Alive & Thrive Initiative, FHI Solutions, Washington, District of Columbia, USA.
Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, USA.
Matern Child Nutr. 2022 Apr;18(2):e13293. doi: 10.1111/mcn.13293. Epub 2021 Nov 23.
Antenatal care (ANC) is the largest health platform globally for delivering maternal nutrition interventions (MNIs) to pregnant women. Yet, large missed opportunities remain in nutrition service delivery. This paper examines how well evidence-based MNIs were incorporated in national policies and programs in Bangladesh, Burkina Faso, Ethiopia and India. We compared the nutrition content of ANC protocols against global recommendations. We used survey data to elucidate the coverage of micronutrient supplementation, weight gain monitoring, dietary and breastfeeding counselling. We reviewed literature, formative research and program assessments to identify barriers and enabling factors of service provision and maternal nutrition practices. Nutrition information in national policies and protocols was often fragmented, incomplete and did not consistently follow global recommendations. Nationally representative data on MNIs in ANC was inadequate, except for iron and folic acid supplementation. Coverage data from subnational surveys showed similar patterns of strengths and weaknesses. MNI coverage was consistently lower than ANC coverage with the lowest coverage of weight gain monitoring and variable coverage of dietary and breastfeeding counselling. Key common factors associated with coverage were micronutrient supply disruptions; suboptimal counselling on maternal diet, weight gain, and breastfeeding; and limited or no record keeping. Adherence of women to micronutrient supplementation and dietary recommendations was low and associated with late and too few ANC contacts, poor maternal knowledge and self-efficacy, and insufficient family and community support. Models of comprehensive nutrition protocols and health systems that deliver maternal nutrition services in ANC are urgently needed along with national data systems to track progress.
产前保健 (ANC) 是全球最大的提供孕产妇营养干预措施 (MNIs) 的卫生平台。然而，在营养服务提供方面仍存在大量未被充分利用的机会。本文考察了孟加拉国、布基纳法索、埃塞俄比亚和印度如何将基于证据的 MNIs 纳入国家政策和方案。我们将 ANC 协议中的营养内容与全球建议进行了比较。我们使用调查数据阐明了微量营养素补充、体重增长监测、饮食和母乳喂养咨询的覆盖情况。我们回顾了文献、形成性研究和方案评估，以确定服务提供和孕产妇营养实践的障碍和促成因素。国家政策和方案中的营养信息往往是零散的、不完整的，并不总是遵循全球建议。除了铁和叶酸补充剂外，国家 ANC 中 MNIs 的代表性数据不足。来自国家以下各级调查的覆盖数据显示出类似的优势和劣势模式。MNIs 的覆盖范围始终低于 ANC 的覆盖范围，体重增长监测的覆盖范围最低，饮食和母乳喂养咨询的覆盖范围各不相同。与覆盖范围相关的共同关键因素是微量营养素供应中断；对孕产妇饮食、体重增长和母乳喂养的咨询不充分；以及记录保存有限或不存在。妇女对微量营养素补充剂和饮食建议的依从性较低，这与 ANC 接触时间晚、次数少、母亲知识和自我效能感差以及家庭和社区支持不足有关。迫切需要 ANC 中提供孕产妇营养服务的综合营养方案和卫生系统模式，以及跟踪进展的国家数据系统。
