat daily: beans, cowpeas, groundnut paste, dodo, nakati, pumpkin leaves and other dark green leaves. Iron from plants is absorbed less easily, which is why what you eat alongside it changes how much you get.
Two practical habits make a real difference. Eat something sour or citrus with the meal, an orange, a passion fruit, a tomato in the sauce, which helps the body take up iron from beans and greens. And keep strong tea away from mealtimes, because it works in the opposite direction. Take the tea an hour or two after eating instead.
- Add pounded silverfish to the bean or greens sauce two or three times a week
- Keep dodo, nakati or pumpkin leaves in the kitchen garden so greens are not a market purchase
- Serve a sour fruit or tomato with the meal rather than after it
- Move tea to between meals, not with them
- Cook groundnut paste into the sauce rather than eating starch on its own
Why the repeat test matters
Anaemia improves slowly, and a mother usually feels better long before her blood has actually recovered. That gap is the trap. She feels stronger, decides the tablets and the visits are done with, and arrives in labour with low blood after all.
Treat the repeat test as an appointment with a date, not as something to do when passing. Write it on the card, tell your village health team member, and tell one person at home whose job it is to remind you.
If the number has not improved, say so plainly at the visit and ask why. Sometimes the answer is that the cause was never treated, sometimes it is that the supplement ran out and nobody said.
What anaemia means for your delivery plan
A mother who is anaemic going into labour needs to deliver where bleeding can be managed and where blood is available if it is needed. That usually means a higher level facility than the nearest one, and it means arranging transport in advance rather than at the moment.
Have the conversation at the antenatal visit where the low result is given, not later. Ask which facility, ask how long the journey takes in the wet season, and agree the transport plan with your household that same week.
Tell your village health team member the result too. A VHT who knows which mothers in her parish are anaemic is the person most likely to notice when one of them stops coming to visits.
This guide describes what generally happens, not what will happen at your facility or your school. Costs, timetables and rules differ between districts and they change. Check anything that matters with your health worker, the head teacher, or your district office. If something here is wrong or out of date, tell us and we will correct it.
Questions people ask
- How do I know if I am anaemic if I feel fine?
- Often you cannot. Mild and moderate anaemia frequently causes nothing more than tiredness that gets blamed on the pregnancy itself. That is the reason for the finger-prick test at antenatal, and the reason to ask what your number was rather than assuming no news is good news.
- Can I fix it with food alone?
- Food is a large part of it and worth changing regardless. But if the clinic has found low blood in pregnancy, food on its own is usually too slow, and if malaria or worms are the cause, food will not touch it. Do what the clinic gives you and change the diet alongside.
- Why do the tablets from the clinic upset my stomach?
- Some mothers do get stomach upset or constipation. Tell the midwife rather than stopping. She can advise on how to take them and can check whether something else is going on. Stopping quietly is the outcome that leads to a mother arriving in labour with blood that never came up.
- Does drinking tea really matter?
- Strong tea taken with a meal reduces how much iron your body takes from beans, greens and other plant foods. It is not poison and nobody is asking you to give it up. Just move it to an hour or two away from the meal.
- The machine at our health centre was not working. What should I do?
- Ask the midwife to check your eyelids, palms and tongue in the meantime, and ask when the test will be available or which nearby facility is testing. Then go and get the test done. Do not let a broken machine become a pregnancy with no blood result on the card.