Opportunities and barriers for maternal nutrition behavior change: an in-depth qualitative analysis of pregnant women and their families in Uttar Pradesh, India

Abstract

BackgroundMaternal undernutrition during pregnancy remains a critical public health issue in India. While evidence-based interventions exist, poor program implementation and limited uptake of behavior change interventions make addressing undernutrition complex. To address this challenge, Alive & Thrive implemented interventions to strengthen interpersonal counseling, micronutrient supplement provision, and community mobilization through the government antenatal care (ANC) platform in Uttar Pradesh, India.ObjectiveThis qualitative study aimed to: (1) examine pregnant women’s experiences of key nutrition-related behaviors (ANC attendance, consuming a diverse diet, supplement intake, weight gain monitoring, and breastfeeding intentions); (2) examine the influence of family members on these behaviors; and (3) identify key facilitators and barriers that affect behavioral adoption.MethodsWe conducted a qualitative study with in-depth interviews with 24 pregnant women, 13 husbands, and 15 mothers-in-law (MIL). We analyzed data through a thematic approach using the Capability-Opportunity-Motivation-Behavior (COM-B) framework.ResultsFor ANC checkups and maternal weight gain monitoring, key facilitators were frontline worker home visits, convenient transportation, and family support, while the primary barrier was low motivation and lack understanding of the importance of ANC checkups. For dietary diversity, there was high reported capability (knowledge related to the key behavior) and most family members were aware of key recommendations; however, structural opportunity barriers (financial strain, lack of food availability and accessibility) prevented behavioral change. Opportunity ranked high for iron and folic acid supplement (IFA) intake, but was not consistently consumed due to side effects. Conversely, lack of supply was the largest barrier for calcium supplement intake. For breastfeeding, there was low overall capability and several participants described receiving inaccurate counseling messages.ConclusionKey drivers of maternal nutrition behavior adoption were indicator specific and varied across the capability-opportunity-motivation behavior change spectrum. Findings from this study can help to strengthen future program effectiveness by identifying specific areas of program improvement.

Effect of preconception multiple micronutrients vs. iron–folic acid supplementation on maternal and birth outcomes among women from developing countries: a systematic review and meta-analysis

“…Several factors affect the weight and micronutrient status during pregnancy, including food insecurity and birth spacing ( 2 ). For this reason, pre-pregnancy care should aim at achieving and sustaining optimal nutritional intake and body weight.…”

“…For this reason, pre-pregnancy care should aim at achieving and sustaining optimal nutritional intake and body weight. In addition, ensuring early and adequate intake of micronutrients during the preconception period would provide added benefits, especially in cases of the pregnancy is unplanned ( 2 , 3 ). In South Asia, malnutrition affects more than 38% of adolescent girls, and the decline in the past decade has not been optimal ( 4 ).…”

“…Providing appropriate interventions (e.g., MMN supplementation) during the preconception period as well as during pregnancy can be crucial to reducing adverse health outcomes. Keeping this in mind, micronutrient supplementation is currently being used as a strategy to improve nutrition in resource-poor settings ( 2 ).…”