The Problem

The most common nutritional deficiency on earth.
Also the most ignored.

It affects women almost exclusively. It is cheap to find and quick to treat. And most of the women who have it have never been tested for it.

1 in 4

women who menstruate has very low iron. The same is true of one in four pregnant women.

Dr. Steven Fein, MD, MPH, hematologist

The scale

Half a billion women.

Anemia is the visible end of iron deficiency. For every woman counted here, more are depleted but not yet anemic, and almost none of them know.

539 million

women aged 15 to 49 are living with anemia worldwide, around 30% of all women in that age group.

World Health Organization, anemia fact sheet, 2019 data

30–50%

of healthy women have no marrow iron stores at all. Not low. None.

Weyand & DeLoughery, ASH Education Program, 2023

25%

of pregnant women have very low iron, the same rate as women who menstruate.

Dr. Steven Fein, MD, MPH

Why it is a women's issue

Menstruation and pregnancy. That is the whole explanation.

“

The main causes of low iron are menstrual periods and pregnancies. This is why low iron is a women's health issue.

Dr. Steven Fein, MD, MPH, hematologist

In pregnancy, deficiency climbs with every trimester

What untreated deficiency does to a pregnancy

2.76×

the risk of postpartum hemorrhage

1.51×

the risk of preterm birth

1.40×

the risk of low birth weight

Meta-analysis of 31 cohort studies, 1,204,017 pregnancies. Frontiers in Global Women's Health, 2025

Black women are twice as likely as White women to be anemic in pregnancy. Iron deficiency is a health equity issue before it is anything else.

ACOG Practice Bulletin 233

What it costs her

It shows up as everything except low iron.

Fatigue, breathlessness, ice craving, hair loss, poor concentration. Filed under stress, under motherhood, under being a woman. It has a name, and it has a test.

At work

“Women who have low iron may miss work more often than others, so they may miss out on a raise or promotion.”

Dr. Steven Fein, MD, MPH

In sport

Up to 60%

of female athletes are iron deficient, and it costs them 3 to 4% of endurance performance. She did not lose her speed. She lost her iron.

Alfaro-Magallanes et al., J Sport Health Sci, 2024

In school

2×

the odds of below-average math scores in iron-deficient adolescent girls. The deficit starts before adulthood.

Halterman et al., Pediatrics, 2001 (NHANES III)

Why it gets missed

Her result said normal. Her body said otherwise.

Iron deficiency is missed for three reasons, and none of them is the woman's fault.

Same women. Different threshold.

3.1%

flagged as deficient using the strictest common threshold

15.3%

flagged as deficient using a threshold many clinicians now recommend

4.9× swing in measured prevalence. Weyand et al., JAMA Network Open, 2024, n = 62,685

Normal was built from depleted women.

Reference ranges come from the population, and 30 to 50% of healthy-looking women have no marrow iron at all. Normal was calibrated on deficiency.

Hemoglobin is the last thing to fall.

A standard blood count checks hemoglobin, which holds up long after iron stores are gone. A normal hemoglobin does not rule out iron deficiency. Ferritin does.

The symptoms have other names.

Tired, stressed, postpartum, busy. Each is a reasonable explanation. Together they mean the test never gets ordered.

If you have symptoms and a normal blood count, ask for a ferritin test. It is the one that measures iron stores.

Get support →

The wait

Years to a diagnosis.
Days to fix it.

The distance between the first symptom and iron in her arm is measured in years. The treatment itself takes about an hour.

First symptom to diagnosis

2.9 years

Akpan et al., Women's Health, 2025

First symptom to IV iron

4.4 years

Akpan et al., Women's Health, 2025

Fem consult to infusion

9 days

ASH 2023, Abstract 2314

58%

of 13,084 diagnosed patients still had unresolved iron deficiency three years later

were resolved within a year

American Society of Hematology, 2024

It is fixable

One of the most fixable problems in medicine.

One hour in a chair. Nine days from consult to treatment. And the outcomes are published, not promised.

94%

report improved symptoms after treatment

ASH 2023, Abstract 2314

1.2 g/dL

average hemoglobin increase in pregnant patients

ASH 2023, Abstract 2381

4.5%

had any reaction, across 7,246 infusions

ASH 2023, Abstract 2314

$28,600

per quality-adjusted life year. Cost-effective, and it should be first-line

ASH, 2026

See how we treat it

Donate

Referred by your provider?

Enroll in the Iron Planning Service.

Your navigator verifies your insurance, finds coverage or funding and gets your infusion scheduled. Name, date of birth and email. Navigation begins when you submit.

Enroll now

For clinicians

Order the ferritin. Refer her.

Send your patient the Fem Foundation enrollment link during the visit. Navigation begins when she submits it, and your orders go to the infusion team.

How referral works

Sources

World Health Organization. Anemia fact sheet, 2019 data.

Weyand AC, DeLoughery TG. Iron deficiency in women. ASH Education Program, 2023.

Weyand AC et al. Prevalence of iron deficiency by threshold. JAMA Network Open, 2024. n = 62,685.

Fein S. Interview, Miami Community Newspapers.

ACOG Practice Bulletin 233. Anemia in pregnancy. NHANES data.

Meta-analysis of 31 cohort studies, 1,204,017 pregnancies. Frontiers in Global Women's Health, 2025.

Akpan I et al. Diagnostic delay in iron deficiency. Women's Health, 2025. n = 71.

American Society of Hematology press release, 2024. n = 13,084.

Alfaro-Magallanes VM et al. Iron deficiency in female athletes. Journal of Sport and Health Science, 2024.

Halterman JS et al. Iron deficiency and cognitive achievement. Pediatrics, 2001. NHANES III.

ASH 2023, Abstract 2314. Fem Network clinic outcomes, 7,246 infusions.

ASH 2023, Abstract 2381. IV iron in pregnancy, 2,971 infusions.

American Society of Hematology, 2026. Cost-effectiveness of IV iron.

The most common nutritional deficiency on earth.Also the most ignored.

Half a billion women.

Menstruation and pregnancy. That is the whole explanation.

In pregnancy, deficiency climbs with every trimester

What untreated deficiency does to a pregnancy

It shows up as everything except low iron.

Her result said normal. Her body said otherwise.

Normal was built from depleted women.

Hemoglobin is the last thing to fall.

The symptoms have other names.

Years to a diagnosis.Days to fix it.

One of the most fixable problems in medicine.

Enroll in the Iron Planning Service.

Order the ferritin. Refer her.

The most common nutritional deficiency on earth.
Also the most ignored.

Years to a diagnosis.
Days to fix it.