Accessibility and compliance to iron folic supplementation among the pregnant women in two sub districts of Bhutan

Abstract

Considerable progress has been made in the control of micronutrient deficiency namely, iodine and vitamin A deficiency in Bhutan in the last two decades. However, iron deficiency anemia among pregnant women remains a major public health problem, despite the existence of universal iron supplementation program. This project studied the factors affecting pregnant women's compliance with iron supplementation regimen. Supply and availability of iron tablets, the distribution system, accessibility to service, and compliance with iron supplementation were investigated. A qualitative study using interview guides, and a semi-coded questionnaire, was conducted in one urban and two rural settings in Bhutan. The study found that pregnant women did not have adequate access to the antenatal service and hence did not get iron tablets, despite abundant iron supply available at the health centres. Major determinants affecting accessibility to antenatal services are physical barriers posed by the geographical terrain, and the inadequate counseling the mothers. The casual perception of pregnancy, late booking visit and feeling shy were determinants on the women's side. Iron tablets were received by women attending antenatal services and they were aware that iron tablets are good for blood and health. However women did not comply strictly with the regularity of iron ingestion as advised by the health personnel. Pregnant women have a casual perception of iron supplements because everyone received iron tablets. Thus, they developed an attitude that iron supplement is not a necessity. This relaxes their attention and care to ingest iron tablets. Forgetfulness was speculated to be an important barrier. Other reasons included the metallic smell of the tablets, nausea, stomach irritation and social taboos against medication. Based on these findings, improving the accessibility of the pregnant women to antenatal clinics should be the most important imperative for addressing the issue of compliance. Other barriers could be overcome thro