Strategies to address anaemia among pregnant and lactating women in India: a formative research study

Abstract

Objective:Over half of pregnant women in India are affected by anaemia, which can lead to premature birth, low birth weight and maternal and child mortality. Using formative research, we aimed to understand social and cultural factors around iron and folic acid (IFA) supplement provision and adherence to identify potential strategies for improving adherence and behaviours to prevent and treat anaemia among pregnant and lactating Indian women.Design:In-depth interviews and focus group discussions with women and key informant interviews with health officials and workers.Setting:Four districts in two Indian states: Allahabad and Bara Banki districts in Uttar Pradesh and Chikkballapura and Mandya districts in Karnataka.Participants:Pregnant and lactating women (n 65) and district officials and community health workers (n 14).Results:Most women were aware of anaemia but did not understand its seriousness and consequences. All women received IFA supplements (predominantly for free), but many were not adherent because of side effects; lack of information from healthcare providers on the causes of anaemia, its seriousness and solutions and low social support. To address anaemia, women were most confident in their ability to prepare and eat healthier foods but lacked control over resources such as appropriate food availability.Conclusions:Based on the findings, we recommend multicomponent interventions to train healthcare providers, address systemic barriers and involve family members to support IFA supplement adherence and dietary changes. Future research will determine which strategies are most effective to reduce the burden of anaemia in India among pregnant and lactating women.

Prevalence and Determinants of Anaemia among Women aged 15-49 in Nepal: A Trend Analysis from Nepal Demographic and Health Surveys from 2006 to 2016

“…Low intake of iron-rich foods together with poor bioavailability, chronic infection, malaria and intestinal helminths, and higher requirement related to menstruation lead to iron deficiency (Ampiah et al, 2019;Jamnok et al, 2020).Educational status, age, access to healthcare, socio-economic status, frequency of pregnancy, availability and consumption of nutrients/diet, and place of residence are identified as associated factors for being anaemic (Sharma et al, 2020). Anaemia affects individuals in the different periods of the life cycle but is most common in lactating mothers, pregnant women and adolescent girls as well (Ayensu et al, 2020;Williams et al, 2020). Nearly one-fifth of the total maternal deaths are resulted directly due to anaemia.…”

Impact of Anemia in Pregnant Women on the Neonatal Conditions

“…The body is capable of restoring iron reserves in 4-5 years. If a woman anticipates an earlier pregnancy, she will inevitably develop anemia [22]. A comprehensive approach to preventing anemia in women of reproductive age is therefore required to improve the hematological status, as also health indicators of mother and child [17], [23].…”

Folate Deficiency in Early Pregnancy Increases the Risk of Low Birth Weight: Survey of Neonates in Eastern China

“…Folate de ciency has been linked to neural tube defects (NTD) (11,12), whereas its impact on other severe pregnancy outcomes is inconclusive. Some studies provide support to maternal MTHFR 677TT genotypes, together with maternal circulating folate and homocysteine (hcy) concentrations are independent risk factors for small gestational age (SGA) (13)(14)(15). Other observational studies found no direct association between low folate levels and pregnancy complications (16)(17)(18).…”