Folic Acid Deficiency in Pakistani Women: A Silent Crisis in Maternal Health

Women’s health in Pakistan has long been overshadowed by competing priorities, lack of awareness, and insufficient public health investment. Maternal health, in particular, has not received the attention it demands, leading to persistent issues that continue to impact generations. Among the many silent nutritional crises faced by Pakistani women, folic acid deficiency stands out as a widespread yet preventable problem. Folic acid plays a critical role in reproductive health, especially during pregnancy. Yet, many women of reproductive age in Pakistan remain deficient due to poor dietary intake, limited supplementation, and inadequate healthcare policies.

Folic Acid Deficiency in Pakistani Women

According to the Pakistan Demographic and Health Survey (PDHS), maternal undernutrition remains alarmingly high, and neural tube defects caused by a lack of folic acid in the diet are among the leading preventable birth defects in the country. Estimates suggest that around 50–60% of Pakistani women of reproductive age suffer from folate deficiency, with rural areas bearing the highest burden. Despite decades of awareness campaigns, supplementation programmes remain inconsistent and inaccessible for many.

Despite being a preventable condition, folic acid deficiency is highly prevalent among Pakistani women. Multiple studies highlight the scale of this crisis:

• Half of pregnant women in Pakistan are folate-deficient, significantly increasing the risk of adverse birth outcomes. 
• The prevalence of neural tube defects in Pakistan is estimated at 4–7 per 1000 births, among the highest in Asia.
• Rural women, with limited access to healthcare and dietary diversity, are particularly vulnerable. Many rely heavily on wheat-based diets lacking in folate-rich foods such as leafy greens, beans, and fortified cereals.

The absence of mandatory food fortification policies exacerbates the problem. Unlike several countries where flour is fortified with folic acid as a cost-effective public health intervention, Pakistan lags behind in nationwide fortification efforts.

Why Folic Acid Matters?

Folic acid, also known as vitamin B9, is crucial for DNA synthesis, cell division, and proper growth. It plays a central role in the formation of red blood cells and in preventing anaemia. More importantly, folic acid in pregnancy is essential to support the rapid cell growth of the placenta and the developing foetus. Adequate levels reduce the risk of serious congenital malformations, particularly neural tube defects (NTDs) such as spina bifida and anencephaly.

Globally, folic acid for maternal health is considered a cornerstone of reproductive nutrition. The World Health Organization (WHO) recommends that all women of reproductive age consume 400 μg of folic acid daily, beginning before conception and continuing throughout pregnancy. Unfortunately, in Pakistan, the lack of folic acid in the diet, coupled with limited pre-conception counselling, means that many women begin pregnancy already deficient.

Harms of Folic Acid Deficiency

Maternal Health Complications

Folic acid deficiency leads to anaemia, increasing risks of fatigue, poor immunity, and complications during pregnancy. Anaemic women face a higher chance of maternal mortality due to haemorrhage or infection during childbirth. 

Birth Defects and Infant Mortality

The most devastating impact of folic acid deficiency in pregnancy is neural tube defects. These severe congenital anomalies result in lifelong disability, poor quality of life, or infant death. The emotional and financial toll on families and healthcare systems is immense.

Intergenerational Malnutrition

Children born to folate-deficient mothers often face stunted growth, developmental delays, and poor academic outcomes. This perpetuates the cycle of poverty and ill health in society.

Economic Burden

The cost of managing preventable birth defects is significantly higher than investing in preventive supplementation. For a country like Pakistan, already struggling with limited healthcare budgets, folic acid deficiency represents not just a health crisis but also an economic one.

Causes of Widespread Deficiency

Lack of Folic Acid in Diet

Pakistani diets are often deficient in fresh fruits and vegetables, especially among low-income groups. Cultural dietary habits, limited affordability, and low awareness mean that folate-rich foods are rarely prioritised.

Poor Supplementation Practices

Folic acid supplementation is often started late in pregnancy, when neural tube development has already occurred within the first 28 days. Pre-conception supplementation is rarely emphasised in routine healthcare.

Healthcare System Gaps

Maternal health services remain fragmented. Counselling about nutrition and folic acid for maternal health is inconsistent, especially in rural areas where access to trained healthcare providers is scarce.

Policy Failures

The absence of mandatory folic acid fortification in staple foods like flour has left millions vulnerable. Research shows that countries such as the United States and South Africa reduced neural tube defects by nearly 30–50% after implementing fortification policies.

Steps to Address the Crisis

Public Awareness Campaigns

Women must be educated about the importance of folic acid in pregnancy and its role in preventing birth defects. Mass media campaigns, school-based programmes, and community health worker initiatives can bridge knowledge gaps.

Mandatory Food Fortification

Fortifying wheat flour with folic acid is one of the most effective strategies to reduce deficiency. With wheat being a staple food for most Pakistanis, fortification ensures population-wide coverage.

Strengthening Pre-conception Care

Healthcare providers should encourage women of reproductive age to begin folic acid supplementation before conception. Integrating this message into family planning services could have a profound impact.

Affordable Supplement Access

Ensuring that high-quality folic acid supplements are available and affordable is crucial. Products like QFolic by Route2Health, which contains bioactive 4th generation folic acid for best absorption, provide a reliable solution.

Research and Data Collection

More local research is needed to track the prevalence of folic acid deficiency and assess the effectiveness of interventions. Policymakers rely on such evidence to design targeted strategies.

Conclusion

Folic acid deficiency in Pakistani women represents a silent yet devastating public health crisis. Its consequences extend far beyond individual mothers, affecting infants, families, and the wider economy. Despite being easily preventable through dietary improvements, supplementation, and fortification, the issue persists due to a lack of awareness, weak healthcare systems, and policy inaction.

Now is the time to act decisively. By addressing the lack of folic acid in the diet, introducing mandatory fortification, and ensuring access to high-quality supplements, Pakistan can protect mothers and children from preventable complications.

For women seeking an effective solution, QFolic by Route2Health, top-of-the-line folic acid tablets for pregnancy, provides bioactive 4th-generation folic acid, ensuring optimal absorption and maximum benefit for maternal health. Investing in women’s nutrition today means investing in a healthier, stronger Pakistan tomorrow.

FAQs

1. Why is folic acid important for maternal health?

Folic acid is essential for DNA synthesis, red blood cell production, and foetal development. It helps prevent neural tube defects in babies and supports overall maternal health during pregnancy.

2. What are the symptoms of folic acid deficiency?

Common symptoms include fatigue, weakness, anaemia, shortness of breath, irritability, and in severe cases, complications in pregnancy such as birth defects.

3. How much folic acid should women take during pregnancy?

The World Health Organization recommends 400 micrograms of folic acid daily before conception and during early pregnancy to reduce the risk of neural tube defects.

4. What foods are good sources of folic acid?

Leafy green vegetables, legumes, citrus fruits, whole grains, and fortified cereals are excellent sources of folic acid. However, many Pakistani diets lack adequate folate-rich foods.

5. Can folic acid supplements help prevent birth defects?

Yes. Taking folic acid in pregnancy significantly lowers the risk of neural tube defects and other birth complications. Supplements ensure women get the right dose when diet alone is insufficient.