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

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J. Ghanekar et al.
TABLE 2. Consumption pattern of iron–folic acid tablets by subjects following fortnightly home visits and counseling
(N = 20)
Expected Actual no.
Month of No. of No. of days No. of tablets no. of tablets of tablets % target dose
pregnancy subjects Value covered received consumed a consumed consumed
5 5 Mean 56 132 71 71 99
Range 44–95 105–205 44–102 43–100 95–104
6 4 Mean 69 135 83 81 98
Range 47–107 50–190 47–107 50–100 93–100
7 8 Mean 48 127 84 80 94
Range 29–62 50–175 39–124 56–120 87–106
8 3 Mean 50 110 76 72 92
Range 32–72 100–125 64–92 60–80 87–96
a. The expected number of tablets consumed is one or two per day, as recommended by the doctor or health worker, for the remainder
of pregnancy.
certain benefits, such as feeling healthy, experiencing
strength, and reduction in weakness.
Counseling to improve compliance
Counseling material
The flip chart on anemia prevention during pregnancy
was prepared with the objective of creating
awareness among pregnant women regarding the
signs and symptoms and the adverse consequences
of anemia, the importance of consuming iron supplements
and foods rich in iron and vitamin C, sources
of iron supplements, and the need to complete the
course of at least 100 tablets until delivery. The flip
chart was full of colorful illustrations depicting the
story of two pregnant women, one anemic and the
other nonanemic.
Focus of counseling
As the EDM data suggested, the women were especially
counseled regarding the benefits of iron supplementation
and ways of overcoming side effects, if any, so that
they could be motivated to continue and complete
the full dose of the supplement prescribed. Family
members were also included in the process, particularly
in persuading the women to remind them to procure
and take the iron supplements on a regular basis.
Impact of counseling during fortnightly home visits on
compliance
As a result of the counseling process, which was refined
on the basis of the EDM data, on average, the women
procured an adequate number of iron–folic acid tablets,
sometimes more than required (table 2), and 95%
of them consumed over 90% of the required number
of tablets.
Impact on benefits experienced
Table 3 presents the data on the benefits actually
experienced by the women before and after counseling.
Among the women who said that they regularly consumed
iron–folic acid tablets at first contact (group A),
the proportion experiencing the benefits markedly
increased as they continued taking the tablets. An
additional benefit, not reported by them earlier, was
that they could work more. In this group, counseling
helped to sustain regularity of consumption when the
women tended to be forgetful and not procure the
tablets. For the women who were irregular consumers
of iron–folic acid tablets at the first contact, counseling
greatly motivated them to consume tablets regularly,
especially after its benefits were explained with the
aid of the flip chart. As they started experiencing these
benefits, their motivation to continue with the supplement
increased. Thus, before the intervention only
two types of benefits were reported in group B, and
very few women reported any benefits; but after the
intervention four types of benefits were reported, and
by a larger proportion of women (table 3).
The benefits of iron–folic acid tablets experienced
by the women were more likely to motivate them to
continue consumption of the tablets, since most of the
women who experienced benefits were the ones who
consumed the tablets regularly.
Impact on hemoglobin levels
The mean hemoglobin level, which was 9.6 g/dl at the
first contact, improved to 11.08 g/dl toward the end
of the last trimester. The prevalence of anemia also
decreased from 75% to 30%. The 13% of women who
were severely anemic at the first contact shifted to the
category of being moderately anemic (hemoglobin
7.0–9.99 g/dl).
Discussion
Much has been documented in the literature regarding
the poor compliance with and inadequate impact of
iron–folic acid supplementation interventions among
deprived pregnant women. What needs to be further