Anaemia is found in 49.6% of pregnant women in Bangladesh, BDHS 2011. Micronutrient Initiative and the Government implemented an improved IC program to increase IFA consumption among pregnant women in two intervention districts (Satkhira, Narsingdhi).
Interventions included strengthening IFAS supply chain through accurate forecasting IFA needs, building functionary capacities, tracking stock and coverage and promoting behaviour change by improving health workers’ IC skills and problem solving with pregnant women during home and other contacts. IFA consumption and women’s receiving IC exposure were measured through cross-sectional surveys at baseline (200 women/district) and ~two years of intervention (300 women/district, 1200 total) in both intervention and comparison districts (Mymensingh, Jessore).
At end-line, 587 of 600 women in intervention districts consumed any IFAS in most recent pregnancy; 94% of consumers (555/ 587) received IC; women’s consumption of 90+ IFA increased from 36% to 84%, an increase of 48 percentage points; logistic regression analysis found that those exposed to improved IC by health workers were 5 times more likely to consume 90+ IFAS (p<0.001). In comparison districts, 560 of 600 women consumed any IFA; 85% of consumers (476/ 560) received IC; consumption of 90+ IFAS increased from 46% to 52%, an increase of 6 percentage points; regression analysis found no significant effect of standard IC on IFAS consumption.
Improved IC played a significant role in increasing adequate utilization of IFAS among pregnant women in the intervention areas. Findings suggest that Bangladesh’s IFAS scale-up could focus more on building capacity to improve IC skills to increase IFAS consumption.