Assessing the Feasibility of Integrating Maternal Nutrition Interventions Into an Existing MNCH Platform in Bangladesh

Inadequate maternal nutrition is likely to undermine the potential impact of IYCF
improvements made in the Alive & Thrive (A&T) first phase because it is linked to poor fetal
growth leading to small-for-gestational age and pre-term newborns. These babies do not
respond to growth promoting feeding practices as well as normal newborns do (WHO Healthy
Growth project). In a study of 16,290 singleton infants born in rural Bangladesh from 2004 to
2007, more than 50% were born with low birth-weight. Low birth-weight is a risk factor for
neonatal deaths, estimated to be 37 per 1,000 live births in Bangladesh. Factors associated
with low birth-weight include young maternal age, poor pre-pregnant nutritional status, short
birth intervals, poor maternal dietary intake (quality, quantity, and diversity), and
inadequate pregnancy weight gain. Better maternal nutrition will improve maternal and newborn
outcomes and facilitate achievement of a continuum of good nutrition.

In setting its country program goal for Bangladesh in phase 2, Alive & Thrive decided to
focus on demonstrating the feasibility of integrating a package of maternal nutrition
interventions in a large-scale MNCH program. Maternal nutrition should receive equal priority
as child nutrition and the A&T program of BRAC already has developed an effective strategy
though improving IYCF practices. MNCH programs offer the best opportunity for achieving large
scale and sustainability. The GOB also promotes mainstreaming of nutrition intervention in
health services. Considering the behavior change focus of the Alive & Thrive strategy,
efforts will concentrate on improving dietary practices, specifically, improved diversity of
foods and energy intakes of pregnant women, and improve the intake of calcium and iron/folic
acid supplements. BRAC's supply system will be used to ensure access to calcium and
iron/folic acid supplements. The current Government of Bangladesh guidelines of supplementing
pregnant women with iron and folic acid and calcium, taken with food (to minimize adverse
effects) would be a focus of behavior change interventions.

The primary objectives of the proposed evaluation are to answer the following questions using
a cluster-randomized evaluation design:

- Can the coverage and utilization of key maternal nutrition interventions be improved
equitably by integrating nutrition-focused BCC and community mobilization into BRAC's
rural MNCH program?

- What factors affect high quality integration of nutrition interventions into a
well-established MNCH program platform?

Secondary objectives are to examine the following question:

• Can an intensive, formative-research based BCC intervention for maternal nutrition improve
the quality of diets of pregnant women in rural Bangladesh and facilitate better early
breastfeeding practices than via routine MNCH services?

Inclusion Criteria:

- Recently delivered women with children <6 months of age

- Pregnant women in second and third trimester and her husbands

- Frontline health workers in the areas

Exclusion Criteria:

- Age <18

- Mental disorders that cannot understand and answer the questions