Role of family support and women’s knowledge on pregnancy-related risks in adherence to maternal iron–folic acid supplementation in Indonesia

Wiradnyani, Luh Ade Ari; Khusun, Helda; Achadi, Endang L; Ocviyanti, Dwiana; Shankar, Anuraj H.

doi:10.1017/s1368980016001002

Cited by 52 publications

(56 citation statements)

References 32 publications

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“…Although this is below the recommended levels, it is substantially better than the current situation (approximately 40 IFA tablets are consumed during pregnancy). Our findings align well with existing literature from Bihar, Pakistan, Indonesia, and Kenya related to associations of maternal knowledge and family support in ensuring sustained IFA adherence (Birhanu et al, ; Wiradnyani, Khusun, Achadi, Ocviyanti, & Shankar, ). Prior research also highlights the role of education and wealth for compliance to IFA recommendations (Nisar, Dibley, & Mir, ; Wendt et al, ).…”

Section: Discussionsupporting

confidence: 91%

Maternal nutrition practices in Uttar Pradesh, India: Role of key influential demand and supply factors

Nguyen

Kachwaha

Avula

et al. 2019

Maternal & Child Nutrition

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Despite strong policy and program commitment, essential maternal nutrition services are not reaching enough women in many countries. This paper examined multifactorial determinants (personal, family, community, and health services) associated with maternal nutrition practices in Uttar Pradesh, India. Data were from a household survey of pregnant (n = 667) and recently delivered women (n = 1,835). Multivariable regression analyses were conducted to examine the determinants of four outcomes: consumption of diverse diets, consumption of iron folic acid (IFA) and calcium tablets, and weight monitoring during pregnancy. Population attributable risk analysis was used to estimate how much the outcomes can be improved under optimal program implementation. During pregnancy, women consumed 28 IFA and 8 calcium tablets, 18% consumed diverse diet, and 17% were weighed ≥3 times. Nutrition knowledge was associated with consumption of diverse diet (odds ratio [OR] = 2.2 times), IFA (2.3 times), calcium (11.7 times), and weight monitoring (1.3 times). Beliefs and self‐efficacy were associated with IFA (OR = 2.0) and calcium consumption (OR = 4.6). Family support and adequate health services were also associated with better nutrition practices. Under optimal program implementation, we estimate that 51% of women would have adequate diet diversity, an average consumption of 98 IFA, and 106 calcium tablets, and women would be weighed 4.9 times during pregnancy. Strengthening existing program operations and increasing demand for services has the potential to result in large improvements in maternal nutrition practices from current baseline levels but may not be sufficient to meet World Health Organization‐recommended levels without creating an enabling environment including improvements in education and income levels to support behaviour change.

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Section: Discussionsupporting

confidence: 91%

Maternal nutrition practices in Uttar Pradesh, India: Role of key influential demand and supply factors

Nguyen

Kachwaha

Avula

et al. 2019

Maternal & Child Nutrition

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“…In a community-based randomized controlled trial in rural Pakistan, education of pregnant women and their husbands on safe motherhood resulted in a higher intake of iron supplements, an improvement of diet, and a lower workload during pregnancy than in the control group ( 45 ). With the use of data from 3 rounds of the Demographic and Health Survey, a study in Indonesia reported a significant association between husband support and adherence to IFA supplementation during pregnancy (which was twice that in households in which husbands were supportive) ( 14 ). A randomized controlled trial in Kenya also showed a positive impact on calcium adherence among pregnant women who had an adherence partner, 52% of whom were husbands ( 23 , 46 ).…”

Section: Discussionmentioning

confidence: 99%

“…The guidelines recommend that, in addition to receiving specific micronutrient supplements and balanced energy and protein dietary supplementation (in food-insecure areas), women should receive relevant and timely counseling about healthy diets, physical activity, and adequate weight gain during pregnancy. To date, most large-scale nutrition interventions in developing countries either focus on specific micronutrient supplementation ( 7–11 ) or balanced energy and protein supplementation ( 3 , 12 ) and solely target women of childbearing age without regard for their autonomy within the household and their ability to adopt the promoted behaviors on their own ( 13 , 14 ). Engaging husbands, especially when they are the head of the household and primary decision makers on family health care, is important to improve care-seeking for women and children ( 15 , 16 ).…”

Section: Introductionmentioning

confidence: 99%

Engagement of Husbands in a Maternal Nutrition Program Substantially Contributed to Greater Intake of Micronutrient Supplements and Dietary Diversity during Pregnancy: Results of a Cluster-Randomized Program Evaluation in Bangladesh

Nguyen

Frongillo

Sanghvi

et al. 2018

The Journal of Nutrition

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BackgroundAlthough husbands may provide support during pregnancy, limited evidence exists on how to promote husbands’ engagement and what impact it has. Alive & Thrive integrated nutrition-focused interventions, targeting both wives and husbands, through an existing Maternal, Neonatal, and Child Health (MNCH) platform in Bangladesh.ObjectivesWe evaluated 1) the impact of a nutrition-focused MNCH program, compared with the standard MNCH program, on husbands’ behavioral determinants (i.e., awareness, knowledge, self-efficacy) and support to wives to adopt optimal nutrition practices and 2) how much of the previously documented impact on women's supplement intake and dietary diversity was explained by husbands’ behavioral determinants and support.MethodsWe used a cluster-randomized design with cross-sectional surveys at baseline (2015) and endline (2016) (n = ∼1000 women and ∼700 husbands/survey). We used mixed linear regression accounting for clustering to estimate difference-in-differences (DIDs) for impact on husbands’ behavioral determinants and path analysis to examine how much these determinants explained the impact on women's nutrition behaviors.ResultsOf husbands in the nutrition-focused MNCH group, 62% were counseled by health workers, 66% attended a husbands’ forum, and 34% saw video shows. The nutrition-focused MNCH, compared with the standard MNCH group, resulted in greater husbands’ awareness (DID: 2.74 of 10 points), knowledge (DID: 1.31), self-efficacy and social norms with regard to optimal nutrition practices (difference: 1.08), and support to their wives (DID: 1.86). Husbands’ behavioral determinants and support explained nearly half of the program impact for maternal supplement intake and one-quarter for dietary diversity.ConclusionsA nutrition-focused MNCH program that promoted and facilitated husbands’ engagement during their wives’ pregnancies significantly improved husbands’ awareness, knowledge, self-efficacy, and support. These improvements substantially explained the program's impact on women's intake of micronutrient supplements and dietary diversity. Targeting wives and husbands and designing activities to engage men in maternal nutrition programs are important to maximize impact. This trial was registered at www.clinicaltrials.gov as NCT02745249.

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“…WRA do not make decisions about their health in isolation; social networks can influence behaviors and family members play a crucial role in supporting the use of IFA tablets in women 38 . Pregnant women whose spouses actively participated in antenatal visits were more likely to demonstrate a significantly higher adherence to IFA supplements than women whose husbands were not active throughout antenatal visits 39 . Mothers and mothers-in-law can also influence the intake and adherence of IFA in pregnant women, even more than their partners as demonstrated by a formative research study among pregnant women in Bangladesh.…”

Section: Introductionmentioning

confidence: 93%

The RANI Project: A socio-normative intervention to reduce anemia in Odisha, India: A formative research protocol

et al. 2018

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Background: More than half of women of reproductive age in India are anemic. Anemia is associated with increased risk of preterm delivery, higher maternal mortality and contributes to fatigue, which affects women’s work productivity. The World Health Organization (WHO) recommends daily oral iron and folic acid (IFA) supplements during pregnancy and weekly supplements for women of reproductive age. Government programs and global donors have distributed and promoted IFA supplements in India for over four decades. However, initial intake and compliance remain inadequate. Objectives: This protocol describes the formative research phase of a larger study, called the Reduction in Anemia through Normative Innovations (RANI) Project, which will test, through a randomized controlled trial, the hypothesis that a social norms-based behavioral intervention in Odisha, India will improve uptake of IFA supplements and reduce anemia among reproductive age women as compared to usual care. The focus of this paper is on the formative research required to develop a sound intervention. We will examine socio-normative barriers to and facilitators of IFA supplement uptake. Methods and analysis: Based on the Theory of Normative Social Behavior, we will adopt a mixed-method, multilevel approach. We will collect data using focus groups, in-depth interviews, observations, Rapid Participatory Ethnographic Evaluation and Research (PEER) techniques, and perceptual mapping methods. Our sample includes reproductive age women (pregnant and not pregnant), their husbands, their mothers/in law and key stakeholders. Before collecting the data, and after analyzing the results, we will hold convenings in India to engage key stakeholders in collaborative design. Following the intervention design, we will test components of the intervention, gather user feedback and fine-tune as necessary. Impact: This study will contribute to the social norms and behavioral intervention research and inform policymakers about the value of adopting a socio-normative approach.

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Role of family support and women’s knowledge on pregnancy-related risks in adherence to maternal iron–folic acid supplementation in Indonesia

Cited by 52 publications

References 32 publications

Maternal nutrition practices in Uttar Pradesh, India: Role of key influential demand and supply factors

Maternal nutrition practices in Uttar Pradesh, India: Role of key influential demand and supply factors

Engagement of Husbands in a Maternal Nutrition Program Substantially Contributed to Greater Intake of Micronutrient Supplements and Dietary Diversity during Pregnancy: Results of a Cluster-Randomized Program Evaluation in Bangladesh

The RANI Project: A socio-normative intervention to reduce anemia in Odisha, India: A formative research protocol

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