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Research was conducted in the Republic of Liberia among 605 pregnant and 16 nonpregnant women to examine the major biological and cultural factors associated with anemia during the last trimester of pregnan­cy. The variables examined included (1) diet quality and food taboos, (2) parasite prevalence and load, (3) hemoglobin phenotype, (4) attitudes to­ward pregnancy, and (5) use of Western antenatal services. World Health Organization (WHO) hemoglobin standards (11.0g/dl) were used to define anemia. Results indicate a 78% prevalence of anemia. The most important determinants included: (1) the diet quality and food taboos, which poten­tially result in a low intake or absorption of biologically available iron, (2) parasitemia by hookworms, (3) traditional attitudes toward pregnancy which minimize the symptoms of anemia and provide only postpartum increases in dietary protein and reduced workload, and (4) the under­utilization of early, available antenatal care, particularly by primiparous teenage women and multiparous women over 35 years of age with five or more living offspring. Hemoglobinopathies such as sickle cell anemia are of low frequency in this population and are minor contributors to anemia.