Understanding Indonesia’s Iron–Folic Acid supplementation policy for pregnant women using triangle and multiple-streams analyses

Maternal anaemia remains a persistent public health issue in Indonesia despite the existence of national Iron–Folic Acid (IFA) supplementation policies. Although IFA distribution is mandated as part of routine antenatal care, programme implementation and adherence vary widely across regions. A qualitative documentary analysis was conducted using the Health Policy Triangle (HPT) and Kingdon’s Multiple Streams Framework (MSF). Secondary sources published between 2010 and 2025 were reviewed, including national regulations, technical guidelines, maternal health reports, national survey data, programme evaluations, and peer-reviewed literature. Data were coded according to HPT domains (actors, context, content, and process) and MSF components (problem, policy, politics, and policy window). The MSF analysis shows that the high prevalence of maternal anaemia served as a clear problem signal, while established national IFA guidelines provided a viable intervention. Political prioritisation within national development plans enabled policy adoption, indicating convergence of the three streams. However, HPT findings reveal persistent implementation gaps, including supply inconsistencies, limited counselling and follow-up, fragmented coordination across governance levels, and socio-behavioural barriers affecting adherence. Although Indonesia’s IFA supplementation policy is well-aligned with global recommendations, its effectiveness remains constrained by operational and contextual challenges. Improving monitoring systems, strengthening provider capacity, enhancing community engagement, and integrating IFA into broader maternal nutrition strategies may increase programme coverage and compliance. The findings highlight that strong policy formulation must be accompanied by effective governance and context-responsive implementation to achieve meaningful maternal health improvements.