Role of family support and women's knowledge on pregnancy-related risks in adherence to maternal iron-folic acid supplementation in Indonesia

Objective: To examine whether women's knowledge of pregnancy-related risks and family support received during pregnancy are associated with adherence to maternal iron-folic acid (IFA) supplementation. Design: Secondary data analysis of the 2002-03, 2007 and 2012 Indonesia Demographic and Health Survey. Analysis of the association between factors associated with adherence (consuming >= 90 IFA tablets), including the women's knowledge and family support, was performed using multivariate logistic regression. Setting: National household survey. Subjects: Women (n 19 133) who had given birth within 2 years prior to the interview date. Results: Knowledge of pregnancy-related risks was associated with increased adherence to IFA supplementation (adjusted OR=1.8; 95% CI 1.6, 2.0), as was full family (particularly husband's) support (adjusted OR= 1.9; 95% CI 1.6, 2.3). Adequate antenatal care (ANC) visits (i.e. four or more) was associated with increased adherence (adjusted OR= 2.2; 95% CI 2.0, 2.4). However, ANC providers missed opportunities to distribute tablets and information, as among women with adequate ANC visits, 15% reported never having received/bought any IFA tablets and 30% had no knowledge of pregnancy-related risks. A significant interaction was observed between family support and the women's educational level in predicting adherence. Family support significantly increased the adherence among women with <9 years of education. Conclusions: Improving women's knowledge of pregnancy-related risks and involving family members, particularly the husband and importantly for less-educated women, improved adherence to IFA supplementation. ANC visit opportunities must be optimized to provide women with sufficient numbers of IFA tablets along with health information (especially on pregnancy-related risks) and partner support counselling.