Abstract
Objectives
Despite strong policy and program commitment, essential maternal nutrition services are not reaching enough women in many countries. This paper examines multi-factorial determinants (personal, family, community, and health services) associated with maternal nutrition practices in Uttar Pradesh, India.
Methods
Data were from a household survey of pregnant (n = 667) and recently delivered women (n = 1,835). Multivariable regression analyses were conducted to examine the determinants of four outcomes: consumption of diverse diets, iron folic acid (IFA) and calcium tablets, and weight monitoring during pregnancy. Population attributable risk analysis was used to estimate how much the outcomes can be improved under optimal program implementation.
Results
During pregnancy, women consumed ∼40 IFA and calcium tablets, 18% consumed diverse diet and 17% were weighed ≥ 3 times. Nutrition knowledge was a key modifiable factor associated with consumption of diverse diet (OR = 2.2 times, β = 0.7 food groups), IFA (2.3 times, 17 tablets), calcium (11.7 times, 18 tablets) and weight monitoring (0.7 times). Beliefs and self-efficacy were associated with IFA (OR = 2.0) and calcium consumption (OR = 4.6). Family support and adequate health services were also associated with better maternal nutrition practices. Under optimal program implementation, we estimate 51% women would have adequate diet diversity, an average consumption of 100 IFA and 90 calcium tablets, and women would be weighed 4.4 times during pregnancy
Conclusions
While the current situation is bleak, many of the key factors associated with maternal dietary diversity, IFA/calcium consumption and weight gain monitoring are modifiable. Strengthening existing program operations to improve the supply of interventions and to create adequate demand through behavior change communication has the potential to result in large improvements in maternal nutrition practices from their baseline levels. However, these efforts will not be sufficient to meet WHO-recommended levels without also putting in place more favorable socio-economic conditions and additional resources.
Funding Sources
Bill & Melinda Gates Foundation, through Alive & Thrive, managed by FHI 360. Additional funding support is from CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), led by the International Food Policy Research Institute.
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