Anemia is an important issue among researchers in the nutrition field because it affects over 500 million women worldwide. Pregnant women are particularly vulnerable to anemia, and iron-folic acid (IFA) supplementation is one of the most effective ways to prevent anemia during pregnancy. Despite more women having access to antenatal care (ANC), the levels of IFA supplementation intake are not increasing. Between 1990 and 2009, the percentage of women receiving antenatal care increased from 64% to 81% across all developing regions, yet IFA coverage remains low. Only three of the twenty-two countries analyzed have IFA coverage rates (defined as taking at least one IFA tablet during pregnancy) above 90%, while 15 countries have ANC attendance rates over 90%.
In order to make more informed nutrition policy and programming decisions, the SPRING project wanted to determine the barriers facing wider, more effective implementation of IFA supplementation programs for pregnant women. SPRING looked at the performance of IFA supplementation systems through ANC in twenty-two countries using Demographic and Health Survey (DHS) data. The analysis highlights four key points where pregnant women falter on the path to recommended supplementation. These results will be presented at this year’s American Public Health Association (APHA) Meeting.
Each country’s IFA programming varies depending on a number of factors, including national prioritization of IFA supplementation in policy, supply systems for IFA distribution, and methods of sensitization about IFA use for health providers and pregnant women. To account for all these different contexts, SPRING decided to conduct its analysis of DHS data separately for each country, and to present findings at the global level. Because the system affecting IFA programming is a broad one, including both supply- and demand-side constraints, the results of the analysis have proven to be widely applicable despite these differences in country contexts.
Country-level analysis provides the detail and context that local program implementers and policymakers need, while the global comparisons of data allow for better understanding of how IFA supplementation programs are being implemented across these different contexts. A unique output of the combined data analysis is the identification of clusters of similar countries. By comparing performance at key points of the IFA supplementation system, SPRING was able to group together countries facing similar problems (or having similar successes) and share that information with the countries.
Sharing this work through the presentation at this year’s APHA Conference is the first step in beginning a global discussion around these programs and options for their improvement. Publication of the country briefs, which will soon be shared on the SPRING website, allow for this global thought to be translated into local action.
The Strengthening Partnerships, Results, and Innovations in Nutrition Globally Project (SPRING) focuses on the prevention of stunting and maternal and child anemia in the first 1,000 days window. By providing state-of-the-art technical support, SPRING aims to strengthen country efforts to scale up high-impact nutrition practices and policies to improve maternal and child nutrition outcomes.
SPRING is funded by USAID under a five-year cooperative agreement. SPRING’s experienced implementation team consists of experts from JSI Research and Training Institute, Inc., Helen Keller International, The International Food Policy Research Institute, Save the Children, and The Manoff Group.
Special thanks to Jack Fiedler, Hana Nekatebeb, Celeste Sununtnasuk, Alexis Strader, Manisha Tharaney, and Tim Williams