In-depth understanding of drivers of maternal behavior change in the context of an ongoing maternal nutrition intervention in Uttar Pradesh, India Open Access

Jhaveri, Neha (Spring 2020)

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Background: Maternal nutrition is one of many contributors to maternal mortality rates in India. Of all the states in India, Uttar Pradesh is one of the highest populated states in India and has some of the poorest maternal and child health outcomes. Undernutrition can lead to adverse outcomes throughout the lifespan. In pregnant women, poor nutrition can lead to complications during birth and mortality, and result in long-term developmental effects for the child. To address this challenge, Alive & Thrive (A&T) with the help of IPE Global, aimed to strengthen interpersonal counseling, micronutrient supplement provision, and community mobilization through the government antenatal care (ANC) platform in Uttar Pradesh, India. However, there is limited knowledge on key factors that influence women’s adoption of key nutrition-related practices (i.e. diet diversity, ANC attendance, iron and calcium supplement intake, and weight monitoring). In order to strengthen the program implementation strategy, there is a need to gain further insight into women’s perspectives and experiences with the maternal nutrition program in Unnao and Kanpur Districts in Uttar Pradesh, India.

Objective: The purpose of this qualitative study was to examine women’s experiences and perspectives on key nutrition-related practices during pregnancy to identify key facilitators and barriers that affect behavioral adoption.

Methods: The study sample consisted of one high and one low performing block in each of the two program districts. A total of 24 semi-structured interviews were conducted with pregnant women who were in their 6-8th month of pregnancy. Data was analyzed through a thematic analysis approach. After forming codes, a codebook was developed and applied to relevant sections of each transcript. Using concepts from the Capability-Opportunity-Motivation (COM-B) framework, codes for each indicator were categorized accordingly. They were then identified as either a facilitator or barrier for each maternal nutrition behavior.

Results: Key facilitators for maternal behavior change included family support, ANC transportation that is provided to take pregnant women to the ANC checkup site, home visits from frontline workers (FLWs), and accurate message recall from the frontline workers, specifically individualized and contextualized counseling that takes into account potential barriers and conveys the importance/ benefits of practicing maternal nutrition behaviors. Barriers included lack of transportation to get to ANC checkup site, household responsibilities/ work duties, crowding at ANC checkup site, inconsistent provision of supplements, aspects of food insecurity, financial strain, and delayed timing of messages.

Conclusions: The findings from this study can help identify areas of program improvement and address potential issues that may influence program effectiveness. Additional training and supervision may be merited to help ensure that FLWs are delivering accurate messages at the appropriate time points in pregnancy. Provision of supplemental materials and details to enhance recall of key messages may aid in the success of maternal nutrition programs. Supply chain, quality of ANC, food insecurity, and poverty remain as structural barriers that were beyond the scope of this intervention, but are critical to program success.

Table of Contents

CHAPTER ONE: Introduction and Rationale  1

CHAPTER TWO: Literature Review    6

CHAPTER THREE: Student Contribution  12

CHAPTER FOUR: Journal Article  19

CHAPTER FIVE: Public Health Implications    64

References     68

Appendix A: Oral Consent Form        75

Appendix B: Pregnant Women In-depth Interview Guide   77

Appendix C: COM-B by Indicator       81

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