NGO probes gaps in tackling anaemia in pregnancy

Are iron-folic acid tablets difficult to take? Is the packaging appropriate? What are health workers advising? Is the mineral content correct?



These are some of the questions the organization Micronutrient Initiative (MI) is posing in several developing countries – studying women’s use of iron-folic acid supplements to get at why despite widespread coverage “on paper”, anaemia prevalence in pregnant women remains high.



The coverage data does not necessarily reflect how or whether women are taking the supplements, or factors that might deter them.



“We know from efficacy trials that if women take iron-folic acid supplements the prevalence of anaemia in late pregnancy and at delivery is low,” Lynnette Neufeld, MI chief technical adviser, told IRIN.



In most countries where MI works there are high levels of anaemia and folic acid deficiency during pregnancy, despite almost all of the countries having iron-folic acid supplementation for pregnant women in their health policies and including the products in their standard drug procurement lists, she said.



“If these policies and the supplements are in place but we are not seeing improvements, something is amiss.”



Countries’ demographic and health surveys have information about iron-folic acid supplement coverage, but generally the question posed to women is simply whether they received the supplements.



“Our plan is to accumulate specifics from the countries where we work about iron-folic acid supplementation to get a clear understanding of formulation, supply issues, usage and other factors, with the aim of creating programmes more effective in reducing anaemia.”



She noted that so far MI is studying programmes for public distribution of prenatal supplements for the most vulnerable populations.



MI has already done ‘mini situation analyses’ in Bangladesh, India, Indonesia and Pakistan, Neufeld said. In one case researchers found that the dose of iron in the supplements used was much higher than World Health Organization (WHO) recommendations and above the level associated with frequent adverse effects including cramping and heartburn.



Women’s nutrition



Many health experts say in discussions about child malnutrition all too often the importance of women’s nutritional status is overlooked.



“Absolutely the nutritional status of a woman during pregnancy gets neglected,” Neufeld said. “But also if a woman is not well-nourished or is anaemic before she’s pregnant that too will affect her and her child.”



The issue is beginning to get more attention. After consultations in 2007 on anaemia in women, WHO put out a policy statement in 2009 on providing iron-folic acid supplementation to non-pregnant women of child-bearing age.



Improving iron and folate nutrition of women of reproductive age could improve pregnancy outcomes as well as enhance maternal and infant health, WHO says in the policy statement.



“There is growing recognition that you cannot fix [nutritional deficiencies] just once a woman is pregnant,” Neufeld said.



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