'This is normal during pregnancy': a qualitative study of anaemia-related perceptions and practices among pregnant women in Mumbai, India.

OBJECTIVES: to explore anaemia-related perceptions and practices among pregnant women in Mumbai, India.
DESIGN: descriptive qualitative study using in-depth interviews and focus group discussions.
SETTING: three government-run maternity hospitals in Mumbai, India. PARTICIPANTS: 31 pregnant women aged 18-33 years; three women completed higher secondary school; 28 were homemakers.
FINDINGS: respondents described anaemia as 'lack of blood in the body' because that was the term used by health providers; yet they did not seem worried about the consequence on their own health. Women perceived anaemia as 'normal during pregnancy' because their body had to simply share resources with the fetus and every female relative had suffered from it during pregnancy. Respondents did recognise weakness and dizziness as symptoms of anaemia. They attributed the cause to a poor diet, but did not know the specific link with iron-deficiency. They listed various negative effects of anaemia on the fetus, but very few stated ill-effects on the mother, and none stated maternal death as an outcome. Women saw their role primarily as child-bearers and prioritised newborn's health over their own. CONCLUSION AND IMPLICATIONS: anaemia stands at the intersection of health, nutrition, culture and gender. Interventions in the country have to go beyond distributing or monitoring compliance with iron-folic acid (IFA) supplements. Health education programmes for women and household members have to highlight the seriousness of anaemia and address socio-cultural norms and gendered behaviours in families with respect to nutrition and health. There is an urgent need in maternal and child health programmes to emphasise the importance of the mother's own health. Anaemia interventions have the potential to become proxies for women's health and empowerment programmes.