An estimated 58 per cent of pregnant women in developing countries are anaemic. Health ministries in most poor countries aim to provide iron supplements for pregnant women. So why is maternal anaemia still rife? Studies by the MotherCare Project and partners in eight countries suggest that supply and distribution problems are currently to blame.

Anaemia is associated with premature delivery, low birth weight and increased risk of maternal or infant death during and after birth. It may cause as many as 20 per cent of maternal deaths and contribute to up to 50 per cent.

Researchers explored the views of pregnant and non-pregnant women and other key informants in Bolivia, Burkina Faso, Guatemala, Honduras, India, Indonesia, Malawi and Pakistan. They also examined the reactions of women receiving iron tablets for the first time.

The results are strikingly similar in all eight countries:

• Women often recognise the symptoms of anaemia, including headache, dizziness, paleness, fainting, weight loss and reduced appetite. They realise that these symptoms are related to a ‘lack of blood’ due to a poor quality diet.
• Half of all women think that these symptoms are a priority health concern with negative consequences for mother or baby.
• Women who visit prenatal health services are often familiar with iron supplements, but do not know why they are prescribed.
• Most women attend prenatal care only in their late second or third trimesters, so it is impossible for them to receive the recommended number of iron tablets.

The majority of women identify positive effects from taking iron tablets such as more energy to work and many say they would be willing to pay for them. So why do these programmes fail? Poor supply is the major obstacle to success, the study found. Other barriers include inadequate counselling and distribution of iron tablets, difficult access to and poor utilisation of prenatal healthcare, beliefs against taking tablets during pregnancy and fears that excess iron will create too much blood or a big baby, making delivery difficult. A third of women have negative side effects from iron supplements, but only one in ten stop taking them as a result.

The researchers conclude that the success of antenatal iron supplement programmes could be increased by:

• improving awareness among community members and health providers of the importance of anaemia prevention and control
• developing communication materials and strategies that take account of local cultural contexts
• training health workers to give women iron tablets and provide accurate information for pregnant women about the seriousness of anaemia, the importance of iron supplementation, and how to manage side effects, using counselling cards, posters or other media
• using innovative community-based distribution strategies
• ensuring adequate stocks of the highest quality of iron tablets

Source(s):
‘Women’s perceptions of iron deficiency and anaemia prevention and control in eight developing countries’, Social Science and Medicine 55: 529-544, by R. Galloway, et al., 2002

Funded by: USAID

id21 Research Highlight: 16 October 2002

Further Information:
Rae Galloway
The World Bank
1818 H Street, NW
Washington
DC 20433
USA

Tel: +1 202 473 7232
Fax: +1 202 522 3489
Contact the contributor: rgalloway@worldbank.org

MotherCare

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