Trials of improved maternal health practice in rural areas of Ethiopia and Kenya explored the effectiveness of counselling women to select someone to remind them to take calcium and iron-folic acid supplements during their pregnancy. These supplements are linked to reduced maternal mortality and ill health.

The research found the approach to be low-cost and acceptable solution to the problem of forgetting to take supplements.

The study involved 50 women from the Oromia region in Ethiopia and 35 women from Kakamega County in Kenya. 42 of the 50 Ethiopian women agreed to an adherence partner, half choosing their husbands and some choosing their older children. 28 of the 35 Kenyan women agreed to an adherence partner, almost all choosing their husbands. The researchers found that the Ethiopian women had more social support generally than the Kenyan women. Women always chose family members: indeed, if they thought an adherence partner meant someone outside the family, they were less keen on the whole idea.

The research consisted of 4 visits to the woman at her home every two weeks. The researchers did not find a universally acceptable description of “adherence partner”, which is not a term they used with the women. Instead they described someone who can remind and encourage the woman to take the tablets.

Women with good support from partners reported adhering better to taking the tablets and overcoming the side-effects.

The study presents a number of illustrative quotations from women. These are interesting for the whole topic of family inclusive care, because they illustrate the variety of families and how family inclusion needs to adapt to the particular circumstances of the woman.

Asking the father of the baby, with a reference to his relationship to his child:

“I will ask my husband because this is our common concern….this baby belongs to both of us; I think he will remind me for the sake of the baby in the womb.”

Not asking a disengaged husband:

“My husband never bothers with these tablets.”

Asking a husband but not involving the rest of the family:

“I told my husband about the importance of the pills…..My in-laws don’t know anything about the pills I am taking.”

Referring to love:

“I want my husband to continue….He reminds me if I have forgotten, brings them to me, gives me heart, and when he sees I have given up, gives me morale to continue….You know if someone loves and cares, he will help remind you about something concerning your life.”

The problem of adherence partners forgetting too:

“I don’t want support…..my husband was reminding me….but he has already forgotten and has not said anything to me.”

The problem of having a husband who works long hours:

“The problem is that he works early in the morning and comes home in the evening….so, it is difficult to always get him due to the nature of his job.”

The researchers realise that the whole approach may be more effective if they could engage directly with and inform the partners, though they worry this might cost too much money to be scalable. We know from much research presented here on FamilyIncluded.com that informing partners is very important to improve effectiveness of such support – the issue is not if, but how this can be done cost effectively.

Martin SL et al. (2016), “Adherence partners” are an acceptable behaviour change strategy to support calcium and iron-folic acid supplementation among pregnant women in Ethiopia and Kenya, Maternal & Child Nutrition

Photo: Rod Waddington. Creative Commons.