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

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68 J. Ghanekar et al. Procurement-related behavior of pregnant women The EDM given in fig. 1 summarizes the pathway taken by the women to procure iron–folic acid supplements from various sources. When a woman confirms her pregnancy, she tells a family member, either her husband or her mother-in-law. Sometimes the family members take her to a government or private hospital or an Anganwadi center, or they do not show any interest; however, the latter happens rarely. At the government hospital and at the Anganwadi, iron supplements in the form of iron–folic acid tablets are provided free of cost to the woman. At a private hospital, the doctor who examines her usually writes a prescription for iron supplements, which the woman may or may not purchase from the local pharmacy. The pregnant women who go to the Anganwadi for supplementary food may also receive iron–folic acid tablets, or they can get the tablets when the Anganwadi worker makes a home visit. The women may also receive iron–folic acid tablets from the Vadodara Municipal Corporation auxiliary nurse midwives or multipurpose female workers when they visit the slum areas or at the maternal and child health clinics conducted by the corporation health posts every week. Although all the women in this study had access to free iron–folic acid supplements, some women received them from government health facilities or purchased them from pharmacies as prescribed by their private medical practitioners. Some women received the supplements from multiple sources, such as ICDS Anganwadis or government hospitals, and they also purchased them from pharmacies, thus often receiving many more tablets than the minimum dose of 100. However, although the iron–folic acid supplements were available to the women from multiple sources that were easily accessible in the study areas, this might not be the case in certain slums located away from government hospitals and private clinics. Compliance-related behavior The in-depth interview data revealed certain household-level factors influencing the consumption of the supplements by the women, which are depicted in the Woman confirms pregnancy Tells FM Visits doctor Visits AWW ANM (home visit) FM does not show interest Government hospital Private hospital AWW gives IFA to PW ANM gives IFA to PW AWW makes a home visit AWW does not make a home visit Doctor advises PW to take IFA supplements Doctor advises PW to take IFA supplements Gives IFA supplements PW does not get IFA supplements Gives IFA supplements free of cost Gives a prescription Buys IFA from pharmacy May also go to AW for food supplements AWW also gives IFA supplements Does not buy IFA FM: IFA: PW: AW: AWW: ANM: Family member(s) Iron–folic acid supplements Pregnant woman ICDS Anganwadi Anganwadi worker Auxiliary nurse midwife Frequent response (>50% of subjects) Infrequent response (
Toward better compliance with iron–folic acid supplements form of an EDM (fig. 2). When a woman procures supplements from the sources mentioned above, her family members play a major role in permitting or supporting her to consume them. It is more common for the family members not to have any objection to the woman’s consuming the tablets. In a few cases, a mother-in-law may persuade a woman not to take the supplements because of cultural beliefs, such as that the tablets are “hot” and may cause miscarriage, and as a result, the woman never takes the tablets. The women often forget to take the tablets regularly and may stop consuming them altogether if there is no one to encourage them at home. If a woman is self-motivated to consume the tablets regularly, she may experience benefits or side effects, which would ultimately make her decide whether to continue or discontinue taking the tablets. Experience of benefits motivates the women to continue with the iron supplementation. Agreement between reported and actual behavior Because the study was conducted on a free-living population and consumption of the supplements was not supervised, the EDMs were developed primarily on the basis of behavior reported during fortnightly home visits. However, the data were verified by crosschecking information with family members and performing regular tablet counts. Further, the data on positive changes in the women’s hemoglobin levels and the increasing proportion of the pregnant women 69 experiencing benefits suggest there was not much difference between reported and actual behavior. Perceived and experienced benefits and side effects Compliance with consumption of the supplements was directly related to benefits perceived by the women, which in turn were those experienced by them. Nearly 70% of the 36 women interviewed felt that the tablets gave them strength (shakti aape). The 86% of the 36 women who regularly consumed the tablets said that they experienced several benefits, and that was the reason given for regular consumption. A third of them stated that they were able to eat food regularly (khorak levay chhe), that their bodies remained healthy (sharir tandurust rahe chhe) due to tablet consumption, and that the tablets improved the quality of their blood (lohi no sudharo thay). Five women said that they felt strong enough to do household work (kam karvanu mann thay chhe) as a result of regular tablet consumption. However, despite the availability of tablets and some awareness of their importance, the women gave variable responses as to the number of tablets consumed (table 2). Only 5 of the subsample of 20 women who received fortnightly home visits complained of side effects during the counseling period. These discomforts included constipation, mild nausea, and sometimes vomiting. It is interesting that after counseling, three women continued to take the tablets despite their discomfort, because at the same time they experienced FM: Family member(s) IFA: Iron–folic acid supplements PW: Pregnant woman AWW: Anganwadi worker Frequent response (>50% of subjects) Infrequent response (
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Contents Review articles Nuclear an
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Special Article Nuclear and isotopi
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Nuclear and isotopic techniques 5 T
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Nuclear and isotopic techniques 7 T
Page 9 and 10:
Nuclear and isotopic techniques the
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Palm oil: A healthful and cost-effe
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Palm oil will be less absorbed and
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Palm oil oil at the present time is
Page 17 and 18: Palm oil crystal forms for the requ
Page 19 and 20: Palm oil myristic acid (14:0) is hi
Page 21 and 22: Palm oil 13. Kritchevsky D. Influen
Page 23 and 24: Introduction to three regional stud
Page 25 and 26: Nutritional status of urban primary
Page 31 and 32: Regional study of nutritional statu
Page 41 and 42: Regional study of nutritional statu
Page 49 and 50: Street food vendors their consumers
Page 51 and 52: Street food vendors whereas roasted
Page 53 and 54: Street food vendors Reardon [28] co
Page 55 and 56: Street food vendors so that bad pre
Page 57 and 58: Iron and energy supplementation imp
Page 59 and 60: Iron and energy supplementation the
Page 61 and 62: Iron and energy supplementation The
Page 63 and 64: Iron and energy supplementation 63
Page 65 and 66: Toward better compliance with iron-
Page 67: Toward better compliance with iron-
Page 71 and 72: Toward better compliance with iron-
Page 73 and 74: Development and validation of a sho
Page 83 and 84: Factors associated with successful
Page 89 and 90: Difference in goiter rates between
Page 91 and 92: Difference in goiter rates Methods
Page 93 and 94: Difference in goiter rates iodized
Page 95 and 96: Iron-deficiency anemia in young wor
Page 107 and 108: Discussion paper What care practice
Page 109 and 110: Letter to the Editor 109 iodized sa
Page 111 and 112: News and notes 2001 World Food Priz
Page 113 and 114: UNU Food and Nutrition Programme NU
Page 115: Note for contributors The editors o
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F&N Bulletin Vol 23 No 1b - United Nations University

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