Abstract
Background: More than half of women of reproductive age in India are anemic. Anemia is associated with increased risk of preterm delivery, higher maternal mortality and contributes to fatigue, which affects women's work productivity. The World Health Organization (WHO) recommends daily oral iron and folic acid (IFA) supplements during pregnancy and weekly supplements for women of reproductive age. Government programs and global donors have distributed and promoted IFA supplements in India for over four decades. However, initial intake and compliance remain inadequate. Objectives: This protocol describes the formative research phase of a larger study, called the Reduction in Anemia through Normative Innovations (RANI) Project, which will test, through a randomized controlled trial, the hypothesis that a social norms-based behavioral intervention in Odisha, India will improve uptake of IFA supplements and reduce anemia among reproductive age women as compared to usual care. The focus of this paper is on the formative research required to develop a sound intervention. We will examine socio-normative barriers to and facilitators of IFA supplement uptake. Methods and analysis: Based on the Theory of Normative Social Behavior, we will adopt a mixed-method,multilevel approach. We will collect data using focus groups, in-depth interviews, observations, Rapid Participatory Ethnographic Evaluation and Research (PEER) techniques, and perceptual mapping methods. Our sample includes reproductive age women (pregnant and not pregnant), their husbands, their mothers/in law and key stakeholders. Before collecting the data, and after analyzing the results, we will hold convenings in India to engage key stakeholders in collaborative design. Following the intervention design, we will test components of the intervention, gather user feedback and fine-tune as necessary. Impact: This study will contribute to the social norms and behavioral intervention research and inform policymakers about the value of adopting a socio-normative approach.
Highlights
Anemia is a condition where the number of red blood cells and their oxygen carrying capacity is insufficient to meet the body’s physiological needs[1]
While young children and pregnant women have the highest rates of anemia, non-pregnant women make up the greatest number of individuals with anemia[3]
Anemia can lead to poor physical capacity and performance, influencing work productivity as well as increasing risk of preterm delivery and higher maternal mortality[2,4]
Summary
Anemia is a condition where the number of red blood cells and their oxygen carrying capacity is insufficient to meet the body’s physiological needs[1]. By the end of the formative assessment period, we will have designed, adaptively tested, and refined an intervention that can be feasibly and effectively implemented to reduce iron-deficiency anemia among women of reproductive age and pregnant women in Odisha, India. To achieve this goal, the formative assessment has the following aims: 1. Preliminary Schedule of Focus Group Discussions (FGDs) and In-depth Interviews (IDIs)
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