Individual and structural environmental influences on utilization of iron and folic acid supplementation among pregnant women in Harare, Zimbabwe

Abstract

Micronutrient deficiencies are prevalent among Zimbabweans with serious health and social implications. Due to a lack of a national micronutrient food fortification policy, the Zimbabwe Ministry of Health and Child Care established a policy for the prevention of maternal micronutrient deficiencies, which centres on pregnant women receiving daily iron and folic acid (IFA) at their first antenatal care visit and throughout pregnancy. Despite these efforts, utilization of IFA supplementation in pregnancy in Zimbabwe is low. This study aimed to understand the experiences and knowledge of IFA supplementation among pregnant women and healthcare workers in Harare, Zimbabwe, and the influence of health-service and social environments on utilization. Semi-structured in-depth interviews were conducted in Shona and English, with pregnant women (n = 24) and healthcare workers (n = 14) providing direct antenatal care services to pregnant women in two high-density community clinics. Data were analysed thematically using NVivo 10. Influences on utilization were at the individual and structural environmental levels. Reasons for low utilization of IFA supplementation included forgetting to take IFA, side effects, misconceptions about IFA, limited access to nutrition information, delayed entry or non-uptake of antenatal care and social norms of pregnant women for IFA supplementation. Utilization was enhanced by knowledge of risks and benefits of supplementation, fear of negative health complications with non-utilization, family support and healthcare worker recommendation for supplementation. Study findings can inform approaches to strengthen micronutrient supplementation utilization to improve the micronutrient status of pregnant women to decrease maternal mortality and improve overall maternal and child health in Zimbabwe. © 2016 John Wiley & Sons Ltd.

Moving beyond individual barriers and identifying multi-level strategies to reduce anemia in Odisha India

“…While IFA were in stock during our one-day observations, providers reported that stock outs were frequent [43]. also reported stock outs [43] but other studies have similarly found that demand issues play a larger role than supply issues [42].…”

“…Our results are similar to other studies in India with some notable differences. From an individual level perspective, other studies have found that side effects, bad small and taste, forgetfulness, and limited information about IFA from frontline health workers hinder use [20,31,42]. Prior studies also show that women believe that taking IFA during pregnancy may lead to a large baby, making labor more challenging [8,26].…”

“…Prior studies also show that women believe that taking IFA during pregnancy may lead to a large baby, making labor more challenging [8,26]. Recent studies have similarly found that health workers are trusted and effective at distributing IFA [42]. A metasynthesis of qualitative research on the social determinants of iron supplementation among women of reproductive age conducted in 17 countries identified social norms as one of the primary factors limiting uptake of IFA [26].…”

“…Considering different levels of the socio-ecological model, individual knowledge, attitudes, and beliefs about IFA and anemia has been highlighted as fundamental to IFA use [8,26]. At the interpersonal level, a growing body of literature also points to social norms as a barrier to IFA uptake and particularly perceptions that most people do not take IFA [26,42]. Social norms are informal rules of behavior considered acceptable in a group or society.…”

Designing a socio-normative intervention to reduce anemia in Odisha India: A formative research protocol

“…A growing body of literature points to social norms as a critical barrier to IFA uptake 34 35 . Social norms are mores or rules of behavior that are considered acceptable in a group or society 36 .…”