A review of the maternal iron and folic acid supplementation programme in Nepal: Achievements and challenges

Abstract

In the late 1990s, an estimated 75% of pregnant women in Nepal were anaemic.Although iron and folic acid (IFA) supplements were available free of charge, coverage among pregnant women was very low. In response, the Government of Nepal launched the Iron Intensification Programme (IIP) in 2003 to improve the coverage of IFA supplementation and anthelminthic treatment during pregnancy, as well as promote the utilization of antenatal care. This review examined how the IIP programme contributed to Nepal's success in increasing the consumption of IFA supplements during pregnancy. Nepal's cadre of Female Community Health Volunteers were engaged in the IIP to support the community-based distribution of IFA supplements to pregnant women and complement IFA distribution through health facilities and outreach services. As a result, the country achieved a fourfold increase in the proportion of women who took IFA supplements during pregnancy between 2001 and 2016 (from 23% to 91%) and a 12-fold increase in the proportion who took IFA supplements for at least 90 days during pregnancy (from 6% to 71%).The increase in coverage of IFA supplements accompanied an increase in the coverage of antenatal care during the same period. By 2016, the prevalence of anaemia in pregnant women decreased to 46%, highlighting the need to tackle other causes of anaemia and improve haemoglobin concentration before pregnancy, while maintaining the successful efforts to reach pregnant women with IFA supplements at the community level.

National, regional, and global estimates of anaemia by severity in women and children for 2000–19: a pooled analysis of population-representative data

“… 23 The dominant public health response to anaemia has been to provide nutrients, primarily iron, to populations at risk through supplementation, fortification of staple foods, and multiple micronutrient powders. Although these strategies can be beneficial in contexts where micronutrient intakes are inadequate, particularly when supplementation is provided as part of antenatal care, 24 , 25 coverage of many of these intervention programmes remains low 26 , 27 , 28 , 29 and complementary interventions are generally needed to address other causes of anaemia. 30 The availability of animal-source foods has increased in most low-income and middle-income countries, especially in east Asia.…”

Unequal coverage of nutrition and health interventions for women and children in seven countries

“…The success is mainly due to the use of community-based delivery systems and service providers with strong social mobilization to reach women, as well as decentralized governance structures. 31 …”

Predictors of iron consumption for at least 90 days during pregnancy: Findings from National Demographic Health Survey, Pakistan (2017–2018)

“…As expected, we found a positive association between the number of ANC visits and iron consumption for ≥90 days. In Pakistan, ANC is considered one of the important routes to deliver iron supplements to pregnant women and this is also true for many other developing countries [45][46][47]. For example, a mixed-method study conducted in Cambodia found ANC as the only way to take iron supplements during pregnancy [48].…”