Concepts of iron deficiency anemia and public health measures in rural Costa Rica

In rural Costa Rica, lay people conceptualize iron deficiency anemia differently from health care providers, and these differences impede public health initiatives. This research is based on 70 ethnographic interviews with mothers of young children 24-48 months of age and interviews with health care personnel in eight rural neighborhoods. Lay explanations of anemia draw on biomedical concepts, such as the amount of iron in the blood or in food, but one common explanation is elaborated to involve a biomedical life-threatening disease, leukemia, in cases where the anemia is not treated. Furthermore, mothers often view the liquid iron given free at the clinic as treatment for anemia as too strong, causing negative dental effects; many refuse to administer the iron drops to their children and give other treatments. Formal public health measures result in effects local people consider unacceptable and not congruent with being a good parent; with few exceptions, the medical community dismisses those preoccupations as inappropriate signs of ignorance on the part of caretakers. The existence of several systems of healing allows for parental rejection of public health measures and easy access to alternative remedies.