# Effect of consuming food cooked in iron pots and behavior change communication on iron status in non-pregnant, non-lactating women: protocol for randomized controlled trial

## TL;DR

This study tests if using iron cookware with behavior support improves iron levels in non-pregnant women in rural India.

## Contribution

The study introduces a combined approach of iron cookware and behavior change communication to combat iron deficiency in a rural setting.

## Key findings

- Women using iron cookware with counseling may show improved hemoglobin and ferritin levels.
- The study will identify barriers to using iron cookware in rural communities.

## Abstract

Iron-deficiency anemia (IDA) remains a significant public health concern, particularly among women of reproductive age in developing countries. Despite ongoing supplementation and fortification programs, the prevalence of anemia remains high due to challenges such as poor compliance, logistical constraints, and limited access to iron and dietary sources. Cooking in iron cookware has been proposed as a low-cost, culturally acceptable strategy for improving dietary iron intake; however, evidence of its effectiveness remains mixed. This randomized controlled trial (RCT) aimed to evaluate the effectiveness of consuming food cooked in iron pots, coupled with a structured behaviour change programme, on improving hemoglobin and ferritin levels among non-pregnant, non-lactating women of reproductive age in rural India.

A community-based randomized controlled trial will be conducted in selected rural blocks of Akola and Wardha districts in Maharashtra, India. Eligible women (aged 18–45 years, non-pregnant, non-lactating) will be randomized into two groups: an intervention group receiving iron cookware along with structured behaviour change communication sessions, and a control group receiving non-iron cookware. Iron status indicators (hemoglobin, ferritin, serum iron, transferrin saturation, and total iron-binding capacity) will be assessed at baseline, 6 months, and 12 months after the intervention. Patient compliance with iron pot usage will be monitored through food diaries, spot checks, and interviews. Barriers and facilitators of adherence will be explored through qualitative assessments.

It is anticipated that women using iron cookware with structured counselling support will demonstrate significant improvements in anemia and iron deficiency indicators compared to controls. This study will also identify the practical, cultural, and economic barriers affecting patient compliance with cooking in iron pots. The findings will contribute to the evidence base for promoting iron cookware as a sustainable intervention in rural population settings. The results will inform community health strategies and align with India’s Anemia Mukt Bharat initiative.

This randomized controlled trial was prospectively registered with the Clinical Trials Registry–India (CTRI) under the registration number CTRI/2025/04/085829, dated April 28, 2025.

The online version contains supplementary material available at 10.1186/s13063-025-09202-0.