Determinants and Inequalities of Adherence to Iron-Folic Acid Supplementationduring Pregnancy in Indonesia

Bunga A  Paramashanti; Esti  Nugraheny; Suparmi Suparmi; Tin  Afifah; Wahyu Pudji  Nugraheni; Yuni Purwatiningsih; Oktarina Oktarina; Muhammad Agus  Mikrajab; Effatul  Afifah; Yhona  Paratmanitya

doi:10.26911/ICPH10/Maternal/2023.30

Authors

	Bunga A Paramashanti Research Center for Public Health and Nutrition, National Research and Innovation Agency (BRIN), Jakarta, Indonesia. ~ Author
	Esti Nugraheny Research Center for Public Health and Nutrition, National Research and Innovation Agency (BRIN), Jakarta, Indonesia ~ Author
	Suparmi Suparmi Research Center for Public Health and Nutrition, National Research and Innovation Agency (BRIN), Jakarta, Indonesia ~ Author
	Tin Afifah Research Center for Public Health and Nutrition, National Research and Innovation Agency (BRIN), Jakarta, Indonesia ~ Author
	Wahyu Pudji Nugraheni Research Center for Public Health and Nutrition, National Research and Innovation Agency (BRIN), Jakarta, Indonesia ~ Author
	Yuni Purwatiningsih Research Center for Public Health and Nutrition, National Research and Innovation Agency (BRIN), Jakarta, Indonesia ~ Author
	Oktarina Oktarina Research Center for Public Health and Nutrition, National Research and Innovation Agency (BRIN), Jakarta, Indonesia ~ Author
	Muhammad Agus Mikrajab Research Center for Public Health and Nutrition, National Research and Innovation Agency (BRIN), Jakarta, Indonesia ~ Author
	Effatul Afifah Alma Ata Graduate School of Public Health, Universitas Alma Ata, Yogyakarta, Indonesia ~ Author
	Yhona Paratmanitya Department of Nutrition, Faculty of Health Sciences, Universitas Alma Ata, Yogyakarta, Indonesia ~ Author

Abstract

Background: Anemia in pregnancy remains a public health issue globally and in Indonesia. Low adherence to iron-folic acid supplementation has been associated with anemia among pregnant women. This study aimed to determine the determinants and inequalities of adherence to antenatal iron-folic acid supplementation in Indonesia.

Subjects and Methods: This was a cross-sectional study using secondary data from the Indonesia Demographic and Health Survey 2017. A total of 12,455 women were included in the study. The dependent variable was adherence to iron-folic acid supplements for at least 90 days. The independent variables were women, household, healthcare, and community levels. Data were analyzed by multiple logistic regression analysis. Concentration indices and concentration curves were used to estimate educational and wealth-related inequalities.

Results: Approximately half of women took iron-folic acid supplements for a minimum of 90 days. Older women (aOR= 1.01; 95% CI: 1.00 to 1.02; p= 0.009), internet access (aOR= 1.33; 95% CI: 1.17 to 1.50; p<0.001), antenatal care visits (aOR= 3.80; 95% CI: 2.95 to 4.88; p<0.001), and residing in Java and Bali (aOR= 1.66; 95% CI: 1.35 to 2.04; p<0.001) were significantly associated with iron-folic acid supplementation adherence. Concentration indices by the women’s education (CI=0.10; p<0.001) and household wealth (CI=0.13 (p<0.001) respectively indicated pro-educated and pro-rich disparities.

Conclusion: Adherence to iron-folic acid supplementation was associated with factors at women, household, healthcare, and community levels. while there are also socioeconomic inequalities. There is an urgent need to design nutrition-specific and sensitive interventions to reduce maternal anemia by targeting women and their families, especially those with poor socioeconomic backgrounds.