Adherence, Determinants and Barriers to Calcium Supplementation in Pregnancy: A Mixed Methods Study

Background: Calcium intake of 1gram/day in pregnancy reduces the risk of pre-ecclampsia and preterm birth. Universal free calcium supplementation program was started throughout India at considerable cost to the government. Although coverage is high, this program is only effective if there is good adherence among mothers, and this is unknown. This study was conducted to estimate the prevalence of adherence to calcium tablets among mothers and to identify the determinants and barriers to adherence to calcium supplementation. Methods: A cross sectional mixed methods study was conducted among mothers attending antenatal clinic at Kundrathur PHC. Mothers with >20 weeks of gestation were recruited consecutively. They were interviewed using the Morisky Medication Adherence Scale (MMAS-8). Barriers to adherence were elicited by freelisting and analysed using Visual Anthropac 1.0. Results: 89 mothers completed the study. The participants had a mean age of 25.29±4.275 years. Majority of mothers were literate and primi gravida. The Mean MMAS score was 4.98±1.79 (95% CI 4.61, 5.36), out of a maximum score of 8. In our study, the majority of mothers (69.66%, 95%CI 59, 78.97) had low adherence, and high adherence was seen only in 6.7% women. (95% CI 2.51, 14.10). Only 3.4% mothers were aware of the role of calcium in hypertension. There was a significant association between adherence and level of education, and having a support person (OR 11.5, 95%CI -2.568, 51.502). Major barriers identified were forgetfulness, big size of the tablet, vomiting, dosing schedule and unavailability of tablets. Conclusion: Adherence to Calcium supplementation is low among mothers. Having a designated support partner in pregnancy, who helps in reminding and giving supplements, can help improve adherence. Addressing the major barriers identified can help in improving adherence and reducing hypertension in pregnancy.