title: Determinants of Persistent Anemia in Poor, Urban Pregnant Women of Chandigarh City, North India: A Mixed Method Approach.
abstract: Maternal anemia continues to be a public health problem in India, despite existence of multipronged governmental programs to combat it.
  
  
  
  This study explores the determinants of persistent anemia in poor pregnant women in an urban population in Chandigarh, India.
  
  
  
  A mixed method approach was used to examine the causes of maternal anemia. Three focus group discussions with pregnant women from different socioeconomic groups and 2 with female health workers were conducted to explore their perceptions and beliefs about maternal anemia and iron folic acid (IFA) tablets in urban settings in 2009. This was followed by interviews of 120 pregnant women about their nutrition knowledge and practices. Food frequency questionnaires were used to estimate daily consumption of nutrients. Finally, a follow-up survey in health clinics explored issues of stock-outs of IFA.
  
  
  
  Sixty-five percent of respondents had hemoglobin less than 11g/dL and were anemic. Only 35% respondents obtained free IFA through public health programs. While 53% of respondents knew that they should eat green leafy vegetables, only 8% reported daily consumption of these vegetables. Focus group discussions highlighted issues around lack of food, especially for slum women, and low decision-making power in the household. Stock-outs of IFA in facilities often pushed women to purchase IFA from chemist shops.
  
  
  
  Clear gaps emerged in pregnant women's knowledge and practice regarding diet and IFA tablet use. Lack of control over decision-making due to their low status of women was also hindering IFA use and healthy eating.
authors.affiliation: Global Health Group, University of California-San Francisco, San Francisco, CA, USA nadia.diamond-smith@ucsf.edu.
authors.forename: Nadia G
authors.initials: NG
authors.lastname: Diamond-Smith
authors.affiliation: Post Graduate Institute of Medical Education & Research (PGIMER), School of Public Health, Chandigarh, India.
authors.forename: Madhu
authors.initials: M
authors.lastname: Gupta
authors.affiliation: Post Graduate Institute of Medical Education & Research (PGIMER), School of Public Health, Chandigarh, India.
authors.forename: Manmeet
authors.initials: M
authors.lastname: Kaur
authors.affiliation: Post Graduate Institute of Medical Education & Research (PGIMER), School of Public Health, Chandigarh, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Kumar
mesh_terms: D000328:Adult; D000740:Anemia / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D017144:Focus Groups; D006801:Humans; D007194:India / Q000453:epidemiology; D011203:Poverty; D011247:Pregnancy; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data*; D016387:Women's Health; D055815:Young Adult
keywords: India; anemia; maternal nutrition; pregnancy health seeking behavior