Assessing the distribution of iron folic-acid tablets through antenatal care: A comparative analysis using DHS data

Purpose: Supplementation of iron-folic acid (IFA) during antenatal care (ANC) has existed for decades but often has low coverage and few women consume the recommended 180 tablets. USAID's SPRING Project has developed an Assessment method that, through analysis of Demographic and Health Survey (DHS) data, illustrates pregnant women's access to and consumption of IFA tablets through ANC. Methods: This tool assesses performance at four points (ANC attendance, IFA received, any IFA taken, and compliance with WHO standards) to understand how well ANC functions as an IFA supplementation platform. This assessment allows policy-makers to identify and rank bottlenecks to scaling-up IFA supplementation. SPRING performed this analysis on 23 countries, highlighting patterns for improved planning. Results: Across all 23 countries, 85% of women attended at least one ANC, 80% of these women received IFA, of which 93% consumed at least one tablet, but only 13% of these women take all 180 tablets. Further analysis reveals patterns with varying levels of ANC coverage, IFA provision during ANC, women taking tablets, and women consuming the recommended 180 tablets. For example, DRC and Haiti perform well on the first point but not the second, while Liberia and Cambodia performed well on all but the last. Policy Implications: Identifying and prioritizing these problem areas is a practical first step. Each performance pattern requires a different approach to improving IFA supplementation through ANC. Usually improvements will depend on identifying and addressing shortcomings in access to ANC, IFA supply management, health workers' practices, and compliance of pregnant women.