A woman can eat what appears to be a healthy diet and still become anaemic.
Across Kenya, four in ten pregnant women face anaemia not because they eat poorly, but because the iron in their food never fully reaches their blood. A quiet collision of plant-heavy diets, cultural myths, tea habits, and supplement inconsistency creates a gap between nourishment and absorption that good intentions alone cannot close. The story of maternal anaemia here is less about scarcity of food and more about the invisible science of how the body receives what it is given — a distinction that, once understood, opens the door to affordable, practical change.
- Nearly 40% of pregnant Kenyan women develop anaemia even when they believe they are eating well, because plant-based iron is absorbed at a fraction of the rate of iron from meat or fish.
- Tea with meals, clay consumption, and compounds in beans and grains actively block the body's ability to use whatever iron is consumed — turning everyday habits into hidden health risks.
- Myths about beetroot and spinach as iron superfoods persist widely, while liver — one of the richest iron sources — is avoided in some communities due to cultural beliefs, leaving women with diets that feel nutritious but fall short.
- Untreated anaemia during pregnancy raises the risk of maternal death, premature birth, low birth weight, and dangerous delivery complications for both mother and child.
- Nutritionists point to simple, low-cost interventions — pairing iron-rich foods with vitamin C, soaking beans before cooking, waiting two hours before drinking tea, and taking supplements consistently — as the most realistic path forward.
Carolyne Awino followed every piece of advice she received during her pregnancy — eating beetroot, traditional vegetables, liver when the family could afford it. She took her iron supplements, even as the side effects pushed her to skip doses for relief. Yet at every clinic visit, the same verdict returned: her blood levels were too low.
Her experience reflects a pattern affecting four in ten pregnant Kenyan women. The problem, nutritionists explain, is not simply what women eat but how much of that iron their bodies can actually absorb. Most Kenyan diets lean heavily on plant-based foods — beans, cereals, vegetables — which provide non-haem iron that the body absorbs at only 2 to 20 per cent efficiency. Haem iron from meat, fish, and organ meats is absorbed far more readily, but remains out of reach for many families.
Pregnancy intensifies the challenge. Blood volume rises by nearly 50 per cent in the second and third trimesters, dramatically increasing iron demand. At the same time, compounds in whole grains and legumes bind to iron in the digestive system, reducing what the body can use. Tea and coffee consumed with meals do the same through tannins and polyphenols. Some pregnant women eat clay to manage cravings — a practice that further blocks absorption while introducing parasites. In other communities, liver is avoided entirely due to traditional beliefs, despite being one of the richest sources of iron available.
Misinformation compounds the problem. Spinach and beetroot are widely trusted as iron-boosting foods, yet spinach's high oxalate content limits absorption, and beetroot contains relatively little iron. Some women abandon supplements believing their diet is sufficient; others rely on supplements alone without improving what they eat. Neither approach works in isolation.
Affordable solutions exist. Small fish like omena offer highly absorbable iron at low cost. Traditional vegetables — terere, managu, and kunde — are iron-rich and often more effective than cabbage or spinach. Soaking beans overnight and fermenting porridge reduces absorption-blocking compounds. Adding lemon juice or eating citrus fruit alongside iron-rich foods significantly boosts uptake. Waiting two hours after meals before drinking tea preserves what the body has absorbed.
With 37 per cent of pregnant women worldwide affected by anaemia, the condition remains one of pregnancy's most common and dangerous complications. For women like Awino, understanding the science of absorption — not just the contents of a plate — may be the most important shift of all.
Carolyne Awino did everything she was told to do. During her pregnancy, relatives and neighbours filled her ears with advice: eat beetroot to boost blood levels, include traditional vegetables in every meal, consume liver and meat whenever possible. She believed them. She tried.
But pregnancy is not a controlled laboratory. Cravings arrived without warning. Morning sickness came in waves that made it impossible to keep down even the most nutritious meals. Money was tight, and the foods that would have helped her most—liver, meat—sat beyond her family's reach. Some weeks, all she could manage was plain white porridge. Other weeks, she prioritised feeding her family over feeding herself, unwilling to spend money on her own nutrition when everyone else needed to eat. She took the iron and folic acid supplements prescribed at her antenatal clinics, but the side effects sometimes felt worse than the problem itself, and she would skip doses to find relief.
At every clinic visit, the same message came back: your blood levels are low, you haven't gained enough weight. She wanted to do better. She honestly did not know what else to do.
Now, with her child one year old, Awino understands that preventing anaemia involves far more than simply eating foods believed to be healthy. Four in every ten pregnant women in Kenya have low haemoglobin levels—about 38 per cent of expectant mothers affected by anaemia—and the reason is not always what appears on the plate.
Amos Kamau, a nutritionist in Nairobi, explains the hidden mechanism: the problem lies not only in what pregnant women eat but in how their bodies absorb iron. Most Kenyan diets rely heavily on plant-based sources—beans, cereals, vegetables—which provide non-haem iron. The body absorbs only 2 to 20 per cent of this type of iron. By contrast, haem iron found in meat, fish and organ meats is absorbed much more efficiently. A woman can fill her plate with vegetables, beans and whole grains every day and still develop anaemia because her body simply cannot extract enough of the iron those foods contain.
The challenge deepens during pregnancy itself. In the second and third trimesters, blood volume increases by nearly 50 per cent to support the growing baby. This surge in demand means that even women with good eating habits often need iron supplements alongside a balanced diet. But absorption is only part of the story. Many nutritious foods naturally contain compounds called phytates and oxalates—found in whole grains, legumes and some vegetables—that bind to iron in the digestive system and make it harder for the body to use. Tea and coffee, consumed with or shortly after meals, contain tannins and polyphenols that do the same thing. Cultural practices compound the problem: some pregnant women eat clay to satisfy cravings, a practice that binds to iron and reduces absorption while exposing them to parasites and contaminants. Other communities discourage expectant mothers from eating liver, one of the richest sources of iron and vitamin B12, because of traditional beliefs.
Misinformation adds another layer. Spinach and beetroot are widely believed to be the best foods for increasing iron levels, yet spinach contains high levels of oxalates that reduce absorption, and beetroot contains relatively little iron despite its other health benefits. Some women stop taking supplements because they believe they are eating well; others rely entirely on supplements without improving their diets. Both approaches fail. A healthy diet and iron supplements work together. One should never replace the other.
The solution does not require expensive foods. Omena—small fish—is an excellent and affordable source of highly absorbable iron, protein and calcium. Traditional African vegetables such as terere, managu and kunde are rich in iron and often contain more of the mineral than cabbage or spinach. Simple preparation methods matter: soaking beans overnight before cooking and fermenting porridge helps reduce compounds that block iron absorption. Pairing iron-rich foods with vitamin C—adding lemon or lime juice to vegetables, or eating fruits like oranges and mangoes with meals—significantly increases absorption. Waiting at least two hours after eating before drinking tea or coffee protects iron uptake.
According to the World Health Organisation, 37 per cent of pregnant women worldwide—about 32 million women—are affected by anaemia, making it one of the most common complications of pregnancy and a major contributor to poor maternal and newborn health. Untreated anaemia increases the risk of maternal death, premature birth, low birth weight, severe fatigue and complications during delivery. Understanding how foods work together, choosing affordable iron-rich foods and consistently taking supplements can make a significant difference in protecting both mother and baby.
Citas Notables
Preventing anaemia is not just about eating iron-rich foods. It is about helping your body absorb that iron while taking your supplements consistently and eating a balanced diet.— Amos Kamau, nutritionist in Nairobi
A healthy diet and iron supplements work together. One should never replace the other.— Amos Kamau, nutritionist in Nairobi
La Conversación del Hearth Otra perspectiva de la historia
Why does a woman eating well still end up anaemic? It seems like the advice should work.
Because eating iron and absorbing iron are two completely different things. Plant-based iron—which is most of what people eat in Kenya—is absorbed poorly by the body. You could eat a plate of beans and vegetables and your body might only use 2 to 20 per cent of the iron in it.
So the food itself isn't the problem.
The food is part of it, but it's also what you drink with the meal, what you eat alongside it, even cultural practices like eating clay. Tea with your meal binds to iron and stops your body from using it. Spinach, which everyone thinks is iron-rich, actually contains compounds that block absorption.
What about supplements? Shouldn't those solve it?
They help, but only if a woman takes them consistently. And many women skip doses because the side effects—nausea, constipation—make them feel worse. Plus, some women think if they're eating well, they don't need supplements. That's backwards. During pregnancy, blood volume increases by 50 per cent. You need both the food and the supplements.
What's the simplest thing a pregnant woman could actually do?
Pair iron-rich foods with vitamin C. Add lemon to your vegetables. Eat fruit after meals. Choose affordable fish like omena instead of expensive meat. Wait two hours after eating before drinking tea. These are small changes that cost almost nothing.
And if she does these things, the anaemia goes away?
If she does these things consistently, along with taking her supplements, yes. The body gets what it needs. The baby gets what it needs. The risk of complications drops significantly.