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Nourishing Wombs: Delivering an Integrated Package of Maternal Nutrition Interventions in Andhra Pradesh and Telangana (India)

Publisher: UNICEF

2 Nourishing wombs iNTroduCTioN Maternal undernutrition is a major cause of poor maternal and fetal outcomes in India. The World Health Organization 2016 guidelines recommend balanced energy and protein supplementation, iron folic acid and calcium supplementation, deworming, weight gain monitoring and counselling on nutrition, family planning, and breastfeeding coupled with efforts to prevent and treat maternal infections as core nutrition interventions for pregnant women. In India, the Integrated Child Development Services (ICDS) programme under the Ministry of Women and Child Development provisions for supplementary food as micronutrient-fortified food and/or energy dense take home ration for pregnant women and breastfeeding mothers at a unit cost of 9.5 Indian rupees in 2017 per women per day for 25 days a month. The supplementary food is intended to provide 600 kcal, 18–20 grams protein and half the recommended dietary allowance of nine essential micronutrients (MWCD, 2010, 2017). The Ministry of Health and Family Welfare delivers iron and folic acid, calcium and deworming tablets, weight gain monitoring, bed nets (malaria-prone areas) and counselling to pregnant women as part of antenatal care services on monthly outreach and facility based antenatal contact points (MOHFW, 2010, 2013, 2014a, 2014b). However, uptake of these services has remained traditionally low. In view of this situation, the state government of erstwhile Andhra Pradesh launched an integrated maternal on-the- spot feeding and counselling programme in 102 high-risk blocks in 2013, which replaced the dry ration with a hot cooked meal, ‘One Full Meal’, to be eaten daily at the anganwadi centre (AWC) for six days a week throughout pregnancy and for six months after delivery over 25 days a month. This platform was tapped for providing supervised micronutrient supplementation (iron and folic acid and calcium) and two counselling sessions per month. Based on the positive experiential evidence, the scheme was universalized in Telangana (Arogya Lakshmi scheme) in 2015 and in Andhra Pradesh (Anna Amrutha Hastham scheme) in 2017. In 2017, it was replicated in specific geographies in four other states – Chhattisgarh, Gujarat, Karnataka and Maharashtra. Given the interest generated by the One Full Meal scheme, as it provides a platform to bundle various nutrition interventions, the State Governments of Andhra Pradesh and Telangana commissioned a study supported by UNICEF. The study objectives were to (i) evaluate on-ground implementation of components of this scheme (meal, health services and counselling) and the recorded Management Information Systems (MIS) data; (ii) seek stakeholder perspectives on what’s working and what’s not; and (iii) explore the potential of this scheme in improving the nutritional profile of the enrolled women.

Author(s): UNICEF India | Views(541)

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