Indonesia: Social Marketing of Iron-Folate Tablets

Through the USAID-funded Mothercare Project (1989-1999), the University of Indonesia Center for Child Survival undertook an operations research project to evaluate different ways to enhance iron-folate tablet distribution and compliance among pregnant women in Indramayu, West Java.

The Manoff Group provided on-site technical assistance to conduct formative research with the community and its traditional and formal health care providers to determine their knowledge, attitudes and behaviors regarding antenatal care, consumption of iron-folate supplements and the use of traditional birth attendants (TBAs) as distributors of the tablets. Based on the research, The Manoff Group worked closely with the University of Indonesia to design and implement a social marketing program to:
  • Use traditional birth attendants as distributors of iron-folate tablets in one area of the district
  • Raise awareness among pregnant women about the importance of taking iron-folate supplements
  • Promote the distribution of information by TBAs and the formal health sector regarding iron-folate tablets and how to overcome the common side effects.

Formative research

Formative, qualitative research (in-depth interviews) was conducted with pregnant women, their husbands and elder female family members, their TBAs and midwives and doctors from the formal health sector to determine:
  • Information about pregnant women's understanding and use of iron-folate tablets
  • Acceptability by pregnant women and TBAs of having TBAs distribute iron-folate tablets
  • Appropriate channels of communication to distribute information and messages about the importance of iron-folate tablets, how to consume them and where to get them.
During household trials, pregnant women took iron tablets for two weeks. This helped women's willingness and ability to take daily iron tablets and how to best overcome resistances to taking them.

Strategy formulation and development

Based on the formative research results, the Manoff Group worked with the University of Indonesia to establish project objectives. A multimedia plan was developed with the University and a local advertising firm to promote iron-folate tablets among various target audiences. Messages were designed based on the research findings and from results of pretests of the media.

A community-based character, "Ibu Sehart," who appeared in the print and radio materials, helped ensure continuity among the various media messages.

Implementation and monitoring

The multi-media program was launched with district and local health officials and community leaders. Traditional and modern health care providers were trained in the use of the counseling materials. Their training provided a forum to distribute the print materials. The radio spots were then aired.

Monitoring activities included field observations, in-depth interviews and data from an operations research survey being done among pregnant women at intermittent times during and after their pregnancy—antenatal and postnatal. Initial observations revealed important programmatic issues that were addressed:
  • There was concern among women about discoloration and crumbling of the iron tablets, so plastic storage bottles were provided.
  • Midwives were not using the counseling cards. Additional training on counseling was provided to the midwives and the flipcharts were disassembled and posted on the clinic walls, so they were more of a reference.