Designing and implementing a maternal iron deficiency and anaemia control strategy in India using a social norms approach and a Self Help Group (SHGs) platform.

Anemia is a major health concern in Odisha, India where approximately half of women of reproductive age (WRA) are anemic. One of the primary recommendations made by the World Health Organization (WHO) for WRA in India is daily oral iron and folic acid (IFA) supplementation during pregnancy and postpartum period together with uptake of deworming medicines and anti-malarial medicines where appropriate. However, both initial supplement intake and compliance remain inadequate. Some of the primary barriers include: lack of knowledge about the cause of anemia and its health consequences, lack of information from health care providers around the connection between IFA tablets and reduction in anemia, forgetfulness, myths and misperceptions around the effects of IFA tablets on a woman’s body or her fetus, and both perceived as well as experienced side effects of IFA.

We seek to promote changes in social norms, knowledge, attitudes, and behaviors of WRA and pregnant women in Odisha through a communication-based behavioral intervention that will operate in existing Self Help Groups. This is not an efficacy trial. We seek to only increase demand for IFA tablets among WRA, as per the recommendations set forth by the Government of Odisha; 239 randomly selected villages were randomized into treatment and control arms so that there are 130 villages villages exposed to the behavioral intervention and 109 that are not.

We hypothesize that exposure to the behavioral intervention will result in increases in IFA demand and utilization, and subsequently reductions in anemia. We will test this hypothesis through measuring change in hemoglobin level, IFA use, knowledge, attitudes, beliefs, and perceptions in approximately 2,061 randomly selected pregnant and non-pregnant WRA that reside in the intervention arm and 2,049 randomly selected WRA that reside in the control arm. A small sub-cohort of non-pregnant women will be randomly selected from this group for further measurements of change in physical activity and cognitive functioning. Women in the treatment group who own a phone will also be randomized into a sub-study delivered through a mobile health platform. These women will either be randomized into an arm where they will receive norms-based anemia messages, violence against women bystander messages (positive control), or nothing at all (negative control).