Accelerating efforts to improve women’s nutrition
Inadequately addressing low birth weight caused by maternal malnutrition (before and
during pregnancy) has been the major cause of persistently high malnutrition in children.
Focusing on first 1000 days – period from conception to end of first two years – is a critical
window of opportunity to address child stunting. However, till date, focus of nutrition
interventions for Indian children have largely been on interventions after birth. The criticality of
focusing on women’s nutrition (pre-pregnancy and during pregnancy) to reduce stunting can be
understood by the fact that 50 per cent of growth failure accrued by 24 months, occurs in womb
and foetal stunting is largely because of nutrition insults in first trimester and pre-pregnancy.
Importantly, pre-pregnancy weight and pregnancy weight gain are independent and additive
predictors of low birth weight.
What interventions to focus on to improve women’s nutrition?
Essential nutrition interventions for improving nutrition for women before and during pregnancy
are now known and include – (1) improve the quantity of household food consumed and its
nutrient quality (2) prevent and manage micronutrient deficiencies and anaemia, (3) increase
women’s access to basic nutrition and health services, (4) improve access to water and sanitation
education/commodities and (4) gender empowerment for preventing too early, too many and too
close pregnancies. Details in Annex. 1. These interventions need to be universalized.
Following activities are proposed:
o Focus maternal diet particularly in First Trimester: improved maternal diet
(quality and quantity) in the first trimester +/-vely influence Birth Weight, even for
short adult women. Focus on early enrollment and improve diet, particularly first
trimester.
o Special package or attention to at risk women. Criteria used can be - (i)
primipara, (ii) repeated and close pregnancies (birth order >3 ), (ii) low prepregnancy weight (<40 kgs) or MUAC <23, (iv) low attained weight at gestation
week 20. One way could be to start a DOT strategy; PD/HEARTH and counseling
sessions and double food supplementation for such women.
o VHND package expanded/strengthened for maternal nutrition:
 Reporting and reviewing of pregnancy weight monitoring as well as rate of
weight gain in second and third trimester (1.5 kg per month weight gain is
recommended).
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Pregnant mothers iodized salt free of cost starting from first trimester of
pregnancy through lactation.
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Maternal calcium supplementation 100 tablets (for pre-eclampsia and
eclampsia prevention) in last three months of pregnancy.

Improving compliance for IFA supplementation given after first trimester.
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Folate tablets provision in first trimester to prevent neural tube deficits.
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Intermittent treatment for malaria Chloroquine (12 tablets) and prevention
through sprays and Insecticide-treated bed nets and better linkage of NRHM
and National Malaria Control program in malaria endemic areas.

Screening and treating UTI infections.
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Maternal deworming.
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Interventions for pre-pregnant women: WIFS, folic acid and at-risk women
identification and family planning interventions.
o Addressing too early, too many and too close pregnancies through:

Partnership with organized federation of women groups (thrift and
credit/livelihood) so as to influence social norms, reach out to newlyweds for
family planning and life education and mobilize girls’ education, esp. secondary
education as Secondary education has a positively delays marriage and first
pregnancy. Women thrift and credit federations are a community support
system and their collectiveness to resolve issues concerning their
neighbourhood and communities is their strength. Mature women federations
(thrift and credit and livelihood) have been formally engaged by government
through a grant-grantee model approach in supply of supplementary food by
ICDS (Andhra Pradesh), running day care centres and fair price shops (in
Chhattisgarh) and in this process have handled grants/funds. Their potential to
promote behaviours as fiormal partners remains untapped.
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Annex.1: ESSENTIAL INTERVENTIONS
Interventions
Adolescents and
Pre-pregnancy
(WRA)
Essential intervention 1: Improved food and nutrient intake (both in quantity and quality)
1.1 Access to generalized household food ration (PDS)
1.2 Access to fortified supplementary foods – (ICDS)*doesnot cover WRA
1.3 Access to knowledge to improve local diet, production and household behaviours
Essential Intervention 2: Prevent micronutrient deficiencies and anemia
2.1 Weekly iron folic acid supplementation and biannual deworming (adolescents and WRA)
2.3 Universal use of iodized salt
2.4 Daily iron folic acid supplementation for 100 days (pregnant and lactating)
2.5 Malaria prevention and treatment, in malaria endemic areas
2.6 Access to knowledge to stop using tobacco products during pregnancy
2.7 Pre and periconceptual folic acid supplementation
2.8 Maternal calcium supplementation
2.9 Maternal deworming (in endemic areas)
2.10 Maternal vitamin A supplementation within eight weeks of delivery)
Essential intervention 3: Improving access to basic health services and special care for at-risk
3.1. Early registration for inclusion to avail outreach, facility and referral health services
3.2 Monitoring of nutrition status (pre-pregnancy weight, BMI, weight gain in pregnancy)
3.3 Quality of full antenatal checkup including screening and special care of at-risk (anemic, low
BMI, low pre-pregnancy weight, low pregnancy weight gain, with night blindness, malaria, HIV
Essential intervention 4: Improving hygiene &sanitation practices and access to safe drinking water
4.1 Sanitation and hygiene education (including menstrual hygiene)
4.2 Access to safe drinking water and improved sanitation facilities
Essential intervention 5: Preventing pregnancies – too early, too many and too soon
5.1 Ensuring legal age of marriage at/after 18 year through awareness, cash transfers and
incentivizing secondary education
5.2 Delaying first and repeated pregnancy through family planning, reproductive health
information, incentives and services
5.3 Maternity entitlement
5.4 Promoting community support system for women, skill development, economic empowerment
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Life cycle stage
Pregnant women
Lactating women
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