In November 2016, the World Health Organization (WHO)’s Recommendations on antenatal care for a positive pregnancy experience presented 49 guidelines to ensure safer and healthier pregnancies. Fourteen of these guidelines were nutrition-related, presenting a renewed opportunity to bring attention to, and improve, maternal nutrition during the critical window of pregnancy.

Maternal nutrition is crucial for the health of the mother and for ensuring healthy fetal growth and development. The first 1000 days, from conception to a child’s second birthday, is a critical time when good nutritional status can reduce the risk of negative maternal and perinatal birth outcomes, and can have lasting effects on the health of the child and wellbeing of the mother.

Comprehensive maternal nutrition services recommended in all settings include addressing dietary practices to promote healthy eating, daily iron-folic acid (IFA) supplementation, calcium supplementation when required, adequate weight gain guided by weight measurement, adequate rest during pregnancy, and supporting the intent to breastfeed exclusively for the newborn’s first six months of life. The WHO guidelines also make recommendations for context-dependent services to ensure appropriate care in all settings.

Nutrition International and UNICEF have partnered to deliver two regional workshops in Africa and Asia, highlighting and sharing the evidence behind, and tools for, intensified action around scaling up or implementing comprehensive maternal nutrition services in antenatal care (ANC).

The first of these workshops was held in Kathmandu, Nepal from May 7 to 9, 2018. Stop Stunting: The Power of Maternal Nutrition brought together government representatives, researchers, UN partners, civil society organizations and other development partners from across the region to discuss and identify actions to accelerate the nutritional care of women during pregnancy and postpartum in South Asia.

The three day workshop generated 10 calls to action to accelerate progress in the nutritional care of women during pregnancy and postpartum:

• National policies and guidelines on maternal nutrition should be in line with evidence-based global recommendations, adapted to the country context.
• Maternal nutrition should be prioritized in national development agendas, and sectoral plans and budgets.
• Greater attention is needed to operationalize national policies and plans on maternal nutrition at the subnational level.
• Service delivery platforms should maximize the opportunities to reach women and families with maternal nutrition interventions.
• Service delivery packages should include context-specific interventions according to the prevalence of malnutrition and the local context.
• Evidence-informed social and behaviour change communication is needed to improve nutrition behaviours, with priority given to improving the dietary intake of women.
• National health and nutrition information systems and surveys should include appropriate indicators to track program performance and progress towards national and global targets on maternal nutrition.
• Implementation research is needed to understand the barriers, enablers and pathways to delivering maternal nutrition interventions at scale with equity.
• Investments are needed from multiple sectors to improve maternal nutrition.
• Regional leadership and platforms on nutrition is needed to support country level actions and facilitate country exchange of knowledge and experience.

Nutrition International has been supporting national and regional governments of high-need countries in their iron-folic acid (IFA) supplementation in pregnancy programming for more than 10 years. While IFA supplementation in pregnancy continues to require attention and full scale-up, many other components of comprehensive maternal nutrition services, such as culturally-resonant, evidence-based dietary counselling, are not being effectively implemented – or implemented at all – in low and middle income countries. With the evidence around the importance of nutrition during pregnancy, as well as gaps in programming, so clearly defined, it is the responsibility of the nutrition community to bring more focus and support to assist countries in intensifying their comprehensive maternal nutrition services.

Through these two workshops and a continued partnership, Nutrition International and UNICEF aim to place maternal nutrition and its impact in the broader context of women’s development, sexual and reproductive rights, child health, and the double burden of malnutrition, and to garner increased government support and investment. By identifying the crucial gaps that exist and improving capabilities to integrate comprehensive maternal nutrition services into ANC, the results have the potential to enhance long-term health and wellness of women and their children on a large scale and for future generations.

The second workshop is tentatively scheduled for October 2018 in Dakar, Senegal.

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