Strengthening nutrition interventions in antenatal care services affects dietary intake, micronutrient intake, gestational weight gain, and breastfeeding in Uttar Pradesh, India: Results of a cluster-randomized program evaluation

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dc.creatorNguyen, Phuong Hong
dc.creatorKachwaha, Shivani
dc.creatorTran, Lan Mai
dc.creatorAvula, Rasmi
dc.creatorYoung, Melissa F.
dc.creatorGhosh, Sebanti
dc.creatorSharma, Praveen Kumar
dc.creatorEscobar-Alegria, Jessica
dc.creatorForissier, Thomas
dc.creatorPatil, Sumeet
dc.creatorFrongillo, Edward A.
dc.creatorMenon, Purnima
dc.date2021-08-18
dc.date2024-05-22T12:10:58Z
dc.date2024-05-22T12:10:58Z
dc.date.accessioned2026-06-27T15:06:42Z
dc.descriptionBackground: Maternal nutrition interventions are inadequately integrated into antenatal care (ANC). Alive & Thrive aimed to strengthen delivery of micronutrient supplements and intensify interpersonal counseling and community mobilization through government ANC services. Objectives: We compared nutrition-intensified ANC (I-ANC) with standard ANC (S-ANC) on coverage of nutrition interventions and maternal nutrition practices. Methods: We used a cluster-randomized design with cross-sectional baseline (2017) and endline (2019) surveys (n ∼660 pregnant and 1800 recently delivered women per survey) and a repeated-measures longitudinal study in 2018–2019 (n = 400). We derived difference-in-difference effect estimates (DIDs) for diet diversity, consumption of micronutrient supplements, weight monitoring, and early breastfeeding practices. Results: Despite substantial secular improvements in service coverage from India's national nutrition program, women in the I-ANC arm received more home visits [DID: 7–14 percentage points (pp)] and counseling on core nutrition messages (DID: 10–23 pp) than in the S-ANC arm. One-third of women got ≥3 home visits and one-fourth received ≥4 ANC check-ups in the I-ANC arm. Improvements were greater in the I-ANC arm than in the S-ANC arm for any receipt and consumption of iron–folic acid (DID: 7.5 pp and 9.5 pp, respectively) and calcium supplements (DID: 14.1 pp and 11.5 pp, respectively). Exclusive breastfeeding improved (DID: 7.5 pp) but early initiation of breastfeeding did not. Maternal food group consumption (∼4 food groups) and probability of adequacy of micronutrients (∼20%) remained low in both arms. Repeated-measures longitudinal analyses showed similar results, with additional impact on consumption of vitamin A–rich foods (10 pp, 11 g/d), other vegetables and fruits (22–29 g/d), and gestational weight gain (0.4 kg). Conclusions: Intensifying nutrition in government ANC services improved maternal nutrition practices even with strong secular trends in service coverage. Dietary diversity, supplement consumption, and breastfeeding practices remained suboptimal. Achieving greater behavior changes will require strengthening the delivery and use of maternal nutrition services integrated into ANC services in the health system. This trial was registered at clinicaltrials.gov as NCT03378141.
dc.identifierhttps://hdl.handle.net/10568/142742
dc.identifier.urihttp://hdl.handle.net/123456789/94858
dc.languageen
dc.publisherOxford University Press
dc.relationhttps://doi.org/10.1093/cdn/nzaa054_122
dc.relationhttps://doi.org/10.1093/cdn/nzab081
dc.relationhttps://doi.org/10.1093/jn/nxab390
dc.relationhttps://doi.org/10.1016/j.foodpol.2021.102173
dc.rightsOpen Access
dc.sourceNguyen, Phuong Hong; Kachwaha, Shivani; Tran, Lan Mai; Avula, Rasmi; Young, Melissa; Ghosh, Sebanti; Sharma, Praveen K.; Escobar-Alegria, Jessica; Forissier, Thomas; Patil, Sumeet; Frongillo, Edward A.; and Menon, Purnima. 2021. Strengthening nutrition interventions in antenatal care services affects dietary intake, micronutrient intake, gestational weight gain, and breastfeeding in Uttar Pradesh, India: Results of a cluster-randomized program evaluation. Journal of Nutrition 151(8): 2282–2295. https://doi.org/10.1093/jn/nxab131
dc.subjectmaternal and child health
dc.subjectchild nutrition
dc.subjectweight gain
dc.subjectmalnutrition
dc.subjectnutrition
dc.subjecttrace elements
dc.subjectpsychology
dc.subjectdiet
dc.subjectbreastfeeding
dc.subjectmaternal nutrition
dc.subjectfood intake
dc.titleStrengthening nutrition interventions in antenatal care services affects dietary intake, micronutrient intake, gestational weight gain, and breastfeeding in Uttar Pradesh, India: Results of a cluster-randomized program evaluation
dc.typeJournal Article

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Instituto Internacional de Investigación sobre Políticas Alimentarias (IFPRI)