Missed opportunities for delivering nutrition interventions in first 1000 days of life in India: insights from the National Family Health Survey, 2006 and 2016

Abstract

ObjectivesExisting health and community nutrition systems have the potential to deliver many nutrition interventions. However, the coverage of nutrition interventions across the delivery platforms of these systems has not been uniform. We (1) examined the opportunity gaps between delivery platforms and corresponding nutrition interventions through the continuum of care in India between 2006 and 2016 and and (2) assessed inequalities in these opportunity gaps.MethodsWe used two rounds of the National Family Health Survey data from 2005 to 2006 and 2015–2016 (n=36 850 and 190 898 mother–child dyads, respectively). We examine the opportunity gaps over time for seven nutrition interventions and their associated delivery platforms at national and state levels. We assessed equality and changes in equality between 2006 and 2016 for opportunity gaps by education, residence, socioeconomic status (SES), public and private platforms.ResultsCoverage of nutrition interventions was consistently lower than the reach of their associated delivery platforms; opportunity gaps ranging from 9 to 32 percentage points (pp) during the pregnancy, 17 pp during delivery and 9–26 pp during childhood in 2006. Between 2006 and 2016, coverage improved for most indicators, but coverage increases for nutrition interventions was lower than for associated delivery platforms. The opportunity gaps were larger among women with higher education (22–57 pp in 2016), higher SES status and living in urban areas (23–57 pp), despite higher coverage of most interventions and the delivery platforms among these groups. Opportunity gaps vary tremendously by state with the highest gaps observed in Tripura, Andaman and Nicobar islands, and Punjab for different indicators.ConclusionsIndia’s progress in coverage of health and nutrition interventions in the last decade is promising, but both opportunity and equality gaps remained. It is critical to close these gaps by addressing policy and programmatic delivery systems bottlenecks to achieve universal coverage for both health and nutrition within the delivery system.

Process of developing models of maternal nutrition interventions integrated into antenatal care services in Bangladesh, Burkina Faso, Ethiopia and India

“… Information on national policies and state ANC services (Nguyen, Avula, et al, 2021) Formative research on dietary patterns, food availability, taboos and influences, channels of communication and IFA sources (CMS, 2015)…”

Gaps in the implementation and uptake of maternal nutrition interventions in antenatal care services in Bangladesh, Burkina Faso, Ethiopia and India

“…Despite this evidence, the coverage of nutrition interventions is far lower than the reach of their associated health service platforms (Heidkamp et al, 2020). In India (UP state), only half of pregnant women who attended ANC reported consuming iron and folic acid (IFA), and substantially fewer women initiated breastfeeding within one hour after delivery, as compared with the proportion of women who delivered in health facilities (Nguyen et al, 2021). Reducing missed opportunities for nutrition in health services offers high potential payoffs for improving maternal and infant nutrition (Heidkamp et al, 2021).…”

Using scenario‐based assessments to examine the feasibility of integrating preventive nutrition services through the primary health care system in Bangladesh

“…A feasible mix of providers supported by relevant skill strengthening is necessary. Providing nutrition services through proposed platforms may also require additional nutrition‐focused staff, collaborating with NGO partners, and incentivizing workers (Heidkamp et al, 2020 ; Nguyen, Avula, et al, 2021 ). The Government of Bangladesh has introduced community‐level Multipurpose Health Volunteers who could be leveraged with cross‐operation plan collaboration under the leadership of National Nutrition Services to create demand and utilization of preventive nutrition service platform.…”

“…A feasible mix of providers supported by relevant skill strengthening is necessary. Providing nutrition services through proposed platforms may also require additional nutrition-focused staff, collaborating with NGO partners, and incentivizing workers (Heidkamp et al, 2020;Nguyen, Avula, et al, 2021). The Government Over the years there have been consistent increases in ANCseeking, facility delivery and care-seeking for childhood illness (Billah et al, 2017).…”