From Tablets to Systems: Barriers and Facilitators to Iron and Folic Acid Supplementation in Pregnancy in India - A Scoping Review of a Decade of Evidence

This scoping review will map and synthesize the available evidence on barriers and facilitators influencing iron–folic acid (IFA) supplementation among pregnant women in India between January 2016 and August 2026. The review is designed to move beyond a narrow focus on tablet receipt or individual adherence and to identify determinants operating across interconnected personal, family/community, institutional/health-system, programme/implementation and policy/national levels. The review will include quantitative, qualitative and mixed-methods evidence, together with relevant grey literature. The review will examine factors influencing receipt, initiation, regular consumption, adherence, compliance, continuation and completion of IFA supplementation. These may include knowledge and perceptions, side effects, forgetfulness and perceived need; family and community beliefs and support; antenatal counselling and health-worker interactions; accessibility, follow-up and supplement availability; supply-chain and distribution mechanisms; outreach, supervision and monitoring; and programme and policy implementation. The evidence will be charted using a standardized form and synthesized descriptively, narratively and thematically rather than through statistical pooling. Findings will be organized using a five-level framework: personal; family/community; institutional/health-system; programme/implementation; and policy/national. Particular attention will be given to interactions across levels, because IFA use may reflect the combined influence of individual experience, social support, health-worker counselling, availability of supplements and programme implementation. Expected outputs are a map of the evidence base, a structured characterization of barriers and facilitators, identification of cross-level pathways, identification of geographical and methodological evidence gaps, and priorities for future research and programme strengthening.