Acceptability and Utilization of Three Nutritional Supplements during Pregnancy: Findings from a Longitudinal, Mixed-Methods Study in Niger

Abstract

Nutritional status in pregnancy is a key determinant of birth outcomes. In low-income countries, maternal diets are often limited, and daily nutrient supplements are recommended to fill nutrient gaps. As a result, it is important to understand the factors influencing acceptability and utilization of nutrient supplements in these settings. Qualitative data (individual interviews and focus group discussions with pregnant women, household members, and study staff) and quantitative data (unannounced household spot checks) were collected in 24 villages in the Maradi region of south-central Niger. Each village was randomly assigned to one of three study arms, with pregnant women receiving either iron and folic acid (IFA) supplements, multiple micronutrient (MMN) supplements, or medium-quantity lipid-based nutrient supplements (MQ-LNS) for daily consumption during pregnancy. Data were collected longitudinally to capture changes in perspective as women progressed through their pregnancy. Participants accepted all three supplement types, and perceived a wide range of health benefits attributed to supplement consumption. However, several important barriers to appropriate consumption were reported, and rumors about the supplements leading to childbirth complications also decreased utilization. The household spot checks suggested that IFA had the highest level of correct consumption. Overall, despite a stated high level of acceptance and enthusiasm for the supplements among participants and their household members, certain fears, side effects, and organoleptic factors led to decreased utilization. The effectiveness of future programs to improve maternal nutritional status through supplementation may be improved by understanding perceived barriers and facilitating factors among participants and tailoring communication efforts appropriately.

Keywords: Niger; diet; maternal nutrition; pregnancy outcomes; prenatal supplement; qualitative methods.

Figure 1

Spot check measure of supplement adherence by study arm and data collection phase: (a) IFA, (b) MMN, (c) MQ-LNS. Note: Correct supplement consumption is defined as having within +/− 2 days’ supply of the expected number of supplements on hand at the time of the spot check.

Figure 1

Spot check measure of supplement adherence by study arm and data collection phase: (a) IFA, (b) MMN, (c) MQ-LNS. Note: Correct supplement consumption is defined as having within +/− 2 days’ supply of the expected number of supplements on hand at the time of the spot check.