NDLI: A qualitative assessment of barriers to iron and folic acid supplementation among pregnant women in Botswana

Content Provider	Springer Nature : BioMed Central
Author	Kebaabetswe, Poloko Diseko, Modiegi Zash, Rebecca Mayondi, Gloria Mabuta, Judith Mmalane, Mompati Makhema, Joseph Lockman, Shahin Moeng, Letumile Lowenthal, Elizabeth Shapiro, Roger Caniglia, Ellen C.
Abstract	Background Antenatal iron and folic acid (IFA) supplementation remains an effective strategy in the prevention of maternal anemia and low birthweight and is universally recommended by WHO. However, uptake of IFA has varied globally due to challenges with acceptability, supply and distribution, counselling and knowledge, and access to health services. In Botswana, nearly one-third of pregnant women engaged in antenatal care do not receive IFA, despite it being standard of care. The objectives of this study were to assess knowledge of and barriers and facilitators to IFA supplementation before and during pregnancy. Methods We conducted qualitative interviews with two key stakeholder groups at two different levels—the individual level (pregnant women) and the service delivery level (health care providers). Here, we present results from interviews with pregnant women at two representative antenatal clinic sites in Botswana in 2022. Results Pregnant women were motivated to be healthy and were knowledgeable about the benefits of supplementation during pregnancy to mothers and their infants; however, women knew more about the benefits of iron than folic acid. Most women were in favor of receiving IFA supplementation prior to pregnancy and receiving fortified foods. Several key barriers were identified: lack of supplement availability in the clinics, poverty, side effects, number of tablets, and adherence. Approaches to overcome these barriers included improving supplement availability, improving health education, increasing supply of nutritious and fortified foods, backyard gardens, and increasing family and monetary support. Conclusions Our study identified a need to 1) increase the availability of supplementation at antenatal clinics and 2) improve education regarding supplementation to include information about the benefits of folic acid and other micronutrients. Implementation research is needed to ascertain whether increasing supply and improving education could increase utilization of supplementation during pregnancy, with the ultimate goal of improving maternal and infant outcomes.
Related Links	https://bmcpublichealth.biomedcentral.com/counter/pdf/10.1186/s12889-024-20685-5.pdf
Ending Page	12
Page Count	12
Starting Page	1
File Format	HTM / HTML
ISSN	14712458
DOI	10.1186/s12889-024-20685-5
Journal	BMC Public Health
Issue Number	1
Volume Number	24
Language	English
Publisher	BioMed Central
Publisher Date	2024-12-04
Access Restriction	Open
Subject Keyword	Public Health Medicine Epidemiology Biostatistics Vaccine Environmental Health Iron Folic Acid Antenatal Supplementation Barriers and Facilitators Pregnancy Medicine/Public Health
Content Type	Text
Resource Type	Article
Subject	Public Health, Environmental and Occupational Health
Journal Impact Factor	3.5/2023
5-Year Journal Impact Factor	3.9/2023

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