Individual and Structural Environmental Influences on Utilization of Iron and Folic Acid Supplementation among Pregnant Women in Harare, Zimbabwe

Abstract

ObjectiveThe Ministry of Health and Child Care of Zimbabwe established a national policy for the prevention of maternal micronutrient deficiencies that centers on pregnant women receiving daily iron and folic acid (IFA) supplements at their first antenatal care visit and throughout pregnancy. Despite these efforts, utilization of IFA supplementation during pregnancy in Zimbabwe is low and no qualitative data existed to explain these low utilization rates. This study aimed to bridge this knowledge gap by investigating the experiences with and knowledge about IFA supplementation of pregnant women and healthcare workers in Harare, Zimbabwe, the health‐service and social environment in which IFA supplementation occurs, and how these influence utilization of IFA supplementation.MethodsSemi‐structured, in‐depth, qualitative interviews were conducted in both Shona and English with pregnant women (n=24) and healthcare workers (n=14) providing direct antenatal care services to pregnant women in two clinics located in two low‐income high‐density suburbs in Harare. Data were analyzed thematically using NVivo 10 software.ResultsInfluences on utilization from the perspectives of pregnant women and healthcare workers were at both the individual and structural environmental levels. Reasons for low utilization of IFA supplementation were side effects, misconceptions about IFA supplementation, limited access to nutrition information, delayed entry or non‐uptake of antenatal care services, and social norms of pregnant women for micronutrient supplementation. Utilization was enhanced by knowledge of risks and benefits of supplementation, fear of negative health complications with non‐utilization, family support, and healthcare‐provider recommendation for micronutrient supplementation.ConclusionsFuture approaches to improve maternal IFA supplementation utilization in Zimbabwe should address individual and structural environmental factors that begin before pregnancy, continue throughout pregnancy, and reach pregnant women who are currently not seeking antenatal care services. Study findings will be used to inform approaches to strengthen micronutrient supplementation utilization in order to improve the micronutrient status of pregnant women, decrease the micronutrient risk factors associated with maternal mortality, and improve overall maternal and child health in Zimbabwe.Support or Funding InformationThis study was supported by a SPARC Graduate Fellowship from the Office of the Vice President for Research at the University of South Carolina.