Drivers of anemia reduction among women of reproductive age in the Philippines: a country case study

Background: Anemia prevalence among women of reproductive age (WRA) in the Philippines was 25% in 2000, decreasing to 13% in 2018. To date, an in-depth assessment of the determinants associated with this decline has not been conducted. Objectives: This study aimed to conduct a systematic in-depth assessment of the quantitative and qualitative determinants of anemia among WRA in the Philippines between 2008 and 2018. Methods: Using standard Exemplars methodology, we conducted quantitative analyses using the Philippines’ National Nutrition Survey, the Expanded National Nutrition Survey, and the Philippines National Demographic and Health Surveys. Qualitative analyses included a comprehensive literature review, program/policy analysis, and interviews with stakeholders to understand country-level enablers and barriers to WRA anemia decline in the Philippines. A final Oaxaca–Blinder decomposition analysis evaluated the relative contribution of direct and indirect factors. Results: Among nonpregnant women (NPW), mean hemoglobin (Hb) increased from 12.7 g/dL in 2008 to 13.1 g/dL in 2018 (P < 0.01), corresponding to an 11%-point decline in anemia prevalence (from 23% to 12%). Inequities by geographical region, household wealth, and women's educational attainment narrowed considerably during this time. Important direct and indirect nutrition programs were introduced during our study period, including universal health care and food fortification. Country experts interviewed credited programs focused on alleviating micronutrient deficiencies and poverty, and improvements in women's health and well-being, for the country's extraordinary success. Oaxaca–Blinder decomposition analysis explained ∼50% of the observed change in mean Hb among NPW, with family planning (35%), household sociodemographics (29%), and improvement in women's nutrition (23%) emerging as critical drivers of anemia decline, corroborating our qualitative and policy analyses. Conclusions: To protect these gains, WRA anemia prevention efforts in the Philippines should continue to focus on universal health care access, women's empowerment, and poverty alleviation.