Abstract
BACKGROUND: Calcium supplementation is an essential intervention to prevent hypertensive disorders in pregnancy. During lactation, it can help in improving maternal bone mineral content and breast milk concentration. In 2014, India introduced Calcium supplementation in public programmes for pregnant women and lactating mothers. It relied on the same delivery mechanism as used for maternal Iron and Folic Acid (IFA) supplementation. After close to a decade, there is a need to assess the coverage achieved and the adherence to regular consumption of Calcium. METHODS: The assessment covered availability, awareness and consumption of Calcium and IFA tablets. A household survey was conducted in rural areas of Chhattisgarh state, interviewing pregnant women in second or third trimester and lactating mothers within 6-months post-partum period. A state-representative sample of 711 pregnant women and 668 lactating mothers was covered. In addition, 157 Auxiliary Nurse cum Midwives (ANMs) were interviewed as they are the key providers of maternal care in India. RESULTS: Around 59.1% of pregnant women and 31.4% of lactating mothers had consumed Calcium the preceding day while 66.7% and 37.9% respectively had Calcium tablets available with them. In comparison, the availability of IFA was better and so was the consumption. The ANMs had received inadequate quantity of Calcium tablets from the health system. Only 11.8% of pregnant women and 8.7% of lactating mothers had consumed the recommended full dosage (two tablets of 500 milligrams each per day) and it closely reflected their awareness level. Two-third of the ANMs believed that a single tablet was the recommended daily dosage of Calcium. The knowledge on correct dosage for Calcium was missing irrespective of the type of health provider or facility accessed. CONCLUSION: Calcium supplementation in pregnancy has made significant progress in rural Chhattisgarh. To improve adherence further, efforts on ensuring availability of Calcium will be more fruitful than mainly focusing on maternal behavioral change. Overall post-partum care including Calcium supplementation seem to be a neglected area in Indian health systems. System wide efforts that influence awareness and practices of providers will be needed to address the gap that exists in dosage of Calcium.