Individual and Facility-Level Determinants of Iron and Folic Acid Receipt and Adequate Consumption among Pregnant Women in Rural Bihar, India

Abstract

BackgroundIn Bihar, India, high maternal anemia prevalence and low iron and folic acid supplement (IFA) receipt and consumption have continued over time despite universal IFA distribution and counseling during pregnancy.PurposeTo examine individual and facility-level determinants of IFA receipt and consumption among pregnant women in rural Bihar, India.MethodsUsing District Level Household Survey (2007–08) data, multilevel modeling was conducted to examine the determinants of two outcomes: IFA receipt (any IFA receipt vs. none) and IFA consumption (≥90 days vs. <90 days). Individual-level and facility-level factors were included. Factor analysis was utilized to construct antenatal care (ANC) quality and health sub-center (HSC) capacity variables.ResultsOverall, 37% of women received any IFA during their last pregnancy. Of those, 24% consumed IFA for 90 or more days. Women were more likely to receive any IFA when they received additional ANC services and counseling, and attended ANC earlier and more frequently. Significant interactions were found between ANC quality factors (odds ratio (OR): 0.37, 95% confidence interval (CI): 0.25, 0.56) and between ANC services and ANC timing and frequency (OR: 0.68, 95% CI: 0.56, 0.82). No HSC factors were significantly associated with IFA receipt. Women were more likely to consume IFA for ≥90 days if they attended at least 4 ANC check-ups and received more ANC services. IFA supply at the HSC (OR: 1.37, 95% CI: 1.04, 1.82) was also significantly associated with IFA consumption.ConclusionsOur findings indicate that individual and ANC factors (timing, frequency, and quality) play a key role in facilitating IFA receipt and consumption. Although HSC capacity factors were not found to influence our outcomes, significant variation at the facility level indicates unmeasured factors that could be important to address in future interventions.

Community-based distribution of iron–folic acid supplementation in low- and middle-income countries: a review of evidence and programme implications

“…CBD of IFA supplementation showed success in reducing anaemia with community-based health workers or volunteers who counselled on health benefits, side-effects and compliance with IFA supplementation. These findings are consistent with other research that found communitylevel workers or volunteers to be instrumental in educating women about common side-effects and how to manage side-effects in order to increase compliance (27,41) . The present review also highlights that CBD of IFA supplementation is a potential platform for encouraging earlier and frequent attendance at ANC, as community-level workers were more likely to identify and reach a greater number of women earlier in pregnancy because women tended not to present to ANC until after the first trimester (27,28,33) .…”

“…• Motivators for women to take IFA supplements included fear of anaemia risks to mother and child, health benefits, regular follow-up and availability, and inclusion of family members in counselling Wendt et al (27) 2015 India Determinants of IFA supplement receipt from health workers and consumption in pregnant women…”

“…Late presentation to ANC, in the second or third trimester, and utilization of health services is a key challenge to maternal IFA supplementation provided through ANC (23,24,26,27) . For example, in the Philippines, the first prenatal visit occurred at 3·80 (SD 1·56) months and mothers averaged less than one visit per month after the initial visit (28) .…”

“…In a randomized study in Senegal, midwives were a strong motivator for improved IFA supplementation compliance in the treatment group (86 %) v. the control group (48 %; P < 0·0001), as midwives encouraged women to take IFA tablets by influencing their perceptions that IFA tablets would improve health and reduce anaemia (21) . In addition to the findings above, seven studies described the use of social marketing, counselling and health education methods, in combination with CBD, to increase access and compliance to IFA supplementation (17,18,24,25,27,31,38) . In Vietnam, rates of buying and consuming a weekly IFA supplement for WRA in programme sites were 55 and 92 %, respectively.…”

A qualitative study of primary care physicians’ perceptions and experiences on iron-folic acid consumption

“…[7][8][9][10] success rate of previously attempted IFA supplementation strategies. 11,12 This evidential understanding may aid to implement the new strategy efficiently taking care of population dynamics.…”