scholarly journals Examining intentions to take iron supplements to inform a behavioral intervention: The Reduction in Anemia through Normative Innovations (RANI) project

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0249646
Author(s):  
Erica Sedlander ◽  
Michael W. Long ◽  
Jeffrey B. Bingenheimer ◽  
Rajiv N. Rimal
Keyword(s):  
Social Norms ◽  
Pregnant Women ◽  
Behavioral Intervention ◽  
Self Efficacy ◽  
Reproductive Age ◽  
Iron Supplement ◽  
Injunctive Norms ◽  
Women Of Reproductive Age ◽  
Iron Supplements ◽  
Supplement Use

Background More than half of women of reproductive age in India have anemia. Over the last decade, India has made some progress towards reducing anemia in pregnant women, but non-pregnant women, who make up the largest sub group of people with anemia, are largely disregarded. Objectives The objective of this paper is to examine intentions to take iron supplements and factors associated with intentions to inform a social norms-based behavioral intervention to increase uptake of iron supplements and reduce anemia in Odisha, India. Methods We collected data from 3,914 randomly sampled non-pregnant women of reproductive age in 81 villages. We conducted a survey and took hemocue (anemia level) readings from each participant. We analyzed data using linear regression models beginning with demographics and social norms and adding other factors such as self-efficacy to take iron supplements, anemia risk perception, and knowledge about anemia in a subsequent model. Results 63% of women in our sample were anemic but less than 5% knew they were anemic. Despite national guidelines that all women of reproductive age should take weekly iron supplements to prevent anemia, less than 3% of women in our sample were currently taking them. While actual use was low, intentions were rather high. On a five point Likert scale where higher numbers meant more intentions to take supplements, average intentions were above the midpoint (M = 3.48, SD = 1.27) and intentions and iron supplement use were significantly correlated (r = .10, p < .001). Both injunctive norms and collective norms were associated with intentions to take iron supplements but descriptive norms were not. Other significant factors included age, breastfeeding, knowledge, self-efficacy, and outcome expectations. The final model accounted for 74% of the variance in iron supplement intentions. Conclusions In this context, where the actual behavior is low but intentions to enact the behavior are high, starting an intervention with injunctive norms messaging (expectations around the behavior) and self-efficacy to enact the behavior is the step we recommend based on our results. As an intervention unfolds and iron supplement use increases, descriptive norms messaging (that people are indeed taking iron supplements) may add value.

scholarly journals Moving beyond individual barriers and identifying multi-level strategies to reduce anemia in Odisha India

2020 ◽  
Author(s):  
Erica Sedlander ◽  
Michael Long ◽  
Satyanarayan Mohanty ◽  
Ashita Munjral ◽  
Jeffrey B. Bingenheimer ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Ecological Model ◽  
Health Workers ◽  
Reproductive Age ◽  
Women Of Reproductive Age ◽  
Indian Government ◽  
Iron Supplements ◽  
Individual Level ◽  
Supplement Use ◽  
The Government

Abstract Background: To reduce the prevalence of anemia, the Indian government recommends daily iron and folic acid supplements (iron supplements) for pregnant women and weekly iron supplements for adolescents and all women of reproductive age. The government has distributed free iron supplements to adolescents and pregnant women for over four decades. However, initial uptake and adherence remain inadequate and non-pregnant women of reproductive age are largely ignored. The aim of this study is to examine the multilevel barriers to iron supplement use and to subsequently identify promising areas to intervene. Methods: We conducted a qualitative study in the state of Odisha, India. Data collection included key informant interviews, focus group discussions with women, husbands, and mothers-in-law, and direct observations in health centers, pharmacies and village health and nutrition days. Results: We found that at the individual level, participants knew that iron supplements prevent anemia but underestimated anemia prevalence and risk in their community. Participants also believed that taking too many iron supplements during pregnancy would “make your baby big” causing a painful birth and a costly cesarean section. At the interpersonal level, mothers-in-law were not supportive of their daughters-in-law taking regular iron supplements during pregnancy but husbands were more supportive. At the community level, participants reported that only pregnant women and adolescents are taking iron supplements, ignoring non-pregnant women altogether. Unequal gender norms are also an upstream barrier for non-pregnant women to prioritize their health to obtain iron supplements. At the policy level, frontline health workers distribute iron supplements to pregnant women only and do not follow up on adherence. Conclusions: Interventions should address multiple barriers to iron supplements use along the socio-ecological model. They should also be tailored to a woman’s reproductive life course stage: adolescents, pregnancy, and non-pregnant women of reproductive age because social norms and available services differ between the subpopulations.

scholarly journals Unpacking How a Social Norms-Based Intervention Affects Iron Folic Acid Supplement Use Among Rural Indian Women

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 685-685
Author(s):  
Erica Sedlander ◽  
Ichhya Pant ◽  
Jeffrey Bart Bingenheimer ◽  
Lipika Patro ◽  
Hagere Yilma ◽  
...  
Keyword(s):  
Folic Acid ◽  
Reproductive Age ◽  
Iron Supplement ◽  
Folic Acid Supplement ◽  
Women Of Reproductive Age ◽  
Community Based ◽  
Group Education ◽  
Iron Supplements ◽  
Supplement Use ◽  
Iron Folic Acid

Abstract Objectives More than a third of women worldwide and more than half of women in India have iron deficiency anemia. In 2012, the World Health Assembly made a global target of a 50% reduction in anemia among all women of reproductive age by the year 2025. Based on formative research, the Reduction in Anemia through Normative Innovations (RANI) project designed a social norms-based intervention to increase iron folic acid supplement use among women of reproductive age in Odisha, India. The objective of this paper is to examine midline data to understand which intervention components had the most effect on taking iron supplements and to suggest intervention modifications accordingly. Methods We collected and analyzed longitudinal data at baseline from the control and treatment arms and again from the same two arms at midline, six months later (n = 1,966 and n = 1,987). For this analysis, our sample includes non-pregnant women of reproductive age (15 – 49 years old). Using nested models, we analyzed data from the different intervention components: monthly community-based testing for anemia, attending participatory group education sessions, and watching locally made videos targeted at different referent groups. We also examined if age, caste, education, and communicating about the intervention moderated the effect of the intervention on iron supplement use. Results After controlling for iron supplement use at baseline, we found that simply being in the treatment arm increased the odds of taking supplements by more than 16 times (OR = 16.73; p = &lt; .001). Being exposed to each of the intervention components separately and as reported here, all together, also increased use. Getting tested for anemia increased a woman's odds of taking iron supplements by 38% (OR = 1.38; p = &lt; .001) followed by watching videos which increased the odds by 26% (OR 1.26; p &lt; .001).Participating in group education sessions had the smallest effect (OR = 1.09; p = &lt; .01). There was not a significant difference in how the intervention affected iron supplement use by age, caste, or education level. Similarly, interpersonal communication did not have an effect. Conclusions While all intervention components increased iron supplement use, community-based anemia testing had the greatest effect. In the final stage of this trial, more resources will go towards anemia testing. Funding Sources The Bill and Melinda Gates Foundation.

scholarly journals Moving beyond individual barriers and identifying multi-level strategies to reduce anemia in Odisha India

2019 ◽  
Author(s):  
Erica Sedlander ◽  
Michael Long ◽  
Satyanarayan Mohanty ◽  
Ashita Munjral ◽  
Jeffrey B. Bingenheimer ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Ecological Model ◽  
Health Workers ◽  
Reproductive Age ◽  
Women Of Reproductive Age ◽  
Indian Government ◽  
Iron Supplements ◽  
Individual Level ◽  
Supplement Use ◽  
The Government

Abstract Background: To reduce the prevalence of anemia, the Indian government recommends daily iron and folic acid supplements (iron supplements) for pregnant women and weekly iron supplements for adolescents and all women of reproductive age. The government has distributed free iron supplements to adolescents and pregnant women for over four decades. However, initial uptake and adherence remain inadequate and non-pregnant women of reproductive age are largely ignored. The aim of this study is to examine the multilevel barriers to iron supplement use and to subsequently identify promising areas to intervene. Methods: We conducted a qualitative study in the state of Odisha, India. Data collection included key informant interviews, focus group discussions with women, husbands, and mothers-in-law, and direct observations in health centers, pharmacies and village health and nutrition days. Results: We found that at the individual level, participants knew that iron supplements prevent anemia but underestimated anemia prevalence and risk in their community. Participants also believed that taking too many iron supplements during pregnancy would “make your baby big” causing a painful birth and a costly cesarean section. At the interpersonal level, mothers-in-law were not supportive of their daughters-in-law taking regular iron supplements during pregnancy but husbands were more supportive. At the community level, participants reported that only pregnant women and adolescents are taking iron supplements, ignoring non-pregnant women altogether. Unequal gender norms are also an upstream barrier for non-pregnant women to prioritize their health to obtain iron supplements. At the policy level, frontline health workers distribute iron supplements to pregnant women only and do not follow up on adherence. Conclusions: Interventions should address multiple barriers to iron supplements use along the socio-ecological model. They should also be tailored to a woman’s reproductive life course stage: adolescents, pregnancy, and non-pregnant women of reproductive age because social norms and available services differ between the subpopulations.

scholarly journals ‘After they finish their meals, I have my meal from the leftovers; I have to adjust:” Examining How Gender Norms Affect Anemia Rates in Odisha India (P04-122-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Erica Sedlander ◽  
Chandni Ladwa ◽  
Sameera Talegawkar ◽  
Rohini Ganjoo ◽  
Rajiv Rimal
Keyword(s):  
Folic Acid ◽  
Focus Group ◽  
Pregnant Women ◽  
Gender Norms ◽  
Reproductive Age ◽  
Deficiency Anemia ◽  
Women Of Reproductive Age ◽  
Iron Supplements ◽  
Rich Food ◽  
Iron Folic Acid

Abstract Objectives Half of women of reproductive age in India have iron deficiency anemia compared to only 23% of men. Most research focuses on biological reasons for this discrepancy and access to iron-folic acid and iron-rich foods. However, recent research in India shows that inequitable gender norms may affect a woman's ability or desire to take iron supplements and to eat iron-rich food. The objective of this study is to examine how and why gender norms may be affecting high and persistent rates of anemia in India. Methods We conducted 25 key informant interviews and 16 focus group discussions with women of reproductive age, adolescents, husbands and mothers-in-law (n = 148) in Odisha, India. We purposively sampled key informants and randomly sampled focus group participants. We analyzed the data using applied thematic analysis in Nvivo software. Results Our data shows that unequal gender norms impact behaviors that are directly related to high rates of anemia. Women are often serving their husband, children, and in-laws first and “adjusting” to whatever is leftover which may be poor in nutritional qualities and less iron rich. Men are also the main breadwinners but often spend their money on alcohol, money that could be spent on iron-rich food for the household. Women reported that extreme fatigue is a normal part of being a woman and that a woman's plight is to take care of her family at any cost. Given that fatigue, the primary symptom of anemia is normalized; women may be less likely to seek treatment. Women tend to prioritize the health of their family over her own which could affect her ability or desire to go to the health center to get tested for anemia or to obtain iron supplements. Pregnant women are more likely to take iron supplements for the health of the baby, not her own health. While non-pregnant women of reproductive age who were not diagnosed with anemia were not focused on preventive health, only major illnesses and thus, were not taking supplements at all. Conclusions More upstream barriers, like gender norms, may be impinging on a woman's ability to take iron folic acid and to eat iron rich foods. Understanding how gender norms contribute to anemia could change the narrative from a biomedical issue to a social justice issue. Funding Sources The Bill and Melinda Gates Foundation. Supporting Tables, Images and/or Graphs

scholarly journals Designing a socio-normative intervention to reduce anemia in Odisha India: A formative research protocol

2018 ◽  
Vol 2 ◽  
pp. 15
Author(s):  
Erica Sedlander ◽  
Rajiv N Rimal ◽  
Sameera A. Talegawkar ◽  
Hagere Yilma ◽  
Wolfgang Munar
Keyword(s):  
Social Norms ◽  
Behavioral Intervention ◽  
Controlled Trial ◽  
Formative Research ◽  
Reproductive Age ◽  
World Health ◽  
Policy Dialogue ◽  
Women Of Reproductive Age ◽  
Reproductive Age Women ◽  
Increased Risk

Background: More than half of women of reproductive age in India are anemic. Anemia is associated with increased risk of preterm delivery, higher maternal mortality and contributes to fatigue, which affects women’s work productivity. The World Health Organization (WHO) recommends daily oral iron and folic acid (IFA) supplements during pregnancy and weekly supplements for women of reproductive age. Government programs and global donors have distributed and promoted IFA supplements in India for over four decades. However, initial intake and compliance remain inadequate. Objectives: This protocol describes the formative research phase of a larger study, which will test, through a randomized controlled trial, the hypothesis that a social norms-based behavioral intervention in Odisha, India will improve uptake of IFA supplements and reduce anemia among reproductive age women as compared to usual care. The focus of this paper is on the formative research required to develop a sound intervention. We will examine socio-normative barriers to and facilitators of IFA supplement uptake. Methods and analysis: Based on the Theory of Normative Social Behavior, we will adopt a mixed-method, multilevel approach. We will collect data using focus groups, in-depth interviews, observations, Rapid Participatory Ethnographic Evaluation and Research (PEER) techniques, and perceptual mapping methods. Our sample includes reproductive age women (pregnant and not pregnant), their husbands, their mothers/in law and key stakeholders. After analyzing the results, we will hold a convening in India to collaboratively design the intervention. Following the intervention design, we will test components of the intervention, gather user feedback and tweak as necessary. Additionally, to improve adoption and sustainability of the intervention, we will conduct policy dialogue with stakeholders throughout the formative research. Impact: This study will contribute to the social norms and behavioral intervention research and inform policymakers about the value of adopting a socio-normative approach.

scholarly journals The RANI Project: A socio-normative intervention to reduce anemia in Odisha, India: A formative research protocol

2018 ◽  
Vol 2 ◽  
pp. 15 ◽  
Author(s):  
Erica Sedlander ◽  
Rajiv N Rimal ◽  
Sameera A. Talegawkar ◽  
Hagere Yilma ◽  
Wolfgang Munar
Keyword(s):  
Social Norms ◽  
Behavioral Intervention ◽  
Controlled Trial ◽  
Formative Research ◽  
Reproductive Age ◽  
World Health ◽  
Women Of Reproductive Age ◽  
Reproductive Age Women ◽  
Key Stakeholders ◽  
Increased Risk

Background: More than half of women of reproductive age in India are anemic. Anemia is associated with increased risk of preterm delivery, higher maternal mortality and contributes to fatigue, which affects women’s work productivity. The World Health Organization (WHO) recommends daily oral iron and folic acid (IFA) supplements during pregnancy and weekly supplements for women of reproductive age. Government programs and global donors have distributed and promoted IFA supplements in India for over four decades. However, initial intake and compliance remain inadequate. Objectives: This protocol describes the formative research phase of a larger study, called the Reduction in Anemia through Normative Innovations (RANI) Project, which will test, through a randomized controlled trial, the hypothesis that a social norms-based behavioral intervention in Odisha, India will improve uptake of IFA supplements and reduce anemia among reproductive age women as compared to usual care. The focus of this paper is on the formative research required to develop a sound intervention. We will examine socio-normative barriers to and facilitators of IFA supplement uptake. Methods and analysis: Based on the Theory of Normative Social Behavior, we will adopt a mixed-method, multilevel approach. We will collect data using focus groups, in-depth interviews, observations, Rapid Participatory Ethnographic Evaluation and Research (PEER) techniques, and perceptual mapping methods. Our sample includes reproductive age women (pregnant and not pregnant), their husbands, their mothers/in law and key stakeholders. Before collecting the data, and after analyzing the results, we will hold convenings in India to engage key stakeholders in collaborative design. Following the intervention design, we will test components of the intervention, gather user feedback and fine-tune as necessary. Impact: This study will contribute to the social norms and behavioral intervention research and inform policymakers about the value of adopting a socio-normative approach.

scholarly journals High burden of anemia among pregnant women in Tanzania: a call to address its determinants

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Bruno F. Sunguya ◽  
Yue Ge ◽  
Linda Mlunde ◽  
Rose Mpembeni ◽  
Germana Leyna ◽  
...  
Keyword(s):  
Food Insecurity ◽  
Pregnant Women ◽  
Reproductive Age ◽  
Gis Mapping ◽  
Demographic And Health Surveys ◽  
Health Coverage ◽  
Nutritional Knowledge ◽  
Women Of Reproductive Age ◽  
Anemia In Pregnancy ◽  
In Pregnancy

Abstract Background Anemia in pregnancy is behind a significant burden of maternal mortality and poor birth outcomes globally. Efforts to address it need evidence on trends and its pertinent factors as they vary from one area to another. Methods We pooled data of 23,203 women of reproductive age whose hemoglobin levels were measured from two Tanzania Demographic and Health Surveys (TDHS). Of them, 2,194 women were pregnant. Analyses employed descriptive analyses to determine the burden of anemia, its characteristics, and severity; GIS mapping to determine the regional changes of anemia between 2005 and 2015; and logistic regression to determine the remaining determinants of anemia among pregnant women using Stata 15. Results The burden of anemia among pregnant women in Tanzania has remained unprecedently high, and varies between regions. There was no significant decline of anemia in general between the two periods after adjusting for individual, households, reproductive, and child characteristics [AOR = 0.964, 95% CI = 0.774–1.202, p = 0.747). Anemia is currently prevalent in 57% of pregnant women in Tanzania. The prevalence is more likely to be higher among women aged 15–19 years than those aged between 20–34 years. It is more likely to be prevalent among those within large families, with no formal education, food insecurity, lack of health insurance, had no antimalaria during pregnancy, and had low frequency of ANC attendance. On the other hand, delivery in a health facility may be potentially protective against anemia. Conclusions Anemia in pregnancy remained persistently high and prevalent among 57% of pregnant women in Tanzania. Efforts to address anemia are crucial and need to be focused in regions with increasing burden of anemia among pregnant women. It is imperative to address important risk factors such as food insecurity, strengthening universal health coverage, empowering women of reproductive age with education and especially nutritional knowledge and advocating for early antenatal booking, attendance, and facility delivery.

Venlafaxine prescription claims among insured women of reproductive age and pregnant women, 2011–2016

2021 ◽  
Author(s):  
April D. Summers ◽  
Kayla N. Anderson ◽  
Elizabeth C. Ailes ◽  
Scott D. Grosse ◽  
William V. Bobo ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Reproductive Age ◽  
Women Of Reproductive Age

scholarly journals Prevalence and Associated Factors of Vitamin A Deficiency among Children and Women in Senegal

2020 ◽  
Vol 8 (2) ◽  
pp. 1-11
Author(s):  
Mane Hélène Faye ◽  
Nicole Idohou-Dossou ◽  
Abdou Badiane ◽  
Anta Agne-Djigo ◽  
Papa Mamadou DD Sylla ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Logistic Regression ◽  
Vitamin A ◽  
Pregnant Women ◽  
Vitamin A Deficiency ◽  
Plasma Concentrations ◽  
Reproductive Age ◽  
Subclinical Inflammation ◽  
Women Of Reproductive Age ◽  
Factors Associated

Background: Like many developing countries, Senegal does not have data on the extent of vitamin A deficiency (VAD) that is representative of its population. The present survey was conducted to fill this gap and to identify factors associated with VAD, prior to the introduction of a large-scale vitamin A oil fortification program. Procedures: A nationwide representative cross-sectional survey involving 1887 children 12 to 59 months old and 1316 women of reproductive age (WRA) was conducted. Blood samples were collected and plasma concentrations of retinol (PR), C-reactive protein (CRP), and alpha-1-acidglycoprotein were measured. PR was adjusted for subclinical inflammation using the BRINDA regression methodology. Multivariate logistic regression was used to identify factors associated with VAD. Findings: The adjusted prevalence of VAD (PR ≤ 0.7 μmol/L) in children was 15.3% and differed by age group, area of residence, and socioeconomic status and half of them had subclinical inflammation. Among WRA, VAD was low (2.3%) and 18.1% had vitamin A insufficiency (VAI). Pregnant women were more affected by VAI (28.4%) and Dakar had lower figures compared with other cities and rural strata. Prevalence of VAI decreased with increasing wealth quintile. In logistic regression, abnormal CRP, poverty, scarce consumption of poultry, oysters, melon, red palm oil, palm kernel oil, Saba senegalensis fruit pulp (Maad) and cowpea, frequent consumption of leeks and consumption of Leptadenia hastata leaves (Mbuum tiakhat), were associated with VAD in children. For women, lower socioeconomic status, fair or poor health status and anemia were negatively associated with VAI. Conclusions: In Senegal, VAD is a moderate public health problem in children and slight among women. Particular attention should be paid to children older than 23 months, pregnant women, rural populations, and poorest households. Nutritional interventions should be implemented alongside morbidity prevention and control. Keywords: vitamin A deficiency, children 12-59 months, women of reproductive age, Senegal.

scholarly journals A Social Norms-Based Intervention Improves Dietary Diversity among Women in Rural India: The Reduction in Anemia through Normative Innovations (RANI) Project

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2822
Author(s):  
Sameera A. Talegawkar ◽  
Yichen Jin ◽  
Erica Sedlander ◽  
Rohini Ganjoo ◽  
Satyaranjan Behera ◽  
...  
Keyword(s):  
Social Norms ◽  
Dietary Diversity ◽  
Reproductive Age ◽  
Control Groups ◽  
Women Of Reproductive Age ◽  
Diet Diversity ◽  
Learning Modules ◽  
Food And Agriculture ◽  
And Control ◽  
Minimum Dietary Diversity

Diet diversity has an important role in the prevention and treatment of anemia. Based on formative research in the community and the theory of normative social behavior, we designed an intervention to improve diet diversity among women of reproductive age. Our study, the Reduction in Anemia through Normative Innovations (RANI) Project, investigated the effect of a social norms-based intervention on diet diversity among women of reproductive age. We randomized villages in Odisha, India, into treatment or control arms, with a minimum of one village buffer between them. We assessed exposure to the intervention by frequency of self-reported images seen from the participatory learning modules, videos watched, and number of hemoglobin tests administered. We assessed diet diversity with the Food and Agriculture Organization’s Minimum Dietary Diversity for Women (MDD-W) questionnaire. We used multiple logistic regression to examine the associations between intervention and diet diversity, adjusting for covariates. Compared with baseline, diet diversity score increased in both treatment and control groups. The odds of having a diverse diet was 47% higher in the treatment group. Higher level of exposure to the RANI intervention was associated with a better diet diversity score, indicating that the intervention was effective in improving diet quality.

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