Background: Economic and gender inequalities are important determinants of anemia in low and middle income countries. Gender dimensions of food security contribute to the undernutrition among women. More than half of women of reproductive age in India are anemic. Anemia causes increased risk of preterm delivery, higher maternal mortality and contributes to fatigue, which influences women’s work productivity. The World Health Organization (WHO) recommends daily oral iron and folic acid (IFA) supplements during pregnancy and weekly supplements for women of reproductive age. Despite the efforts of government programs and global donors to reduce anemia in India, both initial uptake and compliance of IFA remain inadequate. Innovative, multi-level, theory-based methods are urgently needed to address the problem.
Objective: This study will design and test the hypothesis that a social norms-based intervention in Odisha, India will promote changes in social norms, knowledge, attitudes, and behaviors of women of reproductive age and pregnant women.
Methods and Analysis: Based on the Theory of Normative Social Behavior (TNSB), we will use a mixed-method approach that uses both qualitative and quantitative techniques. For our formative research, focus group discussions, in depth interviews, observations, and perceptual mapping techniques will be adopted. Our study sample will include reproductive age women (both pregnant and not pregnant), their husbands, their mothers/in-laws, women’s self-help group leaders, local health officials, and health care providers. The formative research will examine the barriers, facilitators, attitudes and availability of IFA supplements. After analyzing the results, we will hold a convening in India with stakeholders, participants, interventionists, and researchers to collaboratively design the intervention. Following the intervention design, we will test various components of the intervention, gather user feedback and make edits as necessary. Additionally, to improve adoption and sustainability of the intervention, we will conduct ongoing policy dialogue with key stakeholders throughout the formative research
