# Healthcare Providers’ Perceptions and Experiences of Prenatal Iron and Folic Acid Supplementation—A Qualitative Study in Botswana

## TL;DR

This study explores healthcare providers' views on prenatal iron and folic acid use in Botswana, highlighting supply issues and cultural barriers.

## Contribution

The study provides insights into healthcare providers' experiences and perceptions of IFA supplementation in Botswana, identifying actionable barriers and solutions.

## Key findings

- Healthcare providers are knowledgeable about IFA benefits but face challenges like stockouts and late prenatal care.
- Cultural beliefs and side effects are significant barriers to IFA uptake among pregnant women.
- Fortifying staple foods with IFA is seen as a feasible and acceptable solution to improve maternal health.

## Abstract

The World Health Organization recommends daily iron and folic acid (IFA) supplementation during pregnancy to prevent maternal anemia 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. Objectives: To assess knowledge of IFA supplementation, supplement availability, and barriers and facilitators to preconception and antenatal supplementation in Botswana.

We conducted qualitative interviews with 2 key stakeholder groups at 2 different levels: the individual level (pregnant women) and the service delivery level (healthcare providers). In this study, we present results from 16 interviews with healthcare providers at 2 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.

Healthcare 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 stockouts, late antenatal care registration, nonadherence and side effects, costs, and cultural and traditional beliefs. Healthcare providers indicated that foods rich in IFA were available and that fortification of staple foods with IFA would be feasible and acceptable.

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.