<![CDATA[Background: Anemia among pregnant women remains a public health issue in Indonesia, while the distribution of iron supplements does not necessarily translate into consumption. Objectives: To describe trends in anemia among pregnant women and the gap between iron supplement distribution and consumption data; to analyze variations in iron supplement coverage among adolescent girls and pregnant women across provinces in 2022; and to assess its association with the midwife-to-population ratio. Methods: An ecological study using publicly available secondary data: the 2018 Riskesdas, the 2023 SKI, and the 2022 Indonesia Health Profile (34 provinces), as well as the 2020 midwife-to-population ratio. Analyses utilized the median and interquartile range (IQR), the Mann–Whitney U test, and Spearman’s correlation with 95% Fisher-z confidence intervals. Results: The prevalence of anemia among pregnant women was 37.1% (2013), 48.9% (2018), and 27.7% (2023). In 2018, only 38.1% of pregnant women consumed ≥90 iron tablets, whereas the 2022 routine report noted that 86.2% received ≥90 iron tablets. The median TTD coverage among pregnant women across provinces was 82.8% (IQR 77.6–87.7) and among adolescent girls was 46.7% (IQR 30.5–63.2); coverage in the eastern region was significantly lower (60.0% vs. 84.5% among pregnant women; p < 0.001). Coverage among adolescent girls and pregnant women was strongly correlated (ρ = 0.78), whereas the midwife-to-population ratio was negatively correlated with TTD coverage among pregnant women (ρ = −0.48; p = 0.004). Conclusion: Iron-folic acid supplement coverage varies significantly across provinces, and the number of midwives does not guarantee adherence; village midwives need to emphasize adherence counseling, monitoring of consumption, and prevention starting in adolescence.]]>
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