Qualitative investigation of factors influencing use of iron folate tablets by pregnant women in West Java : a summary of findings

The research consisted of 130 indepth interviews, covering both experimental and control areas, of pregnant women, husbands and elder women family members, traditional birth attendants (TBA"s), midwives, and health center doctors. Household trials were also conducted among pregnant women to determine the acceptability of iron tablets after a 10-day use period. Major results were as follows. (1) Maternal anaemia is not perceived as a priority health problem by pregnant women, their families, or traditional and modern maternal care providers. (2) The "TBA depot" model -- distribution of iron tablets to pregnant women from the home of TBA"s -- is more acceptable than house-to-house distribution by TBA"s. (3) There is some community-level resistance to the concept of distribution of iron tablets by TBA"s, who are not currently perceived as a source of "modern" medicines or health information. (4) Some TBA"s were hesitant to accept the proposed role of house-to-house distribution of iron tablets to pregnant women due to their present workload. They were more receptive to distribution of tablets when pregnant women visited their home. (5) Factual knowledge of maternal anaemia, its relationship to maternal and neonatal health, and the need for and benefits of iron supplementation for pregnant women is low at the community level and among traditional and modern maternal care providers. (6) Side effects of iron supplementation (constipation, nausea, change in color of stools) and undesirable tablet characteristics (smell, taste) are common causes of discontinued use. Social support from influential family members and maternal care providers can increase continuation of therapy. (7) Pregnancy and related problems are not discussed openly in the family or community. Pregnant women"s activities outside the home and paddy field, and their exposure to mass media other than radio, is limited. Recommendations for community-based distribution of iron tablets and a related communication strategy are as follows. (1) The resistance by the community and the TBA"s to the "TBA depot" model must be addressed. This means assuring uninterrupted supply of iron tablets, minimizing recording requirements, training TBA"s in motivation and education, integrating tablet distribution into routine prenatal visit schedule and content of care, and issuing some form of identification cards to participating TBA"s. (2) General awareness creation and motivation is required for all target groups about maternal anaemia and iron supplementation for pregnant women. A special focus should be on husbands, whose knowledge of maternal anaemia is lowest and potential influence on compliance with iron supplementation greatest. (3) Factual information about the more technical aspects of maternal anaemia and its relationship to maternal and neonatal health, as well as on ways to motivate women to take iron supplements, should be provided to formal and non-formal maternal care providers. (4) Face-to-face communication and radio should be used. All communications should display sensitivity to the widespread reluctance for open discussion of pregnancy-related problems. (5) Expressed concerns about acceptability, legitimacy, and authority of the TBA"s to distribute iron to pregnant women should be addressed as part of the communication component. (Author abstract, modified)