The Role of Husband in Assisting Wife Who Suffer Anemia in Pregnancy

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THE ROLE OF HUSBAND IN ASSISTING WIFE WHO SUFFER

ANEMIA IN PREGNANCY

Dewi Nopitasari, Bonny Priessandini

Midwifery Academy Of Wijaya Husada

ABSTRACT

Problem in anemia which is commonly suffered by pregnant women is iron deficiency due to
unbalanced nutrition. A qualitative research with Ethnomethodology approach. Participants were
pregnant women who are anemic with Hemoglobin levels (Hb) less than 11g/dl. 38 of participants
consisting of 19 husbands as focus groups and 19 wives as triangulation group obtained through
purposive sampling technique. Data obtained through the method of focus groups discussion and in-
depth interview, analyzed using descriptive analysis techniques.The result showed that the husband’s role
in assisting the wife who suffered from anemia in pregnancy is lacking due to lack of husbnd knowledge
about anemia, its causes and how to deal with anemia in pregnancy. The conclusion is the role of husband in
assisting wife in pregnancy should be supported with husband’s good knowledge about anemia, its causes
and how to deal with anemia in pregnancy in order to prevent anemia in their wives’ pregnancies.

Keywords: Role; Husband; Knowledge; Anemia; Pregnancy

women have anemia in developed country.


INTRODUCTION The prevalence of anemia in pregnant
Anemia in pregnancy will affect the women worldwide is 38%. National data
health and welfare of women. It also collection of anemia in pregnancy
increases the risk of harm for mother and showed 28% prevalence. Therefore,
children. Anemia in pregnancy is also anemia in pregnancy in West Java is
called “Potential danger of mother and considered moderate level of health
child.” Anemia contributes bad impact problem, which need to be noticed. The
for pregnancy, labor, and perpurium. The prevalence of anemia in pregnancy is
most common cause of anemia in pregnancy 16.7%. The prevalence of anemia is
is lack of balanced nutritional higher in the rural area (22%) than in the
consumption, especially iron deficiency. A urban area (19%). According to west Java
wife will be able to undergo her pregnancy Demography and Health Survey, iron
safely if the husband has the knowledge deficiency anemia is one of the most
regarding anemia, its cause, and its common nutritional problem (TLDHS
management. Their lack of knowledge 2009/10).
about anemia will affect the health of their Maternal mortality rate (AKI) is
wife, because the decision and action of the one of the indicator for illustrating the
husband will affect the life of his wife. degree of public health. According to the
The highest proportion anemia in data from RISKESDAS, in 2010, national
woman both in developed or developing maternal mortality rate was 660 death for
country occurred during pregnancy. WHO 100,000 living birth and 557 death for
reported 37-75% (50% average) of 100,000 living birth, respectively. Based on
pregnant women have anemia in these finding, West Java is predicated as one
developing country and 18% of pregnant of the country with the highest maternal

Proceeding International Seminar


“Ethics, Integrity And Management In Health Profession” (8-10 Januari 2019) 110
mortality in the world. High maternal consumed iron supplement during
mortality is caused by several factors, pregnancy increased from 43% in 2003 to
which affect pregnancy and labor itself, 61% in 2009. Nevertheless, only 16% of
either directly or indirectly. Most of the pregnant women consumed iron
cause of death are complications during supplement with appropriate recommended
and after labor. The complications are dose for 90 days as reported by National
known as Classic Triad of obstetrical Strategy on Reproductive, Maternal,
complication consisting of hemorrhage Newborn, Child and Adolecent Health
(50.2%), eclampsia, and sepsis/infection. (NSMNCAH 2015-2019).
According to SDKI Survey, indirect Pregnant women are vulnerable to
causes of maternal mortality are chronic several health problems, either health
energy deficiency (27%) and anemia problem of the diseases related to
(28%). pregnancy itself or another health problem
According to registration result of related to unbalanced nutritional intake.
kohor in 2014, pregnant women in Pasir These correspond to the role of the
Mulya (Pasir Mulya Community Health husband to maintain and increase the
Center), 676 out of 18,492 pregnant health of his pregnant wife so she could
women have anemia. Anemia according to be spared from anemia in pregnancy. This
maternal age classification: a) Age <19 year important role of the husband determined
27/507/ (5.3%); b) Age 20-34 year the health of pregnant women and reduced
632/17472/ (3.6 %); and c) Age >35 year the risk of anemia in both mother and fetus.
17/513/ (3.3 %). All 676 pregnant women The problem of this study: what
with anemia are married. Therefore, the does the husband know about anemia in
husband play an important role to pregnancy, what does the husband known
accompany and monitor the health about the cause of anemia in pregnancy,
condition of his pregnant wife. and how the husband managed anemia in
Anemia in pregnancy affect both pregnancy of his wife.
maternal and fetal health. This The general aim of ths study was
correspond to study by Rukuni (2015), to explore the role of the husband in
which found that anemia in pregnancy accompanying his wife who suffered
could increased the risk of post partum anemia in pregnancy. The specific aim of
hemorrhage, post partum infection, and this study was to describe knowledge of
stillbirth, resulting in maternal and fetal husband regarding anemia in pregnancy,
morbidity and mortality. Anemia also its cause, and its management.
increases the risk of low birth weight
(Karasahin, 2006; Labir, 2013; Kozuki, METHOD
2012; Budiono, 2013;). Anemia in This study used etnomethodological
pregnancy is one of factor that have a strong approach. Etnomethodology is a study of
correlation to Sectio Caesarea (Mulyawati et how individual create and understand
al.; 2011). their daily activities. Therefore,
The prevention of anemia have been etnomethodology studies social reality
performed by the government through the about daily interaction. This study assessed
program of iron tablet administration for the role of husbands in accompanying their
pregnant women. However, this program wife, who suffered from anemia in
had not delivered a satisfying result. The pregnancy, with the following variable:
proportion of pregnant women who husband knowledge of anemia in

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pregnancy, its cause, and its management. We conducted the study from
The participants were pregnant women January 6th 2016 until January 22nd 2018
with anemia and haemoglobin (Hb) less than in West Java, Bogor. We recruited
11gr/dL regardless of their age of pregnancy, informant homogenously. We selected the
using purposive sampling method. We group with higher risk who was native
obtained primary data from focus grup Timor-Leste husband of pregnant woman
discussion (FGD) and in-depth interview. with anemia as target of this study. This
Instrument used for this study was was intended to describe details of how
guideline of FGD, tape recorder, and husbands accompany their anemic pegnant
field notes. We analyzed the data using wife. This process used patriarchy system,
descriptive analysis. where the husband, as the leader of the
We used the following inclusion family, decided all of things related to the
criterias: health of his anemic pregnant wife.
pregnant women with anemia and
Hb less than 11 gr/dL, native Timor-Leste RESULT AND DISCUSSION
husband of pregnant woman with anemia, The average age of the informants
both husband and wife voluntarily agreed was 20-50 year, which is productive age.
to provide the information needed, and Productive means they work and look after
both husband and wife were not suffering their wife during pregnancy. Educational
from mental disorder. The exclusion criteria background of the informants varied from
were as follows: pregnant women without elementary school, junior high school,
anemia, anemic pregnant women with no high school, and college graduate. This
husband, non-native Timor- Leste was intended to understand how far
husband of anemic pregnant woman, educational background affect the
both husband and wife did not knowledge of the husband about anemia
voluntarily agree to provide information in pregnancy. We found that both husband
needed, and both husband and wife were with high and low educational background
suffering from mental disorder. have low understanding regarding anemia
There were 38 participants, in pregnancy, its cause, and its management.
consisting of 19 husbands as focus group Occupation of the informants varied
and 19 wives as triangulation group. We from merchant in the traditional market,
selected informants according to FGD driver, civil employee, private employee,
criteria and divided them to 6 groups lecturer, and 4 unemployed husbands. This
based on age of pregnant women. Pregnant was intended to understand how far
women less than 19 years of age, husbands role in taking care of their
20-34 years of age, and more than anemic pregnant wives are. We defined
35 years of age. We coded each role of husband as a particular position of
characteristic as following: A for husband the husband while accompanying his wife
of pregnant women less than in her pregnancy period, who was
19 years of age, B for husband of suffering from anemia. Anemia in
pregnant women 20-34 years of age, and C pregnancy is a risky condition for pregnant
for husband of pregnant women more than woman herself and for the fetus inside her
35 years of age. We used code from uterus. The most prevalence type of anemia
transcript note during the interaction with in pregnancy is iron deficiency anemia.
informant. Pregnant women are vulnerable to several
health problems, either health problem of

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the diseases related to pregnancy itself or during days of pregnancy, so it
another health problem related to automatically improve their health to avoid
unbalanced nutritional intake. anemia that will endanger both the mother
The knowledge of husband about and the baby inside the womb.
health is a significant factor that affects This study showed that husband
the health of the wife. This is important, role related to knowledge of anemia in
because the knowledge of the husband is a pregnancy based on each answer and
form of support for the wife during analysis result on informant that is
pregnancy. The good knowledge of husband (A1 through A6, B1 to B6 and C1
husband about health, especially about up to C7) grouped in 8 answer that is, first:
anemia, which is caused by unbalanced anemia as lack of blood (Informants A3,
nutritional intake, will make a husband A4, A5, C5 and C7), second: anemia as lack
provide enough nutrition for his wife. of nutrient (Informants B1, B4, C3 and
When the wife started to vomit, feel C4), third: anemia as lack of appetite
nauseous, and grow weak, a husband (Informants B2 and C6), fourth: anemia as
with good health knowledge would provide lack of vitamin ( informants B3 and B5),
his wife a small portion of food repetitively fifth: anemia as lack of food intake
to fulfil her nutritional need and keep her (informants A1), sixth: anemia as lack of
healthy. Knowledge of the husband will white vegetables and water intake
affect his decision and behavior. (informant A2), seventh: anemia as
The role of husbands to accompany difficulty in eating and drinking
and optimally look after their pregnant (informant B6), and eighth: could not
wife with anemia is dependent on figure out what anemia in pregnancy is.
husband knowledge regarding anemia, its Those answers showed lack of knowledge
cause and how to manage the anemia, regarding anemia in pregnancy among
especially in pregnant wife. With sufficient husbands. By definition, anemia in
knowledge, the husband could show his pregnancy is a condition in which a
optimal role that is manifested in the decrease in the number of red blood cells or
behavior or looking after his wife who hemoglobin is less than 11 g/dl, which is
suffered from anemia. The role husbands clearly different from the answer of the
play was not solely due to the anemia in informants.
their pregnant wives, but they also need to Knowledge is information that is
know anemia is a disease, that affect both known or recognized by someone.
the child in the womb, and the mother and Knowledge arises when a person uses
not complicate labor. In addition, husbands reason to recognize a thing or event that
should about the cause of anemia and has not been seen or felt before. Good
what need to be done by the husband in knowledge of the husband would affect
managing anemia in pregnancy. the awareness and involvement in looking
To fulfill the role of assisting and after the pregnancy of anemic wives
looking after their pregnant wife with manifested through improving nutrition
anemia, husband needs to prepare or food of pregnant women, maintaining
adequate knowledge and understanding. physical and mental health of the mother.
Husband as the closest person to their wife With good knowledge, husbands have a
and as a partner should accompany, improve good insight about anemia so they could
the health of their pregnant wife, and pay attention to, remind and choose the
makes them feels comfortable and happy nutrition or a balanced diet for the

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pregnant wives, in doing so contributed the causes of anemia in pregnancy was
to lowering the risk of pregnant women evident from each of the informant
with anemia. Husbands armed with good answers and according to the results of
knowledge of their wives’ pregnancy would the analysis conducted on the husband’s
control their wives’ diet, provide extra- informants, that are (A1 to A6, B1 to B6
quality food and motivate their wives’ to and C1 until With C7) grouped into 11
diligently consume nutritious foods. To answers to the cause of anemia (A1 through
support and maintain the health of the A6, B1 to B6 and C1 to C7) grouped on 11
wives during pregnancy, husbands are answers to the cause of anemia that are,
expected to have a good knowledge because first: lack of rest (informants A1, A2, A4, A5,
the pregnancy is not only a concern for C1, C2, C4, C5 and C7), second: lack of
mothers but husbands also took an drinking water (informants A2, (informants
important role in preventing trouble in A3, A4, A6 and C2), third: lack of vitamin
pregnancy. Lack of knowledge containing foods (informants A4, B1, B2,
undoubtedly affects maternal health B4 and B5), fourth: lack of nutritious food
outcomes because husbands’ decisions and (informants C4, C5 and C7), fifth: avoid
actions will affect wives’ life and morbidity. strenuous work (informants B1, B5 and
The result of the lack of husbands’ B6), sixth: lack of eating (informants C1,
knowledge about anemia in C2 and C3), seventh: the husband gives
pregnancy is strengthened by study attention (informants B2 and B3), eighth:
conducted by Purbadewi (2013), who (informants C3 and C7), ninth: lack of
found that people who have less appetite (informants C2 and C6), tenth:
knowledge about anemia, such as economic condition (informant C1),
understanding about its definition, its eleventh: too much television (informant
cause, signs and symptoms, complication, C2). These answers indicated that
as well as about health behaviors to husbands’ knowledge regarding the causes
prevent the occurrence of anemia, were of anemia in pregnancy was lacking, it was
less likely to avoid anemia in pregnancy. clear between the husbands’ answer and the
This study was also reinforced by actual cause of anemia, which is generally
Ramadani (2011), who showed higher caused by a deficiency of balanced nutrition,
anemia incidence in people with less especially iron deficiency in foods, than
knowledge level (73,1%) than those with other factors such as diseases.
good knowledge (26,9%). That husbands knowledge about
We believed that during this time cause of anemia in pregnancy was lacking,
period, husbands have not played an was reinforced by of Ekowaty (2007), who
optimal role in accompanying pregnant found that husbands have not play an
wife, and the anemia in pregnancy was optimal role in maintaining nutritional
caused by husbands’ lack of knowledge status of pregnant mother. Our
about anemia in pregnancy, so husband interview and observation found that
do not have good knowledge in choosing many husbands do not properly understand
foods rich in iron, protein, vitamin C nutrition needed during the process of
from fruits and vegetables that are very pregnancy and other types of nutritious
important for the health of pregnant foods. Similarly, Purbadewi (2013),
wives to prevent anemia in pregnancy. reported that people with less knowledge
The study found that the role of about anemia will behave negatively, while
husbands related to their knowledge of people who have good knowledge will

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behave positively in to prevent or treat soybeans, green beans) dark green
anemia. This caused those less vegetables (kale, spinach, katuk leaves) and
knowledgeable to prepare food both less fruits (oranges, guavas and bananas)
in quality and amount. (Syafrudin, 2011).
We argue that husbands have not The study revealed that husbands’ little
been playing an optimal role in knowledge about how to manage
accompanying their wives who were anemia in pregnancy will affect the
pregnant and anemic, because the health of wives especially anemia caused
husbands’ knowledge about the cause of by unbalanced nutritional intake.
anemia in pregnancy was lacking, so Therefore, husbands have been providing
husbands did not pay attention to their insufficient support by not providing
wives’ diet, leading to wives easily getting enough nutrition for their wives.
anemia in pregnancy. The study also found that during
The study found that the role of pregnancy, the foods consumed daily by
husbands related to husband’s knowledge the pregnant mother/wife were
about how to manage anemia in pregnancy unbalanced. They were especially eating
was evident from each husband’s answer less fruits and animal protein that contain
and according to the results of analysis lots of iron, potentially leading to high
conducted on the husband’s informant prevalence of anemia in pregnant woman.
namely (A1 to A6, B1 to B6 and C1 up to Based on FGD results with informants, the
C7) grouped into 11 (eleven) answers on average wife said that:
how to treat anemia, first: preventing
overwork (informants A2, A3, A4, A6, B5, “Meat and fruit eat once in a while. Every
B6 and C6), second: provide vitamins- day only eat rice and vegetables”
containing food (informants A4, B1, B2, B4
and B5), third: buy fruits (Informant B3, The result that husbands’ were
C2 , C4 and C5), fourth: provide nutritious lacking knowledge about the ways and
food (informants C2, C4 and C7), fifth: help practices to manage in pregnancy was
in preparing meal (A5, B6 and C6), sixth: supported by Purnadhibrata (2011),
invite wife for a walk (informants A3 and which stated less energy and protein
A4), seventh: provide enough food consequently decreased work productivity,
(informants C1 and C5), eighth: avoid as the body became weak because iron
stress (informants A4 and C1), ninth: buy could not be absorbed perfectly due to
vegetables (informant A3), tenth: wash limited availability of heme in protein. To
clothes (informant A5) and eleventh: keep the nutritional content consumed by
refrain from drinking coffee and tea the pregnant wife fulfilled, the role of
(informant C3). These answers showed the husbands was to remind and choose the
husbands’ knowledge of how to deal with right daily diet for wives. Essential
anemia is lacking. It was clear between nutritious foods necessary for the wife
the answers of informants and the actual during pregnancy through daily diet
treatment of anemia and ways to prevent it, include calories, protein from vegetables
which among others are, improving the diet and vegetables, and vegetables and fruits
of pregnant women, for example by that contain lots of vitamin C. Adequate
increasing consumption of foods that nutrition could be obtained by consuming
contain lots of iron such as: eggs, milk, fish, various types of food every day.
liver, fish, meat, beans (tempeh, tofu,

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The result that husbands’ were Our study concluded that the role
lack in knowledge about ways and practices of the husbands in accompanying their
of anemia treatment in pregnancy was wives who have anemia in pregnancy was
supported by Wardyani (2012), who found still lacking. This was due to lack of
that 44, 1% of husbands did not know knowledge about anemia, it causes and it
about the wives’ diet during pregnancy. management in pregnancy. We have a few
Another relevant study also found that suggestion in this study: First: Health
44.9% of husbands failed to provide Institution should improve maternal and
nutritious food to their pregnant wives. child health program by involving husband
Kwopong (2012), found that the cause of during pregnancy examination in the
pregnant women easily developing anemia examination room so husbands can
was poor diet (63%). understand the cause and how to solve
The result that the husbands were every problem. Health Institution should
lacking in knowledge regarding the ways increase the dissemination of information
and practices of anemic management in about anemia in pregnancy to married
pregnancy supported by Ishak S (2005), couples, through health promotion
who studied involvement of husbands in activities both through print and
the nutrition or diet of pregnant women electronic media as well as Personal
and found that of 96 study subjects or Medical Treatment/ Konsulta Saude
husbands inquired, 74 (77,1%) reported Pesoal (KSP), so couples (husband and
paying attention to dietary intake of wife wife) could learn about anemia and how
especially during pregnancy, while 22 to manage it in pregnancy to prevent the
(22,9%) others say not too concerned with occurrence of anemia in wives. Second:
state of nutrition during the pregnancy of Maternal and Child Health Officers at Pasir
their wives, it means nutrition or good Mulya (Puskesmas) should provide
food during pregnant wife or not pregnant counseling nutrition education and
is no different. This research is in line with prevention of anemia in pregnancy to
the study by Umami (2007), which found anemic pregnant mother along with her
that most respondents (55,1%) provide husband and that pregnant women
nutritious food for their wives but many consume foods high in iron and regular Fe
(44,9%) still do not provide nutritious food tablet consumption during pregnancy.
for their wives. Third: The husband’s active role in
We believed that husbands’ seeking information about anemia, causes
knowledge of the ways and practices of and ways of handling anemia in pregnancy
anemic management in pregnancy is by asking health workers, when
lacking that husbands did not know how accompanying the wife to conduct
to treat their wives with anemia by pregnancy checks in health facilities would
improving menus and increasing help husbands understand and have
consumption of foods containing plenty of effective measures to help their wives.
iron from animal and vegetable proteins,
green vegetables, and fruits.

CONCLUSION
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