Antenatal care (ANC) programs are crucial for ensuring the health of pregnant women and their babies. In India, where maternal and child undernutrition remains a significant public health challenge, integrating effective nutrition interventions into ANC services is paramount. A recent study investigated the impact of a nutrition-intensified antenatal care (I-ANC) program compared to the standard ANC (S-ANC) program in India, focusing on the delivery of micronutrient supplements, enhanced counseling, and community mobilization through government ANC services. This analysis sheds light on the effectiveness of intensified nutrition components within the existing Antenatal Care Program In India and highlights areas for further improvement.
Study Overview: Objectives and Methods
The core objective of the research was to evaluate and compare the effectiveness of nutrition-intensified ANC (I-ANC) against the standard ANC (S-ANC) in India. The study specifically aimed to measure the coverage of vital nutrition interventions and assess maternal nutrition practices within these two approaches. To achieve this, researchers employed a rigorous cluster-randomized study design. This involved cross-sectional baseline (2017) and endline (2019) surveys, each encompassing approximately 660 pregnant women and 1800 recently delivered women. Complementing these surveys, a repeated-measures longitudinal study was conducted between 2018 and 2019, tracking a cohort of 400 women. This comprehensive methodology allowed for robust difference-in-difference (DID) estimations to determine the impact on key indicators such as diet diversity, micronutrient supplement consumption, weight monitoring, and early breastfeeding practices.
Key Findings: Impact of Nutrition-Intensified ANC
The study revealed that while India’s national nutrition program has driven overall improvements in service coverage, the nutrition-intensified ANC (I-ANC) program demonstrated significant added benefits. Women in the I-ANC arm experienced a notable increase in home visits, with a difference-in-difference (DID) of 7-14 percentage points compared to the standard ANC (S-ANC) arm. Furthermore, counseling on essential nutrition messages was substantially more prevalent in the I-ANC group, showing a DID of 10-23 percentage points. Impressively, in the I-ANC arm, one-third of women received three or more home visits, and one-fourth benefited from four or more ANC check-ups, indicating a more engaged and proactive healthcare approach.
Crucially, the I-ANC program led to greater improvements in the uptake and consumption of vital micronutrient supplements. Compared to the S-ANC arm, women in the I-ANC arm showed significantly higher rates of both receiving and consuming iron-folic acid supplements (DID: 7.5 pp and 9.5 pp, respectively) and calcium supplements (DID: 14.1 pp and 11.5 pp, respectively). In terms of infant feeding practices, exclusive breastfeeding rates showed a positive improvement (DID: 7.5 pp) under the I-ANC program. However, early initiation of breastfeeding did not show a significant difference between the two arms.
Despite these positive outcomes, the study also highlighted areas needing further attention. Maternal food group consumption remained around four food groups, and the probability of micronutrient adequacy stayed at approximately 20% in both the I-ANC and S-ANC arms. These figures indicate that while service delivery improved, dietary diversity and overall micronutrient adequacy remained suboptimal for pregnant women. Longitudinal analyses reinforced these findings, further demonstrating the positive impact of I-ANC on the consumption of vitamin A-rich foods (10 pp, 11 g/d), other vegetables and fruits (22-29 g/d), and gestational weight gain (0.4 kg).
Challenges and Future Directions
The findings of this study underscore that intensifying nutrition within government antenatal care services in India leads to tangible improvements in maternal nutrition practices, even amidst broader positive trends in service coverage driven by national programs. However, the persistence of suboptimal dietary diversity, supplement consumption, and breastfeeding practices indicates that more robust interventions are needed. Achieving greater behavior change and maximizing the nutritional status of pregnant women will necessitate strengthening both the delivery and effective utilization of maternal nutrition services. These services must be seamlessly integrated into the broader antenatal care program in India and the overall health system to ensure comprehensive and impactful care. Future efforts should focus on strategies to enhance dietary diversity, improve the consistent consumption of recommended supplements, and promote optimal breastfeeding practices to further elevate the health and well-being of mothers and infants in India.
