F&N Bulletin Vol 23 No 1b - United Nations University

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Objectives
The objectives of the study were to understand the
household-level behaviors of slum-dwelling pregnant
women and their family members related to procurement
of and compliance with iron supplements in
an urban setting using qualitative research tools; to
develop EDMs displaying the pathway of sequential
behaviors of pregnant women as they registered for
antenatal care, procured iron supplements, and consumed
them; and to improve the compliance of pregnant
women with respect to the consumption of iron
supplements as a result of counseling based on the
data obtained from the EDMs.
Methods
The urban health-care system of Vadodara city
The Vadodara Municipal Corporation’s Health Department
offers antenatal care services at no cost to slumdwelling
pregnant women through its Health Posts and
Family Welfare Centers. The Family Welfare Program
of the Corporation provides various health and nutrition
services, such as family planning, maternal, and
child-health services, which include antenatal care
services, immunization of mothers and children, nutrition
health education, and emergency health-care
services in case of epidemics and natural calamities
such as floods. In this urban setting, multiple healthcare
facilities were available to these women in government
hospitals, family welfare centers, and Anganwadis,
as well as clinics of private medical practitioners.
Anganwadis are centers run by the Integrated Child
Development Services (ICDS), a national-level nutrition
program in India for preschool children, pregnant
and lactating women, and women between 15 and
45 years of age belonging to the low-socioeconomic
group. Each Anganwadi covers a population of 1,000
in urban and rural areas and 700 in tribal areas.
Study site and sample
Four urban slums under a municipal ward in Vadodara
with access to both government and private medical
facilities were purposively selected for the study. All
pregnant women in these slums who were at 17 to 32
weeks of gestation formed the sample of the study
(n = 36). The pregnant women were identified with the
help of local ICDS Anganwadi workers. The Anganwadi
workers resided in the same areas and hence were
familiar with the residents.
Experimental design
In-depth interviews were conducted with all 36 pregnant
women and 20 of their family members (either
a husband or a mother-in-law). The interview protocol
contained open-ended questions pertaining to
information regarding their perceptions and use of
antenatal care services, especially procurement and
consumption of iron supplements by the subjects.
Fortnightly home visits were made to a subsample of
20 pregnant women to trace their behaviors during the
previous fortnight related to their procurement of and
compliance with iron supplementation. The women
were asked about the number of tablets procured
(including source of procurement) and consumed.
In addition, tablets were counted to verify reported
data. The hemoglobin levels of the women were also
assessed in the initial visit by the cyanmethemoglobin
method [4].
Subsequently, EDMs were developed based on the
qualitative data obtained through the open-ended
interviews and fortnightly visits. The EDMs followed
the pathway regarding procurement- and compliancerelated
behaviors of the women.
The women were then given counseling about
maternal anemia, with the aid of a flip chart, during
home visits that were continued fortnightly until the
end of pregnancy. The focus of the counseling was
determined by the data emerging from the EDMs. The
major goal was to motivate women to continue with
supplementation and to cope with any side effects. The
counseling was followed by measurement of hemoglobin
levels of the pregnant women at term.
Data management and analysis
J. Ghanekar et al.
The qualitative data were collected mainly by indepth
interviews. The questions were formulated
according to themes and were given thematic codes
after translation into English. The raw field notes were
recorded in detail in a dialogue-script form in the
local language, Gujarati, by the investigators. These
notes were expanded and subsequently translated
into English, keeping the translation as close as possible
to the original responses in the local language.
Significant verbatim quotes were retained in Gujarati.
The expanded and translated notes were keyed in a
word-processing software package and filed. These files
were later coded according to a previously prepared
code list, which was modified if necessary as data
coding progressed. The codes were created according
to the respondents’ perspective and meaning of the
questions.
A data-search computer software package (DT
Search) was used to search theme-wise responses,
which were further categorized and summarized. For
example, in searching for information on the source of
the iron supplements, a code of “iron tablets—place of
procurement” was used to compile information from
all subjects in this regard.