Non-adherence to iron and folic acid consumption among Indian pregnant women: evidences from national family health survey-5 data (2019-21).

Abstract

Background: Iron and Folic Acid (IFA) supplementation is one of the highly recommended strategies to tackle anemia. Under the backdrop of high anemia prevalence among pregnant women, this study examines the level of non-adherence with IFA supplementation, separately for 100 + days and 180 + days, among pregnant women in India.

Methods: The analysis is conducted on a sample of 174,947 women, who bought or received IFA tablets/syrup during their last pregnancy, and was surveyed during the National Family Health Survey-5 (2019-21). The NFHS is a cross-sectional survey that claims to represent 95% of the Indian population. The survey adopted stratified random sampling specific to rural and urban population. Descriptive statistics and conditional probabilities are calculated to examine the initiation and attainment of different levels of IFA consumption across selected background variables. Binary logistic regressions are employed to understand the influence of socio-economic factors on non-adherence of IFA supplementation for minimum 100 days and 180 days, and the results are presented as adjusted odds ratios at 95% confidence intervals.

Results: While the probability of initiation of IFA tablets is fairly high among pregnant women in India, the probability of consuming at least 100 tablets declines drastically for pregnant women irrespective of their socio-economic profile. The chances of not taking IFA for at least 100 days and 180 days are lesser by 21% and 15% respectively for urban with respect to rural women. When compared to the richest, the poorest face 1.6 times higher odds for not consuming IFA for at least 100 days, and 1.96 times higher in case of non-adherence for minimum 180 days. Women with no education shows 1.73 and 1.46 times higher likelihood to be non-adherent with both criteria as compared to those with higher education. Minimum four antenatal care (ANC) visits and husband's presence during any of these visits demonstrated significant associations. Risk of non-compliance is lesser among women with lower birth order as compared to pregnancies of third and higher birth order.

Conclusion: It is mandatory to involve community health workers in awareness generation and close monitoring of IFA consumption behaviour first ensuring access to IFA supplements, and then adherence for 100 + days, which in turn will improve the possibility of meeting 180 days' recommendation.