A Situation Analysis of Effective Interventions, Barriers and Opportunities for Improving Maternal Nutrition in Bihar, India Público
Noznesky, Elizabeth Ann (2011)
Published
Abstract
Introduction: Maternal underweight and anemia are serious
problems in Bihar and are
important factors in the persistence of high levels of child
undernutrition. Although
numerous programs and platforms exist for delivering effective
interventions for
improving maternal nutrition, the coverage and quality of these
interventions is low and
they are not achieving the desired results.
Objective: This study aimed to assess the status of
effective interventions for improving
maternal nutrition in Bihar and to identify barriers and
opportunities for expanding
coverage and quality.
Methods: Forty-eight key informant interviews were
conducted with policy makers,
program managers and service providers in Bihar at state, district,
block and facility
levels. Secondary data was collected from survey reports and
program documents. All
data was analyzed thematically.
Results: Numerous barriers impede the delivery of
effective interventions for improving
maternal nutrition in Bihar. Implementation level barriers include
the shortage of human
resources; an inadequate supply of basic equipment and supplies;
and low recognition of
the magnitude and consequences of maternal undernutrition. Policy
level barriers include
low prioritization of maternal nutrition and the lack of emphasis
on delaying and spacing
births. Societal barriers include poverty, gender inequality and
caste-based
discrimination. Innovations for improving program delivery include
household mapping
and microplanning; cash incentives for meeting targets; and
electronic fund transfer
systems. Potential platforms for delivering interventions include
Panvjayati Raj
Institutions, women's Self-Help Groups, and programs to educate and
empower
adolescent girls.
Discussion: Significant progress has been made in recent
years by the new Government
of Bihar to expand the coverage and quality of public health
services throughout the state.
However, due to years of neglect under previous governments, much
remains to be done.
Recommendations for strengthening the delivery of interventions to
improve maternal
and birth outcomes include setting targets in program
implementation plans, increasing
outreach to adolescent girls and women outside of pregnancy,
strengthening field
supervision, empowering women and increasing the involvement of
community-based
organizations. Recommendations will be shared with the Government
of Bihar and its
partners to assist them in their efforts to improve maternal and
child health.
Table of Contents
Table of Contents
1. Introduction. 1
1.1. Rationale. 1
1.2. Problem statement 4
1.3. Purpose statement 7
1.4. Study objectives. 7
1.5. Research questions. 7
1.6. Significance Statement 8
2. Lit Review.. 10
2.1. Maternal undernutrition. 10
2.2. Low birth weight 12
2.3. Effective interventions for maternal and birth outcomes. 14
2.3.1. Iron folic acid supplementation. 14
2.3.2. Multiple micronutrient supplementation. 15
2.3.3. Protein and energy supplementation. 16
2.3.4. Food Fortification. 18
2.3.5. Community nutrition interventions. 19
2.3.6. Deworming. 19
2.3.7. Treatment and prevention of malaria. 19
2.3.8. Family planning interventions. 20
2.3.9. Development interventions. 21
3. Methods. 22
3.1. Introduction. 22
3.2. Setting and study population. 23
3.2.1. Selection of sites for field visits. 23
3.2.2. Selection of key informants. 25
3.3. Research design. 26
3.3.1. Research instruments. 26
3.3.2. Research procedures. 28
3.3.3. Data Analysis. 29
4. Results. 30
4.1. Overview of Bihar 30
4.2. Maternal undernutrition. 31
4.3. Existing interventions for improving maternal nutrition. 34
4.3.1. Iron Folic Acid supplementation. 35
4.3.2. Deworming. 36
4.3.3. Protein energy supplementation. 37
4.3.4. Nutrition education. 37
4.3.5. Family planning. 38
4.3.6. Social Safety Nets. 39
4.4. Platforms and mechanisms for delivering interventions. 40
4.4.1. Primary Health Care System.. 40
4.4.2. National Rural Health Mission. 43
4.4.3. Integrated Child Development Services (ICDS) 45
4.4.4. School Anemia Control Program.. 47
4.4.5. Targeted Public Distribution System (TPDS) 47
4.5. Barriers to the effective delivery of interventions. 48
4.6. Promising innovations. 49
4.7. Other potential delivery platforms. 50
5. Discussion. 51
5.1. Barriers. 52
5.1.1 Implementation level 52
5.1.2 Policy level 55
5.1.3 Societal level 57
5.2. Innovations. 60
5.3. Other potential delivery platforms. 63
5.4. Strengths and limitations. 66
6. Conclusions and Recommendations. 67
7. References. 71
8. Appendices. 82
8.1. List of key informants by position and organization. 82
8.2. Key Informant Interview Guide. 85
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