Public Health Nutrition

Biological and behavioural determinants

Determinants of compliance to antenatal micronutrient supplementation and women’s perceptions of supplement use in rural Nepal

Bharati Kulkarnia1, Parul Christiana2 c1, Steven C LeClerqa2 and Subarna K Khatrya3

a1 National Institute of Nutrition, Hyderabad, India

a2 Department of International Health, Center for Human Nutrition, Bloomberg School of Public Health, 615 N. Wolfe Street – W2041, Baltimore, MD 21205, USA

a3 Nepal Nutrition Intervention Project, Sarlahi, Kathmandu, Nepal


Objective We examined factors affecting compliance to antenatal micronutrient supplementation and women’s perceptions of supplement use.

Design Randomized controlled supplementation trial of four alternative combinations of micronutrients given during pregnancy through to 3 months postpartum. Women were visited twice weekly to monitor compliance and to replenish tablets by female study workers. At 6 weeks postpartum women with live births (n 4096) were interviewed regarding their perceptions of the supplement. Median compliance calculated as percentage of total eligible doses received by women was high (84 %).

Setting Rural southern Nepal.

Subjects Pregnant women.

Results Women with high compliance (above the median of 84 %) were likely to be older, less educated, poorer, undernourished, belong to lower caste and of Pahadi (hill) ethnicity compared with women with low compliance (at or below the median of 84 %). Smoking and drinking alcohol in the past week during pregnancy were strongly associated with low compliance. The major reason for irregular intake was forgetting to take supplements. A higher proportion of the high compliers liked taking the supplements but only half of them were willing to purchase them in the future. A large proportion of women (91 %) perceived a benefit from taking the supplement such as improved strength and health, whereas only about 10 % perceived any side-effects which were not a major barrier to compliance.

Conclusions The present analysis highlights that poor, undernourished, uneducated women can have high compliance to antenatal supplementation if they are supplied with the tablets and reminded to take them regularly, and counselled about side-effects.

(Received September 03 2008)

(Accepted February 26 2009)

(Online publication May 19 2009)


c1 Corresponding author: Email