Journal of Social and Education Research
Volume 03 Nomor 02 June 2025
e-ISSN: 3021-8977, Hal 94-101
Available online at: https://journal.larpainstitute.com/index.php/jser

Community and Family-Centered Midwifery Care for Moderate Anemia in
Third Trimester: The Case of Mrs. 'I' in Pemangket
Sumartini1*, Ismiati2
,2Prodi Profesi Bidan, Universitas Qamarul Huda Badaruddin , Indonesia

1

Addres: : H. Badruddin Street, Bagu, Praya Subdistrict, Central Lombok Regency, West Nusa
Tenggara, Indonesia
Corresponding: sumartini041998@email.com

Abstract. Anemia during pregnancy remains a major health issue, especially in developing countries like
Indonesia. This report presents community midwifery care for the family of Mr. “M,” focusing on Mrs. “I” who
was diagnosed with moderate anemia in the third trimester of pregnancy in Pemangket Hamlet, Ubung Village,
Jonggat District, Central Lombok Regency. The objective of this activity was to provide education and
intervention related to pregnancy anemia using a family-based approach. The method used is a case study with
steps including problem identification, analysis, potential diagnosis, planning, intervention, and evaluation. The
assessment showed that lack of compliance in taking iron tablets and limited nutritional knowledge were the main
contributing factors to anemia. Interventions such as health education, iron tablet monitoring, and family support
led to increased awareness and adherence in managing anemia. This community-based approach is expected to
serve as an effective strategy in tackling pregnancy-related anemia in rural areas.
Keywords: pregnancy anemia, community midwifery care, third trimester, family education

1. INTRODUCTION
Anemia during pregnancy is a major health problem in developing countries, with a high
morbidity rate among pregnant women. The average rate of pregnancy-related anemia in Asia
is estimated at 72.6% (Sasmita, 2022). The high prevalence of anemia in pregnant women is a
significant concern for the Indonesian government, as it is associated with increased maternal
morbidity and mortality. Pregnant women are considered anemic when their hemoglobin levels
are below 11 g/dl in the first and third trimesters, and below 10.5 g/dl in the second trimester
(Hariati et al., 2020).
According to WHO data, maternal mortality remains high globally, with over 300,000
deaths annually due to bleeding, hypertensive disorders, and sepsis. WHO states that the
prevalence of pregnancy-related anemia ranges from 20.0% to 89.0%, using 11 g/dl of
hemoglobin as the threshold (WHO, 2021). In Indonesia, the three leading causes of maternal
death during 2018–2019 were bleeding, hypertension, and infection, with bleeding often linked
to anemia (Ministry of Health RI, 2020).
The NTB Provincial Health Profile reports 29 cases of anemia in 2016, 30 cases in 2017,
and a rise to 34 cases in 2018 (NTB Health Department Report, 2018). In Central Lombok
Regency, the prevalence of anemia among pregnant women is 8.77%. The number of anemia

Community and Family-Centered Midwifery Care for Moderate Anemia in Third Trimester: The Case of Mrs. 'I' in
Pemangket

cases in pregnant women in this area has increased yearly from 2021 to 2022. In 2021, 34
(4.19%) pregnant women had anemia, which rose to 48 (5.92%) in 2022.
According to the 2020 PWS KIA report from UPTD Ubung Health Center, there were
858 pregnant women in the area. The coverage of first antenatal visits (K1) was 109.09%,
complete antenatal care visits (K4) 94.41%, risk factor and complication detection 103.86%,
managed maternal complications 132.75%, deliveries by health personnel 96.94%, non-health
personnel deliveries 0.49%, and health facility deliveries 96.94%. Anemic pregnant women
accounted for 3.50%, while those with Chronic Energy Deficiency (CED) were 13.29%.
The impact of anemia during pregnancy includes reduced immune function, increased
risk of infection, decreased quality of life, and potential complications such as miscarriage,
bleeding that could lead to maternal death, premature birth (before 9 months), low birth weight
(BB < 2500g), short birth length (<48 cm), and in cases of severe anemia, the risk of stillbirth
(Ministry of Health RI, 2020).
Another contributing factor is poor compliance in consuming iron (Fe) tablets. Pregnant
women are advised to consume at least 90 Fe tablets throughout pregnancy. Regular intake
helps increase hemoglobin levels. Proper consumption requires awareness and compliance
from the pregnant woman (Dewi & Mardiana, 2021). According to the Ministry of Health RI
(2020), causes of anemia include poor and unbalanced diet, CED (mid-upper arm
circumference <23.5 cm), closely spaced pregnancies (<2 years), and infections that cause iron
loss.
Research by Zuiatna (2021) shows a significant correlation between knowledge and the
incidence of anemia (p-value 0.040 < 0.05). One major cause of anemia in pregnant women is
the lack of knowledge regarding the importance of consuming nutritious foods for both mother
and fetus. Iron is an essential nutrient, and insufficient intake increases the risk of anemia,
negatively impacting fetal growth and development. It can be concluded that anemia in
pregnant women is caused by poor adherence to Fe tablet consumption and lack of knowledge
regarding the importance of a nutritious diet.
2. METHODE
This research employed a descriptive qualitative case study design, focusing on the
provision of community-based midwifery care for a pregnant woman experiencing moderate
anemia in her third trimester. The subject was Mrs. “I”, aged 25, who was selected based on
her risk status as identified by the local health center. The study was conducted in Pemangket
Hamlet, Ubung Village, Jonggat Subdistrict, Central Lombok Regency, during the period of
September to October 2024.
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Community and Family-Centered Midwifery Care for Moderate Anemia in Third Trimester: The Case of Mrs. 'I' in
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The population of the study consisted of pregnant women with risk indicators,
particularly those suffering from anemia, within the jurisdiction of UPTD Puskesmas Ubung.
However, the sample was determined purposively, focusing solely on one family unit to allow
an in-depth and focused exploration. The data collection techniques involved interviews,
observations, physical examinations, and document analysis. These instruments were designed
to gather both subjective and objective data, including hemoglobin levels, nutritional intake,
adherence to iron tablet consumption, and environmental conditions.
The data obtained were analyzed using descriptive qualitative methods. Data were
compiled, categorized, and interpreted based on community midwifery management principles,
including problem identification, analysis, diagnosis formulation, intervention planning,
implementation, and evaluation. The research model followed the community midwifery
approach emphasizing health education, early detection, preventive action, and family
empowerment.
No advanced statistical tests such as F-test or t-test were applied in this research, given
its qualitative nature. However, the interpretation of findings is supported by existing literature
and clinical guidelines related to maternal anemia management. The instruments used were
reviewed for content validity through expert judgment, and findings from the field confirmed
their practical reliability. Symbols and variables, such as Hb (hemoglobin levels) and Fe (iron
intake), are presented in narrative form throughout the discussion.
This methodological approach aimed not only to address the clinical management of
moderate anemia but also to enhance maternal awareness and family involvement in improving
maternal health outcomes within a community context.
3. RESULT AND DISCUSSION
a. Result
1) Data Collection Process, Timeframe, and Study Location
The data collection for this study was conducted over a period of one month, from
September to October 2024. The location of the study was Pemangket Hamlet, located
within the working area of UPTD Puskesmas Ubung, Jonggat Subdistrict, Central Lombok
Regency. The subject of the study was a 25-year-old pregnant woman, Mrs. “I”, in her
third trimester of pregnancy and diagnosed with moderate anemia. Data collection
included structured interviews, home and environmental observations, physical
examinations, and a review of antenatal care documentation and Fe tablet compliance
records.
2) Research Findings
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Community and Family-Centered Midwifery Care for Moderate Anemia in Third Trimester: The Case of Mrs. 'I' in
Pemangket

The assessment revealed that Mrs. “I” had a hemoglobin level of 8.5 g/dl during her
third trimester, indicating moderate anemia. The client reported irregular consumption of
iron (Fe) tablets, with only 45 out of the recommended 90 tablets taken during pregnancy.
Nutritional intake was insufficient, consisting mainly of carbohydrate-based meals with
limited iron-rich food sources such as meat and green vegetables. The client also lacked
knowledge regarding anemia and its risks during pregnancy.
Table 1 below summarizes the key findings
Indicator
Hemoglobin Level
Compliance with Fe Tablet Intake
Nutritional Intake
Knowledge of Anemia Risks
ANC Visit Compliance (K1–K4)

Observation Result
8.5 g/dl (Moderate Anemia)
45 tablets consumed (non-compliant)
Low in iron, dominated by rice-based
food
Limited
Complete (K4 reached)

b. Discussion
The findings of this study clearly confirm that non-compliance with iron (Fe)
supplementation and inadequate nutritional intake are major factors significantly
contributing to the incidence of moderate anemia in pregnant women. This aligns with the
findings of Dewi and Mardiana (2021), who identified adherence to Fe tablet consumption
and nutritional knowledge as key determinants of anemia during pregnancy. Such noncompliance is reflected in the subject’s low hemoglobin levels, indicative of chronic iron
deficiency and reduced oxygen transport capacity in the blood.
Limited knowledge regarding iron-rich food sources further exacerbates the anemia
condition in pregnant women. This is consistent with the report from the Ministry of Health
of the Republic of Indonesia (2020), which states that hemoglobin levels below 11 g/dL
during the third trimester are indicative of anemia and are often closely related to
insufficient iron intake. A lack of understanding about the importance of balanced nutrition
and foods that support iron status improvement is a significant barrier to effective anemia
management.
Beyond adherence and nutritional knowledge, the social and cultural context of the
family plays a crucial role in influencing the health behaviors of pregnant women. The
family-based educational intervention in this study successfully increased the subject’s
awareness and commitment to continuing iron supplementation and consuming iron-rich
nutritious foods. These findings support the community-based health promotion theory,

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Community and Family-Centered Midwifery Care for Moderate Anemia in Third Trimester: The Case of Mrs. 'I' in
Pemangket

which emphasizes the importance of family empowerment in facilitating behavioral
change (Kurniati, 2020).
Educational approaches involving the family as the unit of intervention are effective
strategies for enhancing adherence and promoting healthy lifestyle practices among
pregnant women. A study by Sulung et al. (2022) similarly found that family support is a
critical factor in the success of iron supplementation programs and anemia management.
This underscores the necessity for maternal health programs to adopt holistic and contextspecific approaches that consider the social environment of the mother.
Low compliance with Fe tablet consumption is often influenced by multiple factors,
including medication side effects, lack of motivation, and insufficient supervision during
antenatal care (ANC) visits. Therefore, continuous monitoring and personalized education
approaches are key to improving the effectiveness of iron supplementation programs.
Koerniawati et al. (2021) assert that good knowledge about anemia and iron intake
positively correlates with adherence to Fe tablet consumption.
From a healthcare service perspective, routine hemoglobin level screening during
ANC visits is essential for early detection and management of anemia. The role of
midwives and healthcare providers is critical in delivering comprehensive nutritional
counseling and motivating pregnant women to maintain a balanced diet and comply with
iron supplementation (Ambarwati et al., 2019). Such approaches contribute to reducing
anemia prevalence and preventing pregnancy-related complications.
Furthermore, improvement in anemia status during pregnancy not only benefits
maternal health but also positively impacts fetal growth and development while preventing
maternal and neonatal morbidity and mortality. Wulandari et al. (2021) demonstrated that
iron-deficiency anemia in pregnancy increases the risk of preterm birth, low birth weight,
and long-term cognitive developmental disorders in children.
In summary, this study emphasizes the importance of a multidimensional approach
in managing anemia in pregnant women, encompassing continuous education, adherence
monitoring, family support, and strengthening healthcare services. Integrated, communitybased interventions are believed to significantly reduce anemia prevalence and improve
the overall health outcomes of mothers and infants.

4. CONCLUSION
This study concludes that moderate anemia during the third trimester of pregnancy in the
case of Mrs. “I” was primarily caused by non-compliance with iron tablet (Fe) consumption
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and inadequate nutritional intake, particularly a lack of iron-rich foods. The subject's limited
knowledge regarding the risks of anemia and the importance of a balanced diet further
contributed to the condition. Through the application of community-based midwifery care,
including targeted education and family engagement, there was a noticeable improvement in
the subject’s awareness and commitment to managing her condition. These findings support
the importance of personalized health education and active family involvement in addressing
maternal health issues within the community setting.

Based on these conclusions, it is recommended that midwives continue to strengthen
antenatal counseling efforts with an emphasis on the importance of iron supplementation and
adequate nutrition. Regular monitoring of hemoglobin levels and Fe tablet adherence should
be part of routine ANC services. Community health workers should also involve family
members to reinforce knowledge and support compliance in daily life. While the findings are
relevant to the specific case examined, caution must be exercised in generalizing the results to
broader populations due to the study’s limited sample size and localized context.
A limitation of this study lies in its single-subject case approach, which may not fully
capture the diversity of experiences among pregnant women with anemia in other regions.
Future research is encouraged to include a larger and more diverse sample to examine
variations in anemia causes and responses to intervention strategies. Longitudinal studies may
also provide deeper insights into long-term outcomes of community-based maternal health
interventions. Despite these limitations, this study provides valuable insights into the practical
role of midwives and family-centered care in preventing and managing maternal anemia.
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