AbstractBackground The World Health Organization (WHO) recommends daily iron and folic acid (IFA) supplementation during pregnancy to prevent maternal anaemia and adverse birth outcomes such as preterm birth. However, uptake of IFA has varied substantially in low- and middle-income countries due to issues regarding supply, knowledge, access to health services, and acceptability. In Botswana, nearly one-third of pregnant women do not receive IFA. Methods We conducted qualitative interviews with two key stakeholder groups at two different levels – the individual level (pregnant women) and the service delivery level (health care providers). Here we present results from 16 interviews with health care providers at two representative antenatal clinic sites in Botswana in 2022 – 8 nurse/midwives, 4 pharmacists, 2 dieticians, and 2 Ministry of Health sexual and reproductive health officials. Results Health care providers were knowledgeable about the benefits of IFA supplementation and prescribed supplements when available. Several key barriers were identified: lack of availability of supplements due to frequent and long-lasting stock-outs, late antenatal care registration, non-adherence and side effects, costs, and cultural and traditional beliefs. Health care providers indicated that foods rich in IFA were available and that fortification of staple foods with IFA would be feasible and acceptable. Conclusion Our study identified an urgent need to increase the availability of IFA supplementation at antenatal clinics, with the ultimate goal of improving maternal and infant outcomes. In addition, addressing patient concerns around side effects and providing foods fortified with IFA to pregnant women could improve maternal and infant health.
Moeng et al. (Sun,) studied this question.