Opportunities and barriers for maternal nutrition behavior change: an in-depth qualitative analysis of pregnant women and their families in Uttar Pradesh, India

• Type of Material: Article
• Authors: Neha R Jhaveri, Emory University; Natalia E Poveda, Emory University; Shivani Kachwaha, Johns Hopkins University; Dawn L Comeau, Emory University; Phuong H Nguyen, International Food Policy Research Institute (IFPRI), Washington; Melissa F Young, Emory University
• Language: English
• Date: 2023-07-04
• Publisher: FRONTIERS MEDIA SA
• Publication Version: Preprint (Prior to Peer Review)
• Copyright Statement: © 2023 Jhaveri, Poveda, Kachwaha, Comeau, Nguyen and Young.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3389/fnut.2023.1185696
• Title of Journal or Parent Work: FRONTIERS IN NUTRITION
• Volume: 10
• Start Page: 1185696
• End Page: 1185696
• Grant/Funding Information: This work was supported by the Bill & Melinda Gates Foundation (through Alive & Thrive, managed by FHI Solutions) and Emory University.
• Keywords: Science & Technology; Nutrition & Dietetics; diet diversity; iron and folic acid supplement intake; BANGLADESH; INTERVENTIONS; maternal nutrition; COM-B; antenatal care checkup; MODEL; weight monitoring; PATHWAYS; breastfeeding; calcium supplement intake; Life Sciences & Biomedicine
• Research Categories: Psychology, Behavioral; Health Sciences, Public Health; Health Sciences, Education; Health Sciences, Nutrition

Abstract

Background: Maternal undernutrition during pregnancy remains a critical public health issue in India. While evidence-based interventions exist, poor program implementation and limited uptake of behavior change interventions make addressing undernutrition complex. To address this challenge, Alive & Thrive implemented interventions to strengthen interpersonal counseling, micronutrient supplement provision, and community mobilization through the government antenatal care (ANC) platform in Uttar Pradesh, India. Objective: This qualitative study aimed to: (1) examine pregnant women’s experiences of key nutrition-related behaviors (ANC attendance, consuming a diverse diet, supplement intake, weight gain monitoring, and breastfeeding intentions); (2) examine the influence of family members on these behaviors; and (3) identify key facilitators and barriers that affect behavioral adoption. Methods: We conducted a qualitative study with in-depth interviews with 24 pregnant women, 13 husbands, and 15 mothers-in-law (MIL). We analyzed data through a thematic approach using the Capability-Opportunity-Motivation-Behavior (COM-B) framework. Results: For ANC checkups and maternal weight gain monitoring, key facilitators were frontline worker home visits, convenient transportation, and family support, while the primary barrier was low motivation and lack understanding of the importance of ANC checkups. For dietary diversity, there was high reported capability (knowledge related to the key behavior) and most family members were aware of key recommendations; however, structural opportunity barriers (financial strain, lack of food availability and accessibility) prevented behavioral change. Opportunity ranked high for iron and folic acid supplement (IFA) intake, but was not consistently consumed due to side effects. Conversely, lack of supply was the largest barrier for calcium supplement intake. For breastfeeding, there was low overall capability and several participants described receiving inaccurate counseling messages. Conclusion: Key drivers of maternal nutrition behavior adoption were indicator specific and varied across the capability-opportunity-motivation behavior change spectrum. Findings from this study can help to strengthen future program effectiveness by identifying specific areas of program improvement.