To reduce the prevalence of anemia, the Indian government recommends daily iron and folic acid supplements (iron supplements) for pregnant women and weekly iron supplements for adolescents and all women of reproductive age. The government has distributed free iron supplements to adolescents and pregnant women for over four decades. However, initial uptake and adherence remain inadequate and non-pregnant women of reproductive age are largely ignored. The aim of this study is to examine the multilevel barriers to iron supplement use and to subsequently identify promising areas to intervene. We conducted a qualitative study in the state of Odisha, India. Data collection included key informant interviews, focus group discussions with women, husbands, and mothers-in-law, and direct observations in health centers, pharmacies and village health and nutrition days. We found that at the individual level, participants knew that iron supplements prevent anemia but underestimated anemia prevalence and risk in their community. Participants also believed that taking too many iron supplements during pregnancy would “make your baby big” causing a painful birth and a costly cesarean section. At the interpersonal level, mothers-in-law were not supportive of their daughters-in-law taking regular iron supplements during pregnancy but husbands were more supportive. At the community level, participants reported that only pregnant women and adolescents are taking iron supplements, ignoring non-pregnant women altogether. Unequal gender norms are also an upstream barrier for non-pregnant women to prioritize their health to obtain iron supplements. At the policy level, frontline health workers distribute iron supplements to pregnant women only and do not follow up on adherence. Interventions should address multiple barriers to iron supplement use along the socio-ecological model. They should also be tailored to a woman’s reproductive life course stage: adolescents, pregnancy, and non-pregnant women of reproductive age because social norms and available services differ between the subpopulations.

中文翻译：

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超越个人障碍并确定降低奥里萨邦贫血的多层次战略。

为了降低贫血的患病率，印度政府建议孕妇每天补充铁和叶酸（铁补充剂），青少年和所有育龄妇女每周补充铁剂。政府已经为青少年和孕妇免费分发了铁补充剂已有40多年了。但是，最初的摄取和依从性仍然不足，未怀孕的育龄妇女在很大程度上被忽略了。这项研究的目的是检查铁补充剂使用的多层次障碍，并随后确定有希望干预的领域。我们在印度奥里萨邦进行了定性研究。数据收集包括主要的信息提供者访谈，与妇女，丈夫和婆婆的焦点小组讨论以及在卫生中心的直接观察，药房和乡村健康与营养日。我们发现，在个人层面上，参与者知道铁补充剂可预防贫血，但低估了其社区中的贫血患病率和风险。参与者还认为，怀孕期间服用过多的铁补充剂将“使您的宝宝​​变大”，从而导致痛苦的分娩和昂贵的剖宫产。在人际关系方面，岳母不支持their妇在怀孕期间定期补充铁剂，而丈夫则更为支持。在社区一级，参与者报告说，只有孕妇和青少年正在服用铁补充剂，而完全忽略了未怀孕的妇女。性别规范不平等也是未怀孕妇女优先考虑其健康状况以获取铁补充剂的上游障碍。在政策层面，前线卫生工作者仅向孕妇分发铁补充剂，并且不遵循依从性。干预措施应解决沿社会生态模型使用铁补充剂的多个障碍。它们还应针对妇女的生殖生活过程阶段进行调整：青春期，怀孕和育龄的非怀孕妇女，因为不同人群之间的社会规范和可获得的服务有所不同。