A situation analysis of public health interventions, barriers, and opportunities for improving maternal nutrition in Bihar, India.
BACKGROUND
Maternal underweight and anemia are highly prevalent in Bihar, especially among adolescent girls aged 15 to 19 years. Although numerous programs and platforms exist for delivering efficacious interventions for improving maternal nutrition, the coverage and quality of these interventions are low.


OBJECTIVE
To examine existing interventions for reducing maternal undernutrition in Bihar and identify barriers to and opportunities for expanding their coverage and quality.


METHODS
The research was conducted in New Delhi and Bihar between May and August 2010. Forty-eight key informant interviews were conducted with policy makers, program managers, and service providers at multiple levels. Secondary data were collected from survey reports and program documents. All data were analyzed thematically.


RESULTS
Barriers to the delivery and uptake of interventions to improve maternal nutrition include the shortage of essential inputs, low prioritization of maternal undernutrition, sterilization bias within the family planning program, weak management systems, poverty, gender inequality, caste discrimination, and flooding. In order to overcome barriers and improve service delivery, the current government and its partners have introduced structural reforms within the public health system, launched new programs for underserved groups, developed innovative approaches, and experimented with new technologies.


CONCLUSIONS
Since coming to power, the Government of Bihar has achieved impressive increases in the coverage of prioritized health services, such as institutional deliveries and immunization. This success presents it with an excellent opportunity to further reduce maternal and infant mortality by turning its attention to the serious problem of maternal undernutrition and low birthweight.
Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30327, USA. enoznesky@gmail.com
Elizabeth A
EA
Noznesky
Usha
U
Ramakrishnan
Reynaldo
R
Martorell
D000293:Adolescent; D016497:Adolescent Health Services; D000328:Adult; D002662:Child Health Services / Q000379:methods; D002675:Child, Preschool; D003906:Developing Countries; D005260:Female; D006284:Health Plan Implementation; D006292:Health Priorities; D006293:Health Promotion; D006801:Humans; D007194:India; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D044342:Malnutrition / Q000178:diet therapy / Q000503:physiopathology / Q000517:prevention & control*; D008427:Maternal Health Services / Q000379:methods*; D039382:Maternal Nutritional Physiological Phenomena; D018673:Nutrition Policy; D011247:Pregnancy; D055815:Young Adult