Maternal anaemia prevalence in low‐income countries is unacceptably high. Our research explored the individual‐, family‐ and community‐level factors affecting antenatal care uptake, iron folic acid (IFA) intake and consumption of micronutrient‐rich diets among pregnant women in the plains of Nepal. We discuss how these findings informed the development of a home visit and community mobilisation intervention to reduce anaemia in pregnancy. We used a qualitative methodology informed by the socio‐ecological framework, conducting semi‐structured interviews with recently pregnant women and key informants, and focus group discussions with mothers‐in‐law and fathers. We found that harmful gender norms restricted women's access to nutrient‐rich food, restricted their mobility and access to antenatal care. These norms also restricted fathers' role to that of the provider, as opposed to the caregiver. Pregnant women, mothers‐in‐law and fathers lacked awareness about iron‐rich foods and how to manage the side effects of IFA. Fathers lacked trust in government health facilities affecting access to care and trust in the efficacy of IFA. Our research informed interventions by (1) informing the development of intervention tools and training; (2) informing the intervention focus to engaging mothers‐in‐law and men to enable behaviour change; and (3) demonstrating the need to work in synergy across individual, family and community levels to address power and positionality, gender norms, trust in health services and harmful norms. Participatory groups and home visits will enable the development and implementation of feasible and acceptable strategies to address family and contextual issues generating knowledge and an enabling environment for behaviour change.

In this article, we discuss the role of participatory video (PV) as a tool for developing community-level solutions to ‘Antimicrobial Resistance’ (AMR) in Nepal. In recent years, PV has become an ever more popular tool in development contexts for supporting communities in low and middle income countries to raise awareness of issues that they do not feel are adequately represented in mainstream media. One area of growing interest in this regard is public health. However, PV has not, to date, been used to address AMR, currently considered to be one of the biggest public health issues we face globally. Placing our project within the wider context of ‘participatory documentary’ practice, we examine the world-view presented in the films this project generated, a dimension of such projects that is, somewhat curiously perhaps, often overlooked, with commentators tending to focus on the process of delivering PV, rather than the final products made. Here we are particularly interested in questions of power and how a close reading of the texts produced highlights the complexity of the power relationships at work in these films, which, in turn, can allow us to reflect in new ways on the processes at work in the project.

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Anaemia in pregnancy is a persistent health problem in Nepal and could be reduced through nutrition counselling and strengthened iron folic acid supplementation programmes. We analysed 24-hour diet recall data from 846 pregnant women in rural plains Nepal, using linear programming to identify the potential for optimised food-based strategies to increase iron adequacy. We then conducted qualitative research to analyse how anaemia was defined and recognised, how families used food-based strategies to address anaemia, and the acceptability of optimised food-based strategies. We did 16 interviews of recently pregnant mothers, three focus group discussions with fathers, three focus group discussions with mothers-in-law, and four interviews with key informants. Dietary analyses showed optimised diets did not achieve 100% of recommended iron intakes, but iron intakes could be doubled by increasing intakes of green leaves, egg, and meat. Families sought to address anaemia through food-based strategies but were often unable to because of the perceived expense of providing an ‘energy-giving’ diet. Some foods were avoided because of religious or cultural taboos, or because they were low-status and could evoke social consequences if eaten. There is a need for counselling to offer affordable ways for families to optimise iron adequacy. The participation of communities in tailoring advice to ensure cultural relevance and alignment with local norms is necessary to enable its effectiveness.