The little iron fish fighting anaemia in rural Cambodia.
By Alannah Walsh
Nearly two billion people suffer from anaemia as a result of iron deficiency, making it one of the world’s largest nutritional challenges. Iron is a micronutrient that is essential for cognitive and physical development, especially in children under the age of five. Children whose diets lack iron commonly suffer from low energy levels, dizziness and lethargy.
Most of those affected by anaemia are women of childbearing age and young children. Women suffering from anaemia during pregnancy are at increased risk of haemorrhaging during childbirth and are also at greater risk of infection. 40% of maternal deaths have been directly and indirectly attributed to iron deficiency.
While iron deficiency is a serious problem on a global scale, it can be easily treated by taking iron supplements, usually pills or powders, every day. However, these supplements are often inaccessible to people in developing countries, meaning effective anaemia treatment remains elusive for millions of people.
Lucky Iron Fish was born out of a doctoral research project addressing high anaemia levels in Cambodia. Dr Christopher Charles moved there in 2008 to study a cluster of rural villages whose populations were severely iron deficient.
The results of the survey were shocking – anaemia rates of close to 90% in women and children were recorded. As a result, much of the rural population lacked the energy to work, learn, and play. Dr Charles and his team were determined to find an affordable, accessible and sustainable source of iron for the villagers.
Upon initial research, cooking in cast iron pots seemed to be a viable solution. However, Cambodian people favour cooking in aluminium pots as they are both cheaper and lighter to carry. It was back to the drawing board. After some experimentation, iron blocks to add to cooking vessels were prototyped. In the early stages these took the form of rectangular blocks, then discs, and later even flowers. Again, however, uptake was slow. But as Dr Charles and his team spent more time surrounded by and immersed in Cambodian culture, traditions, and heritage, they began to realise the shape they were looking for – a fish!
In Cambodia, fish is eaten every day and in almost every meal. The great Mekong River sustains the diets and livelihoods of millions of Cambodians. But most importantly, fish are also a symbol of luck in Cambodia.
The fish-shaped pieces of iron yielded remarkable results. Early clinical trials led by Dr. Charles and his team showed more than 80% adherence among users. These high compliance rates were accompanied by measurable improvements in iron levels and a marked decrease in anaemia rates across the target Cambodian villages.
Since those initial trials, Lucky Iron Fish has expanded its reach to over 88 countries, directly improving the lives of more than 285,000 people. Their model is built around reinvestment. A portion of every sale goes toward supplying iron fish to those who cannot afford them, enabling a built-in subsidy mechanism. To date, more than 65,000 units have been donated to individuals and families in underserved communities.
This success was not just due to the iron itself, but to the culturally attuned way in which it was delivered. The shift from iron pans to generic iron blocks and eventually to the fish shape—a meaningful and familiar symbol in Cambodian culture—transformed how people related to the healthcare intervention. By rooting the solution in local culture, the team bridged the gap between scientific efficacy and everyday practice.