Tackling Anaemia by Tracking Progress

Problem

Anaemia is a pervasive condition impacting s/o women (15-49 years of age) in India as per National Family and Health Survey-4 (2015-16). Anaemia has several negative effects especially during pregnancy including premature delivery, low birth weight, and leads to leading to maternal mortality. Iron deficiency anaemia is the most prevalent form of anaemia caused by a lack of iron in blood. One effective way to tackle Iron- deficiency anaemia is through a seemingly simple behaviour: pregnant women take an iron and Folic Acid (IFA) supplement every day. However, three factors contribute to women not adopting this behaviour: forgetfulness to take the pill, lack of awareness about the ill-effects of anaemia on their and their child's health, and management of side effects from taking the pills.

Conventional Solution

Auxiliary Nurse Midwives (ANis), ASH As, and AWWs are responsible for counselling pregnant women to take the IFA pills everyday for the stipulated time period. However, unless the pill is taken every day, it is not effective. Women are unable to form this habit and this behavioural barrier needs to be addressed.

Behavioural Insights Based Solution

Understanding this, the anaemia behaviour change programme was launched to lab- test common barriers to uptake and adherence of IFA pills. The lab test identified two interventions - goal tracker and a counselling card job aid for FLWs - that showed promising results. Following the lab test, a larger field-based study was conducted. A calendar, which is used as a goal tracking device, addresses the behavioural barrier of forgetfulness by placing beautiful calendars within the households of pregnant women and creating an enabling environment to track adherence. These calendars have six sheets with 30 scratchable surface blocks on each sheet. Every time a woman looks at the calendar, she is reminded to take the pill. When she takes the pill, she scratches a block on her calendar to reveal an image of a happy and healthy baby. As the month progresses, she scratches all 30 marks to reveal 30 happy baby faces, reminding her that she is getting closer to her goal of bringing a healthy and happy baby into the world.

Lesson

The calendar is an interactive goal tracking device that triggers users towards a habit formation exercise, thereby increasing the probability of adherence. Results from the field show that the calendar improved adherence.

"When I'm cooking, cleaning or sleeping, when I look at the calendar, I remember to eat the iron tablet. Once I eat it, I scratch off the date and see the picture of the baby, which keeps me motivated."- Rekha, resident of Rangai Village, Madhya Pradesh

Source : Stories of Change from India's Aspirational districts - NITI Aayog publication