(OR10-01-26) Acceptability and Adherence to Antenatal Calcium Supplementation Among Pregnant Women in Urban India: A Mixed-Methods Study

Sunday, July 26, 2026

10:30 AM - 10:42 AM ET

Location: Maryland Ballroom C

Presenting Author(s)

Pratibha Dwarkanath, Ph.D (she/her/hers)

Professor
St. John's Research Institute
Bangalore, Karnataka, India

Disclosure(s): No relevant financial relationship(s) with ineligible companies to disclose.

Co-Author(s)

CS

Christopher Sudfeld, Sc.D

Harvard T.H. Chan School of Public Health
Boston, Massachusetts, United States
JR

John Michael Raj, MSc

St. John's Medical College
Bangalore, Karnataka, India
SH

Sudarshan Hebbani, Ph.D

Surana College, Kengeri
Bangalore, Karnataka, India
PR

Poornima R, MSc, M.Phil

St. John's Research Institute
Bangalore, Karnataka, India
RC

Roopashree C, MSc

St. John's Research Institute
Bangalore, Karnataka, India
NN

Nancy Nanditha

St. John's Research Institute
Bangalore, Karnataka, India
NB

Nirmala Buggi, MD

Bruhat Bengaluru Mahanagara Palike, Bangalore
Banglore, Karnataka, India
SR

Shobha Rani, M.D

Bruhat Bengaluru Mahanagar Palike, Bangalore
Bangalore, Karnataka, India
TT

Tinku Thomas, Ph.D

St. John's Medical College
Bangalore, Karnataka, India
AK

Anura V. Kurpad, Prof, MBBS, PhD

Professor
St. John’s Medical College
Bangalore, Karnataka, India
WF

Wafaie W. Fawzi, MBBS. DrPH (he/him/his)

Professor
Harvard T.H. Chan School of Public Health
Boston, Massachusetts, United States

Disclosure(s):

Pratibha Dwarkanath, Ph.D: No relevant financial relationship(s) with ineligible companies to disclose.

Wafaie W. Fawzi, MBBS. DrPH: No relevant financial relationship(s) with ineligible companies to disclose.

Objectives: Hypertensive disorders of pregnancy cause 10-15% of maternal deaths globally. Calcium-supplementation can prevent preeclampsia in low- and middle-income countries with low dietary calcium intake, but data on acceptability and adherence to high-dose supplementation (≥1000 mg/d) in public health programs is limited.

Methods: An open-label prospective study of daily calcium supplementation (1000 mg/day) was conducted among 275 pregnant women enrolled at ≤20 weeks of gestation during routine antenatal care (ANC) visits in urban Bangalore, India, and followed until delivery. A mixed-methods approach was used to evaluate the acceptability and adherence to routine antenatal calcium supplementation as per Indian National guidelines among pregnant women and healthcare providers. Qualitative data was obtained through focus group discussions (FGDs) to identify individual, familial, and health-system factors influencing adherence and perceived facilitators and barriers towards supplementation program. Logistic regression analysis examined factors associated with low adherence ( < 75%).

Results: After the first month of taking calcium, post recruitment, 13.4% reported to have disliked the calcium supplement and this decreased to 7.9% in third trimester. Overall, 157 (57.3%) had ≥75% adherence to the calcium-supplementation regimen. Disliking calcium pills at first ANC follow-up (OR:3.5, 95%; CI:1.58–7.57) or the third trimester visit (OR:7.5, 95%; CI:2.38–23.40) was significantly associated with < 75% adherence to calcium-supplementation. FGDs in third trimester identified enablers such as self-perceived benefits, family, and healthcare worker support, while barriers included preference for private clinics (which did not provide free-calcium-supplements), the size and number of calcium tablets/day.

Conclusions: Achieving high adherence to calcium-supplementation was challenging during pregnancy. Interventions and strategies supporting pregnant women, strengthening counseling, engaging family support and healthcare systems, should be assessed to enhance the effective implementation of antenatal calcium supplementation programs.

Funding Sources: Bill & Melinda Gates Foundation