Prenatal programs focus on identifying and counseling pregnant women on appropriate care and nutrition, including breast-feeding, tetanus toxoid immunization, iron/folic acid supplementation, and referral of high-risk pregnancies. Malaria chemopro-phylaxis, especially among primigravidae, and deworming need to be encouraged to prevent anemia in areas where these parasites are public health problems. The provision of postpartum vitamin A supplementation is increasing and needs to be further expanded.

Some programs provide and target supplementary food to at-risk and undernourished women. These programs are effective in increasing weight gain during pregnancy, but they have a significant beneficial effect on birth weight only in women who are genuinely at risk of an inadequate diet, such as rural African women who continue to perform difficult manual work during the hungry season. In other settings, the effect is less clear.

Despite the research evidence that iron supplementation is efficacious, this relatively simple program has not been effective in reducing the prevalence of anemia among women. Most iron/ folic acid supplement programs suffer from serious operational constraints related to supply and distribution systems, access to health care services, motivation of health care providers, and compliance. Lack of good quality, low-cost, generic iron supplements, suitable compounds and dispensing mechanisms, and potential side effects are unsolved problems that affect compliance.

Although there is little evidence that an iron supplement program works, it remains one of the few options available to improve iron status of the population, and it is the only program that has the potential to meet the high iron requirements of pregnancy. Operation research has shown that intermittent supplementation is less appropriate for pregnant women and daily iron supplementation should be continued as the intervention of choice.

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