Demand or Supply: What is the Limiting Factor to the Success of Iron-Folic Acid Supplementation?

Session: Nutrition Across the Continuum of Care for Maternal and Newborn Health

Presenter: Asri Adisamita, University of Indonesia
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Background: Anemia prevalence has not changed in many regions over the last several decades. In Indonesia, the national prevalence of anemia among pregnant women declined from 50.9% in 1995 to 37.1% in 2013. The proportion of women taking any IFA supplements increased from 67.1% in 1994 to 89.1% in 2013. However, only one-third of women (33%) took 90+ IFAS in 2013. This presentation reviews how Indonesia increased coverage of women taking any IFAS and the remaining challenges for reducing the prevalence of anemia.

Methodology: We reviewed literature on Indonesia’s past and current strategies to reduce maternal anemia and identified programmatic barriers to reducing anemia.

Results: Sufficient supplies, equitable distribution, and high demand from the user are three essential components for successful IFAS programs. While national supplies of IFAS in Indonesia are good, IFAS are not available at all service points. Demand creation through effective communication has not been scaled-up. Studies in Indonesia show that women are concerned about IFAS causing too much blood and a big baby which is believed to cause obstetric complications. Women are concerned about unpleasant side effects which they are not told how to manage. The MotherCare project 1990-1999 increased the coverage and compliance of IFAS after increasing distribution points through traditional birth attendants and the marriage registration program combined with a communications campaign to increase demand and adherence. In addition, two national pharmaceutical companies produced IFAS and distributed it through private sector vendors which increased the IFAS availability.

Conclusions: IFAS are effective in reducing anemia when access is accompanied by demand creation and strategies that improve adherence to accelerate the reduction of anemia, Indonesia needs to redouble its efforts to ensure that adequate supplies are widely available and that counseling strategies address behavioral obstacles to achieve strong adherence to IFAS, as recommended in pregnancy.