The quality of maternal nutrition and infant feeding counselling during antenatal care in South Asia

Abstract

Antenatal care (ANC) provides a platform to counsel pregnant women on maternal nutrition and to prepare the mother to breastfeed. Recent reviews suggest that gaps in the coverage and quality of counselling during pregnancy may partly explain why services do not consistently translate to improved behavioural outcomes in South Asia. This scoping literature review collates evidence on the coverage and quality of counselling on maternal nutrition and infant feeding during ANC in five South Asian countries and the effectiveness of approaches to improve the quality of counselling.Coverage data were extracted from the most recent national surveys, and a scoping review of peer-reviewed and grey literature (1990-2019) was conducted. Only Afghanistan and Pakistan have survey data on the coverage of counselling on both maternal nutrition and breastfeeding, nine studies described the quality of counselling and three studies assessed the effectiveness of interventions to improve the quality of services. This limited body of evidence suggests that inequalities in access to services, gaps in capacity building opportunities for frontline workers and the short duration and frequency of counselling contracts constrain quality, while the format, duration, frequency and content of health worker training, together with supportive supervision, are probable approaches to improve quality. Greater attention is needed to integrate indicators into monitoring and supervision mechanisms, periodic surveys and programme evaluations to assess the status of and track progress in improving quality and to build accountability for quality counselling, while research is needed to understand how best to assess and strengthen quality in specific settings.

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

“…Our study identified substantial data gaps on coverage and quality of maternal nutrition services, which is consistent with previous findings in the Asia region (Torlesse et al, 2021). National surveys and routine monitoring data systems lacked process indicators needed for tracking nutrition interventions in ANC.…”

“…Before the publication of the WHO ANC guidelines in 2016, nutrition interventions received little priority in ANC services. Thus, there is scarce evidence on the content, quality, and factors associated with maternal nutrition interventions (MNIs) during ANC (Benova et al, 2018; Torlesse et al, 2021), other than IFA supplementation (Kavle & Landry, 2018; Sanghvi et al, 2010; Sununtnasuk et al, 2016). This paper provides details on the package of four MNIs as part of ANC in two sub‐Saharan and two South Asian countries (Bangladesh, Burkina Faso, Ethiopia and India).…”

Strengthening Nutrition Interventions in Antenatal Care Services Affects Dietary Intake, Micronutrient Intake, Gestational Weight Gain, and Breastfeeding in Uttar Pradesh, India: Results of a Cluster-Randomized Program Evaluation

“…A recent evidence review on maternal nutrition counseling has highlighted concerns of lack of information related to the coverage and quality of counseling, specifically the format, duration, and frequency of counseling; content of health worker training; and supportive supervision ( 11 ). Our study bridged key evidence gaps by including details of timing and frequency of contacts by service providers, duration and content of counseling, and mode of interactions through home visits and community events.…”

“…Maternal nutrition interventions can be delivered through several platforms; among them, health systems are considered the most effective platform to reach women and children in the first 1000 d ( 10 ). Gaps in coverage and inconsistent quality of counseling on maternal nutrition, however, have hindered the improvement of behavioral outcomes associated with the services ( 11 ). In 2016, the WHO issued new guidelines on antenatal care (ANC) for a positive pregnancy experience ( 12 ), but evidence-based interventions to improve maternal nutrition are currently poorly integrated in ANC services globally ( 3 ).…”

Antenatal care processes in rural Southern Nepal: gaps in and quality of service provision—a cohort study

“…Asian countries. 31 We did not measure the quality of the counselling messaging themselves, only their delivery. However, Torlesse et al's findings may mean that the coverage measures in our population may overestimate the proportion of women who received quality counselling that led to information transfer from provider to client.…”