Perceptions of women, their husbands and healthcare providers about anemia in rural Pakistan: Findings from a qualitative exploratory study

Abstract

Background In Pakistan, there is a dearth of literature on the perceptions of anemia among women of reproductive age (WRA). This study was undertaken to explore the perceptions of women, their husbands, and healthcare providers about anemia, its possible causes, and how anemia impacts maternal and child health in Thatta, Pakistan. Methods A qualitative study was conducted in Thatta, Pakistan from September to December 2018. Using a pre-tested semi-structured interview (SSI), we collected data to understand their definitions of anemia through ten focus group discussions (FGDs) with women and their partners and ten primary informant interviews (KIIs) with healthcare providers. We identified six major themes: (I) Knowledge and awareness of anemia, (II) Causes and consequences of Anemia, (III) Dietary practices, (IV) Knowledge and practices regarding the use of iron-folic acid supplements, (V) Factors influencing prevention and control of anemia and (VI) Women’s health behavior. We analyzed the data through thematic analysis using NVivo 10 software. Results Most community members were not aware of the term anemia but described anemia as a condition characterized by ‘blood deficiency’ in the body. All study participants perceived anemia as an important health problem tending to cause adverse outcomes among WRA and their children. Study participants perceived gutka (chewable tobacco) consumption as an important cause of anemia. Healthcare providers identified short inter-pregnancy intervals, lack of family planning, poor health-seeking behavior, and consumption of unhealthy food as causes of anemia in the district. Consumption of unhealthy food might not be related to related to a poorer knowledge of iron-deficient foods, but economic constraints. This was further endorsed by the healthcare providers who mentioned that most women were too poor to afford iron-rich foods. All men and women were generally well versed with the sources of good nutrition to be consumed by WRA to prevent anemia. Conclusion The findings suggest that the government should plan to develop strategies for poverty-stricken and vulnerable rural women and plan health awareness programs to improve dietary practices, compliance with supplements, and health-seeking behavior among women of reproductive age. There is a need to develop effective counseling strategies and context-specific health education sessions to improve the health-seeking behavior of women and men in the Thatta district of Pakistan. Besides, there is need to address social determinants of health such as poverty that pushes women of poorer socioeconomic strata to eat less nutritious foods and have more anaemia. Therefore, a comprehensive and robust strategic plan need to be adopted by government that focuses not only on the awareness programs, but also aim to reduce inequities that lead to pregnant women eat iron-poor foods, which, in turn, forces them to become anemic.

“Can’t live willingly”: A thematic synthesis of qualitative evidence exploring how early marriage and early pregnancy affect experiences of pregnancy in South Asia

“…Girls usually left school before or shortly after marriage, negatively affecting their knowledge of reproductive and maternal health which was often taught in school [ 45 , 46 , 48 , 49 , 51 , 54 – 56 , 58 , 60 , 69 , 80 , 100 , 109 , 113 , 115 ]. This 17-year-old mother expressed how her lack of education negatively affected pregnancy preparedness:…”

“…Across South Asia, younger girls were thought to have an increased risk of experiencing complications during pregnancy and delivery due to their physical immaturity [ 21 , 48 – 50 , 54 , 59 , 60 , 65 , 68 , 71 , 74 , 85 , 88 , 95 , 98 , 100 , 102 , 105 , 109 , 116 , 119 , 121 ]. This was attributed to early marriage [ 47 , 51 , 55 , 66 , 77 , 88 , 110 ].…”

Exploring the relationship between anemia in pregnancy and infant mortality: a narrative review

“…Another research conducted in Thatta revealed that the majority of the women were not aware of what anemia was, and would consider it a blood deficiency. Lack of knowledge combined with limited access to health in lower socioeconomic conditions made anemia prevalent in pregnant women of rural areas [16] . In Urban areas, lack of nutritional education, lack of a balanced diet with lower intake of red meat, egg, and fruit, low iron levels prior to pregnancy, and increased consumption of tea were found to be a cause of high rates of anemia [17] .…”