Methods: Anemia testing was carried out on a nationally representative sample of 2,216 women age 15-49, 574 of their children under age five and 539 men age 15 - 59. The anemia testing was done by using the HemoCue system. Results: Compared to the 1995 KDHS, in the 1999 KDHS the rate of moderate-to-severe anemia has declined from 12 to 9 percent among women and from 39 to 26 percent among children under age three. The prevalence of moderate-to-severe anemia among women with two or more births (11 percent) is almost twice as high as that among women with less than two births or no pregnancies (7 and 6 percent, respectively). Women with average birth interval of less than 24 months are more likely to have moderate-to-severe anemia (16 percent) than women with a birth interval of more than 24 month (12 percent). The data showed that 48 percent of women in Kazakhstan received iron pills during their last pregnancy. On average, women took iron pills for 22 days. The West region has the lowest percentage of women who took iron pills during their last pregnancy (42 percent). The 1999 KDHS data showed that the hemoglobin distribution curves for women and children are shifted downward compared with the curve for men. This pattern is characteristic of populations where iron deficiency is the main cause of anemia, and confirms suggestions that anemia among women and children in Kazakhstan is primarily due to negative iron balance. Learning Objectives: For decades, anemia has been considered one of Kazakhstan's leading public health problems. In 1995, high anemia levels among women and children were determined in conjunction with the 1995 Kazakhstan Demographic and Health Survey (KDHS). In 1999 a new anemia study was designed in conjunction with the 1999 KDHS to to analyze trends in the prevalence of anemia since the 1995 KDHS, and to determine, if negative iron balance is the main cause of anemia in Kazakhstan.