Optimizing Uptake and Adherence for Iron and Folic Acid supplements amongst pregnant and lactating women in Bihar, India
Partner Organisations:
Bill and Melinda Gates Foundation
CSBC
Project Concern International (PCI) India
Friday and Theo
With a population of 128 million, Bihar is India’s third most populous state, with over 85% living in rural areas. Anaemia remains a major health issue. Despite receiving 90+ IFA tablets, over 50% of pregnant women did not consume them fully, pointing to behavioral barriers.​ Among non-adherent women, the most common reasons were not feeling the need, not perceiving benefits, or being advised against it—while 12% simply forgot. ​​These ‘Feeling’, ‘Coping’, and ‘Authority’ barriers highlight the need to address both conscious and unconscious emotions influencing IFA adherence.
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The Emotional Appraisal framework was used to identify the key drivers to behavior, isolate the trigger emotions in the decision-making process and build hypotheses around
possible solutions.
Qualitative Research was conducted using a gamified approach in a workshop setting across two districts in rural Bihar with pregnant and lactating women to uncover behavioural barriers and enablers to uptake and adhere to the IFA prescription provided to them during their ANC checkups. Focus group discussions were also conducted with other stakeholders who influence this decision - ANMs, ASHA workers, Mother -in- laws, mothers, husbands etc
Co-design workshops were held with stakeholders to further understand the need and create quick prototypes. These prototypes were further developed in collaboration with our design partners. Design and behavioural learnings from the testing was shared with the design partners to be taken to the next stage.
