2. Nutrition: Nutrition may be defined as the science of
food and its relationship to health.
It is concerned primarily with the part played by
nutrients in body growth, development and
maintenance
Nutritional status is the current body status, of a
person or a population group, related to their state of
nourishment (the consumption and utilization of
nutrients).
4. Maternal Nutrition Indicators in India
Women age 20-24 years married before age 18 years is
Mothers who had at-least 4 antenatal check-ups was
Mothers who consumed iron folic acid for 100 days or more when they were
pregnant
Mothers who had full antenatal care is
Registered pregnancies for which the mother received Mother and Child
Protection(MCP) card is
Women whose Body Mass Index (BMI) is below normal (BMI < 18.5 kg/m2) is
Pregnant women age 15-49 years who are anaemic (<11.0 g/dl) is
MMR
IMR
27
%
21
%
51%
30
%
89% 23
%
50
%167
41
48
58
%
30
%
80
%
3%
10
%
14%
39
%
208
8. Major Issues in Maternal Nutrition
Inadequate weight and height
Micronutrient deficiencies
9. What is Malnutrition?
Undernutrition
- BMI < 18.5
- Short Stature (<145 cm)
Overnutrition
- Overweight (BMI > 23)
- Obese (BMI > 25)
Micronutrient Deficiencies
- can coexist with undernutrition & Overnutrition
10. Maternal Malnutrition – Magnitude of Problem
Undernutrition
- In India, 22.9% adult women with BMI < 18.5 (NFHS-4)
- In Bihar, 30.4%
– Short stature (<145 cm)
Overnutrition
– In India, 20.7% adult women with BMI > 23 (NFHS-4)
- In Bihar, 11.7%
11. Consequences of Women’s Chronic Energy
Deficiency
Infections
Obstructed labor
Maternal mortality
Low birth weight
Neonatal and infant mortality
12. The Intergenerational Cycle of Malnutrition
Child growth failure
Early
pregnancy
Small adult women
Low birth
weight babies
Low weight and
height in teens
ACC/SCN, 1992
13.
14. Determinants of Intrauterine Growth Retardation
Low pre-pregnancy weight
Short stature
Low caloric intake
Maternal low birth-weight
Non nutritional factors
Kramer, 1989
15.
16.
17. Micronutrient deficiencies in women
Anaemia
– About half of anaemiais due to iron deficiency
- 50% prevalence in India, 58% prevalence in Bihar
Iodine deficiency disorders (IDD)
– 28.5% (population wide based on urinary iodine concentration <100ug/L)
– Pregnant women are also quite at risk of IDD but there is limited data on IDD
in pregnant women
Vitamin A deficiency
– 15.3% -19.1 million pregnant women (based on SR<0.70 umol/L)
19. Dietary Iron Requirements Throughout the Life
Cycle
Required iron intake
(mg Fe/1000 kcal)
Stoltzfus, 1997
Age (years)
Pregnancy
0
2
4
6
8
10
12
0 10 20 30 40 50 60 70
Men
Women
20. Consequences of Anaemia and Iron Deficiency
Maternal deaths
- Anaemia during pregnancy is a risk factor
for more than a quarter of maternal
deaths
Low Birth Weight
Prematurity
Reduced transfer of Iron to Fetus
Neonatal mortality
27. Major Interventions in Maternal Nutrition
Improve weight and height
Improve micronutrient status
28. How to??
Nutritional Interventions
Counseling on healthy eating (dietary diversity, balanced
protein energy intake, and food quantity)
Breastfeeding promotion and support
Measuring weight
Daily Calcium supplementation
Daily oral iron and folic acid supplementation
29. How to??
Assessments & Health System Interventions
Adequate number of ANC contacts starting in the first
trimester during pregnancy
Community-based interventions to improve communication
and support
Recruitment and retention of staff and task-shifting of
components of ANC
31. Gestational Weight Gain Monitoring:
BMI Ideal weight gain
during pregnancy
Underweight <
18.50
13–18
Normal weight
18.50–24.99
11–16
Overweight ≥ 25.00 7–11
Obese ≥ 30.00 5–9
Developed by Institute of Medicine; adopted by
WHO and UNICEF.
32. Programs Addressing Maternal Nutrition in India
Janani Suraksha Yojana (JSY)
RMNCH + A Strategy
Janani Shishu Suraksha Karyakram (JSSK)
Integrated Child Development Services Scheme (ICDS)
Kishori Shakti Yojana & SABALA
Iron + Initiative & WIFS
NIDDCP
PMSMA
MAA
35. Nutrition continues as important part of Sustainable
Development Goals (SDGs)
Goal 2: End hunger, achieve food security and improved nutrition and promote sustainable
agriculture.
By 2030, end all forms of malnutrition, including achieving, by 2025, the internationally agreed
targets on stunting and wasting in children under 5 years of age, and address the nutritional
needs of adolescent girls, pregnant and lactating women and older persons
Goal 3: Ensure healthy lives and promote well-being for all at all ages.
By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000
live births
By 2030, end preventable deaths of new-borns and children under 5 years of age, with all
countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and
under-5 mortality to at least as low as 25 per 1,000 live births
35
36. Recommendations & Guidelines
Intervention Recommendation Guidance
Energy & Protein
Supplementation during
Pregnancy
+ 350 Kcal (Pregnancy)
+ 600-520 Kcal (Lactation)
No recent guidelines
Nutritional Counselling Counseling through food
based dietary guidelines
recommended
No recent guidelines
Iron-folic acid (IFA)
supplementation
100 mg Elemental Iron & 500
mcg Folic Acid daily for 100
days antenatal & Postnatal
NRHM, Iron + initiative
WIFS for adolescent girls Iron + initiative
Iodine Supplementation Salt Fortification NIDDCP
Vitamin A supplementation
(in 3rdtrimester)
Only recommended in areas
of severe Vitamin A deficiency
to prevent night blindness.
WHO Guideline 2011 Vitamin
A supplementation in
pregnant women
37. Recommendations & Guidelines
Interventions Recommendations Guidelines
Calcium
supplementation
In populations where low
intake of calcium
WHO Recommendation
2013
Calcium supplementation
In pregnant women
42. Training of Healthcare staff
Training and orientation of all healthcare staff
of Community Medicine, Gynaecology and
Pediatrics departments of DMCH
Faculty, Residents, Para-medical staff including nurses, lab
technicians and counselors, Non-clinical staff and fourth grade
employees
Training of 4 days for nurses and 1 day for
others
43. IYCF Counseling Center at DMCH
Two centers established in
Deptt. of Obs. & Gynae focusing on ANC and post-natal cases
At preventive clinic – IYCF services are provided by counselor who
visits Immunization Clinic, Pediatrics OPD and Pediatrics IPD
Around 950 mothers counseled per month
No pre-lacteal feeding
No bottle feeding
44. Field experiences
Trained MAMTAs doing more or less optimum
counseling to post-natal cases
Group counseling in wards
Complementary feeding is almost neglected
Unavailability of separate IYCF counselor in most
of the districts- RMNCH Counselor given task of
IYCF, deaddicion FP etc.
No referral system from Immunization and Child
OPD in many districts
46. Comparison
Strategy/Service South Africa India
1000 days SUN Framework - Roadmap No Roadmap
Continuum of Care Community -> PHC ->
Hospital
Weak
Promotion of EBF &
Complementary feeding
Strong (IYCF, IMCI) Moderate (IYCF, IMNCI)
Nutritional Assessment of
Mothers
Strong Weak
Healthy Eating and optimal
weight management
Moderate (School health
services)
Weak
Improved hygiene practices
including hand washing
Moderate Moderate
47. References
1. Comprehensive Implementation Plan on Maternal, Infant & Young Child Nutrition, WHO, 2014
2. WHO recommendations on antenatal care for positive pregnancy experience, WHO, 2016
3. Scaling Up Nutrition A Framework For Action September 2010
4. Roadmap for Nutrition in South Africa, 2013-2017
5. Guidance for Formative Research on Maternal Nutrition for Prepared for the Infant and Young
Child Nutrition Project, The Manoff Group, August, 2011
6. Implementation manual, community based maternal nutrition program, Bangladesh, 2017
7. Essentials of Nutrition for Women. E-Course on Programming for IYCF, UNICEF and Cornell
University. 2015.
8. Dietary guidelines for Indians – A Manual, National Institute of Nutrition, ICMR, 2011
9. Maternal & Child Nutrition, October 2011, Vol. 7, Supplement 3
48. “Life is a flame that is always
burning itself out, but it catches
fire again every time a child is
born.”
