Public health interventions, barriers, and opportunities for improving maternal nutrition in India.
BACKGROUND
Inadequate nutrient intake, early and multiple pregnancies, poverty, caste discrimination, and gender inequality contribute to poor maternal nutrition in India. While malnutrition is seen throughout the life cycle, it is most acute during childhood, adolescence, pregnancy, and lactation. Although nutrition policies are on the books and interventions are in place, child malnutrition and maternal undernutrition persist as severe public health problems.


OBJECTIVE
To evaluate the implementation of maternal nutrition programs in India.


METHODS
The research was conducted in two phases. Phase 1 consisted of a desk review of national and state policies pertinent to maternal nutrition and national-level key informant interviews with respondents who have a working knowledge of relevant organizations and interventions. Phase 2 utilized in-depth interviews and focus group discussions at the state, district, and community levels in eight districts of two states: Tamil Nadu and Uttar Pradesh. All data were analyzed thematically.


RESULTS
India has a rich portfolio of programs and policies that address maternal health and nutrition; however, systematic weaknesses, logistical gaps, resource scarcity, and poor utilization continue to hamper progress.


CONCLUSIONS
Elevating the priority given to maternal nutrition in government health programs and implementing strategies to improve women's status will help to address many of the challenges facing India's nutrition programs. Programs can be strengthened by promoting integration of services, ensuring effective procurement mechanisms for micronutrient and food supplements, establishing regional training facilities for improved program implementation, and strengthening program monitoring and evaluation.
Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA. uramakr@emory.edu
Usha
U
Ramakrishnan
Alyssa
A
Lowe
Sheila
S
Vir
Shuba
S
Kumar
Rani
R
Mohanraj
Anuraag
A
Chaturvedi
Elizabeth A
EA
Noznesky
Reynaldo
R
Martorell
John B
JB
Mason
D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000178:diet therapy / Q000503:physiopathology / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D005260:Female; D017144:Focus Groups; D006284:Health Plan Implementation; D006292:Health Priorities; 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; D008875:Middle Aged; D018673:Nutrition Policy; D011247:Pregnancy; D055815:Young Adult