The risk that a woman in a low-resource country will die of PE/E and related life-threatening convulsions is approximately 300 times greater than that for a woman in a high-resource country. Moreover, the disorder is difficult to identify in low-income settings because it requires detection of high blood pressure and protein in the urine--tests that are not always available. Prevention of PE/E would be ideal and, based on studies in a number of different low-resource countries, WHO now recommends that pregnant women take 1.5-2.0 grams of calcium daily to prevent PE/E where dietary intake of calcium is limited.
It is estimated that by giving women calcium with their daily iron-folic acid (IFA) supplement, also recommended by WHO, nearly 30% of maternal deaths from obstetric complications could be averted. The cost of calcium and iron, when compared with treating PE/E, is inexpensive (US $0.10-0.15 per day), and it is possible to deliver these interventions through antenatal care (ANC) contacts in countries where coverage of ANC is early and frequent. In countries where ANC coverage is still limited, community-based distribution by community workers or private sector shops hold promise for increasing the coverage of these life-saving interventions.
While cost and delivery are part of the programmatic equation, demand-side issues are also important to ensure an effective program leading to reductions in maternal mortality. The only recommendation that WHO gives about how women should take calcium is that they should take calcium and IFA at different times of day. The critical questions that have not yet been answered include:
What are women’s perceptions about PE/E and taking calcium to prevent PE/E?
What messages are needed to explain to women why taking both calcium and IFA are important for their health and why they should take the full course of recommended supplements?
Will women take three supplements of calcium every day during pregnancy?
Will women take calcium and IFA at different times of day to maximize the absorption of both?
To discuss both demand and supply-side issues related to calcium and IFA supplementation--two life-saving interventions for ANC--MCHIP and its partners are holding a Nutrition Meeting on 3 May 2012 in Dhaka, Bangladesh for the Asia and Middle East region. This meeting will proceed the MCHIP and partners three-day meeting on postpartum hemorrhage, PE/E and newborn care from 4-6 May 2012. (Click here for more information on these meetings, including registration.)
Thank you for your continued interest in the MCHIP Program -- and happy National Nutrition Month!
Rae Galloway, MCHIP Technical Lead in Nutrition
Justine Kavle, MCHIP Senior Program Officer, Nutrition