Understanding Behavioral Drivers of Iron and Folic Acid Supplementation and Vitamin A- and Iron-Rich Food Consumption among Women and Adolescent Girls in Niger.

Objective: This study examined drivers and barriers to iron and folic acid (IFA) supplementation and consumption of iron- and vitamin A-rich foods among women of reproductive age (WRA) and adolescent girls in Niger.

Design: This was an exploratory qualitative study using focus group discussions and semi-structured interviews.

Setting: This study was conducted in the rural areas of three districts in Maradi and Zinder regions of southern Niger.

Participants: The study included a purposive sample of 56 WRA (15-49 years), 34 non-pregnant adolescent girls (10-14 years), 105 family members and community leaders, 32 health workers, and 12 national and regional level stakeholders.

Results: Respondents demonstrated widespread knowledge of recommendations for IFA during pregnancy and had positive attitudes toward supplements. However, supply barriers were significant, and adherence was limited by side effects, among other constraints. Despite knowledge about and positive attitudes towards micronutrient source foods, respondents reported that limited food access was an overriding constraint to increasing consumption. WRA were seen as nutritionally vulnerable, however husbands were often not able to provide sufficient nutritious food and there was a cultural expectation that wives serve themselves food last. Adolescent girls were not seen as nutritionally vulnerable and there was little family support for their consumption of nutritious foods.

Conclusions: Projects should work with local actors to develop multi-pronged solutions that address supply and access barriers for IFA and micronutrient-rich foods and to improve social support for nutrition.