Hidden Hunger: Nutritional Deficiencies in Pregnant Refugee Women and the Urgent Need for Action

Pregnancy is often described as a time of hope, planning, and anticipation. For refugee women arriving in Canada, these hopes are intertwined with uncertainty: adapting to a new country, navigating a complex healthcare system, and facing cultural and linguistic barriers. Amid these challenges lies another, often invisible risk, nutritional deficiencies.

Pregnant refugee women are at increased risk for deficiencies in key nutrients such as vitamin B12, iron, and folate, which are essential for maternal health and fetal development.1,2 Research consistently shows that newly arrived refugee women frequently present with low levels of these nutrients, placing them at higher risk for anemia, preterm birth, low birth weight, and long-term developmental issues in their children.3,4 One recent study at the Mosaic Refugee Health Clinic in Calgary found that 43% of pregnant refugees tested had vitamin B12 deficiency, while over half were anemic and 50% had iron deficiency.5 Later access to prenatal care was associated with a higher risk of B12 deficiency, highlighting the impact of systemic barriers on maternal health.4 Barriers contributing to these deficiencies include food insecurity, cultural dietary restrictions, economic constraints, and delayed access to prenatal care.6

The consequences are profound. Vitamin B12 deficiency during pregnancy can lead to neurological complications for both mother and baby.7 Iron deficiency and anemia increase the risk of fatigue, infection, and adverse birth outcomes.8 Folate deficiency is well known to raise the risk of neural tube defects. These risks are preventable, and yet refugee women remain disproportionately affected.9

Current Canadian guidelines do not recommend routine B12 screening during pregnancy, except for specific high-risk populations.10 While prenatal vitamins are available through public health programs and community clinics, not all refugee women can consistently access or afford them.

Addressing this requires a multi-pronged approach that ensures refugee women receive early and equitable prenatal care, with culturally appropriate nutritional guidance. Routine screening for deficiencies such as vitamin B12, iron, and folate should be implemented for high-risk populations, even when symptoms are absent. Prenatal vitamins and targeted supplements must be accessible and free through community clinics and refugee programs. Finally, research and policy efforts should focus on understanding the prevalence and impact of nutritional deficiencies and integrating maternal nutrition as a priority in refugee health initiatives.

The health of refugee mothers and their babies is a public health issue that intersects with equity, access to care, and social justice. Nutritional deficiencies in pregnancy are preventable and treatable, yet too many women face these risks silently. By implementing systematic screening, culturally sensitive care, and supportive policies, Canada can ensure that refugee mothers do not carry the additional burden of hidden hunger during one of the most vulnerable periods of their lives.

References

1.     Benson J, Phillips C, Kay M, et al. Low vitamin B12 levels among newly arrived refugees from Bhutan, Iran and Afghanistan: a multicentre Australian study. PLoS One. 2013;8(2):e57998.

2.     Davidson MB, Brown G, Street L, McBrien K, Norrie E, Hull A, et al. Iron deficiency, anemia and association with refugee camp exposure among recently resettled refugees: a Canadian retrospective cohort study. PLoS One. 2022;17(12):e0278838.

3.     Abou-Rizk J, Jeremias T, Nasreddine L, Jomaa L, Hwalla N, Tamim H, Frank J, Scherbaum V. Anemia and Nutritional Status of Syrian Refugee Mothers and Their Children under Five Years in Greater Beirut, Lebanon. Int J Environ Res Public Health. 2021 Jun 27;18(13):6894.

4.     ICES. Refugee women have higher risk of premature birth, study finds [Internet]. Toronto: Institute for Clinical Evaluative Sciences; 2016 Jan 28 [cited 2026 Jan 27]. Available from: https://www.ices.on.ca/news-releases/refugee-women-have-higher-risk-of-premature-birth-study-finds/?utm_

5.     Mosaic Refugee Health Clinic, Calgary. Vitamin B12 deficiency, iron deficiency, and anemia among pregnant refugee patients: a retrospective chart review, 2015–2020. Calgary (AB): Mosaic Refugee Health Clinic; 2020.

6.     Jesuthasan J, Witte Z, Oertelt-Prigione S. Health-Related Needs and Barriers for Forcibly Displaced Women: A Systematic Review. Gender and the Genome. 2019;3.

7.     Finkelstein JL, Layden AJ, Stover PJ. Vitamin B-12 and perinatal health. Adv Nutr. 2015;6(5):552–563.

8.     Abu-Ouf NM, Jan MM. The impact of maternal iron deficiency and iron deficiency anemia on child's health. Saudi Med J. 2015 Feb;36(2):146-9.

9.     Qi YP, Crider KS, Williams AM, Tripp K, Mapango C, Rhodes EC, et al. Folate and vitamin B12 status and predicted neural tube defects risk among nonpregnant women of reproductive age from the Malawi National Micronutrient Survey, 2015–2016. Birth Defects Res. 2024;116(3):e2329.

10.  O’Connor DL, Blake J, Robinson N, Tumback L, Cheung A, et al. Canadian consensus on female nutrition: adolescence, reproduction, menopause, and beyond. J Obstet Gynaecol Can. 2016 Jun;38(6):508–554.e18.