Iron supplementation: knowledge perceptions and usage among pregnant women in rural India.

In rural India where the prevalence of anemia among women of childbearing age ranges from 34% to 99% the government initiated iron and folic acid tablet distribution to pregnant women as part of the Child Survival/Safe Motherhood Program. However the 1992-93 National Family Health Survey of India found that only 50% of new mothers had taken the tablets during pregnancy indicating inadequate program coverage. To investigate the factors associated with this low coverage interviews were conducted with 153 pregnant women from 3 blocks in the Agra district of Uttar Pradesh; in addition in-depth discussions were held with 63 antenatal clinic patients. Only 44% of pregnant women used all the tablets given to them. Iron tablets were perceived as a means for pregnant women to gain strength; however only 15% perceived improvements in their health status as a result of tablet use. Compliance was highest among women 25-29 years of age and those who received a large supply (100 tablets) at 1 antenatal visit. Consumption of the iron-folic acid tablets was also improved when pregnant women were knowledgeable about the tablets and had positive experiences with their use. Health workers provided women with inadequate counseling on the benefits of the tablets and how to take them. Overall these findings indicate a need for provision of more complete and accurate information to pregnant women about the benefits and side effects of iron-folic acid tablet use.