AMixed-Method Study on Iron-Folic Acid Adherenceandits Determinants amongPregnant Women in Puducherry, India

Introduction: Anaemia poses a significant risk to maternal health, contributing to preventable morbidity and mortality among pregnant women. Iron-folic acid (IFA) supplements are provided free of charge to meet the pregnancy's nutritional needs; however, consumption and adherence remains suboptimal. Objectives: To assess the compliance and associated factors for IFA supplementation and to explore the perceptions and barriers among pregnant women attending antenatal clinic. Method: The authors conducted a sequential explanatory mixed-method study at a tertiary care hospital, involving 219 pregnant women in the third trimester seeking antenatal care. The participants were selected through systematic random sampling during the study period of two months. Quantitative data were collected using a pre-tested interview schedule and the Morisky Green Levine Medication Adherence Scale. Qualitative data were obtained through focus group discussions, analyzed using content analysis. Results: Among the participants, 64.4% (95% CI: 57.7%-70.7%) were adherent to IFA during pregnancy. Factors significantly associated with adherence included higher monthly income, increase the number of antenatal check ups and absence of anemia. Common reasons for non-adherence were forgetfulness (62.8%), unawareness (26.9%), side-effects (25.6%), inadequate counseling (23.1%) and tablet taste (3.8%). Qualitative analysis revealed two themes and eight categories. The categories identified under knowledge regarding anaemia were causes, symptoms, complications, treatment options and places for procuring IFA supplements and the categories under barriers to adherence were patient factors, medication factors and health system factors. Conclusion: Approximately one-third of pregnant women did not adhere to IFA supplementation. Findings underscore the importance of consistent nutrition counseling during ante-natal visits, with a special focus on addressing side effects. These results have implications for maternal health programs and policies aimed at improving adherence to essential supplements during pregnancy.