Nutrition Interventions Integrated into an Existing Maternal, Neonatal, and Child Health Program Reduce Food Insecurity Among Recently Delivered and Pregnant Women in Bangladesh

Abstract

Background: Antenatal care may be a means to reduce food insecurity in pregnancy and postpartum periods.

Objective: With the use of a cluster-randomized design, we tested whether participation in nutrition-focused antenatal care intending to improve household knowledge about the importance of nutrition for pregnant and lactating women and encourage allocation of household resources to ensure sufficient quality and quantity of foods, without providing food assistance, would reduce household food insecurity.

Methods: Alive & Thrive integrated nutrition interventions into an existing Maternal, Neonatal, and Child Health (MNCH) program in Bangladesh. The nutrition-focused MNCH package was delivered in 10 subdistricts through antenatal care visits with the use of interpersonal communication, community mobilization, and monitoring of weight gain, aiming to improve maternal diet quality, quantity, and micronutrient intake during pregnancy and breastfeeding. The package included components that could reduce food insecurity, measured using the Household Food Insecurity Access Scale. To examine the impact of the nutrition-focused MNCH package compared with the standard MNCH package, we used linear and multinomial logit regression models, adjusted for subdistrict clustering, to test differences at endline in items, domains, and categories of food insecurity, after first confirming no differences at baseline.

Results: At baseline, nearly half of households were food insecure. At endline, the groups differed in food insecurity, whether expressed as items, domains, or categories, with food insecurity in the nutrition-focused MNCH group 22 percentage points lower than in the standard MNCH group and 20 percentage points lower than at baseline.

Conclusions: Participation in nutrition-focused antenatal care reduced household food insecurity among recently delivered and pregnant women. Integration of social and behavioral nutrition interventions into antenatal care with components that promote food security provides a potentially effective means to reduce food insecurity, without incurring high costs of providing supplemental food, in populations where limited resources can be directed towards accessing adequate and appropriate foods. Registered at clinicaltrials.gov as NCT02745249.

Figures

FIGURE 1

Trial profile. MNCH, Maternal, Neonatal, and Child Health.

FIGURE 2

Household food insecurity among RDW and PW, by survey round (i.e., baseline in 2015 and endline in 2016) and intervention package (i.e., nutrition-focused and standard MNCH), for domains: (A) RDW-anxiety and uncertainty about the household food supply, (B) RDW-insufficient quality, (C) RDW-insufficient food intake, (D) PW-anxiety and uncertainty about the household food supply, (E) PW-insufficient quality, and (F) PW-insufficient food intake. **P < 0.01, ***P < 0.001. MNCH, Maternal, Neonatal, and Child Health; PW, pregnant women; RDW, recently delivered women.

FIGURE 3

Categories of household food insecurity among RDW and PW, by survey round (i.e., baseline in 2015 and endline in 2016) and intervention package (i.e., nutrition-focused and standard MNCH). A food-secure household experienced none of the food insecurity (access) conditions, or just experienced worry, but rarely. A mildly food-insecure household worried about not having enough food sometimes or often, and/or was unable to eat preferred foods, and/or ate a more monotonous diet than desired. A moderately food-insecure household sacrificed quality more frequently, by eating a monotonous diet or undesirable foods sometimes or often, and/or started to cut back on quantity by reducing the size of meals or number of meals. A severely food-insecure household graduated to cutting back on meal size or number of meals often, and/or experienced any of the 3 most severe conditions (running out of food, going to bed hungry, or going a whole day and night without eating). MNCH, Maternal, Neonatal, and Child Health; PW, pregnant women; RDW, recently delivered women.