Maternal nutrition

Dear Anonymous,

Perhaps if you could explain a little bit more about the context you are designing a Maternal Nutrition intervention in, those on this forum could help suggest tailored interventions.

In terms of IYCF-E, maternal nutrition can be seen as a conduit for child health but women's nutrition is just as important in its own right.

For general guidance on maternal nutrition in emergencies you can refer to http://www.urd.org/IMG/pdf/Maternal_Nutrition_paper_meeting_report-FINAL.pdf

To develop something within your setting, examine women's pre-crisis vulnerability to malnutrition such as their elevated needs due to pregnancy, lactation, menstruation and gender bias in infectious disease, inadequate micronutrient intakes, mental health problems, early marriage and pregnancy, limited autonomy and lower status in household. Which of these were present in your setting? Consider the factors resulting from the emergency which may now be further undermining maternal nutrition and tailor your response to address these. Examples of such factors are reduced intakes, greater time pressures, inadequate food aid, increased risk of mental health problems, gender based violence, disrupted health services and supply chains and limited mobility / autonomy to access humanitarian services. Take into account the greater nutritional needs of breastfeeding women and their greater vulnerability to inadequate intakes.

Interventions could include:
- Additional inexpensive locally available foods.
- Using the most nutritious foods in the general rations e.g. CSB/WSB.
- Additional ration allocation for PLW.
- Inclusion in supplementary feeding programmes
- Targeted micronutrient rich foods
- Sprinkles/multiple micronutrients
- Advice or recipes for food preparation (especially for unfamiliar foods)
- Provision of household items such as cooking equipment, cups etc.
- Voucher and cash schemes e.g. fresh food vouchers
- Education to ensure that meals are prepared hygienically and to an adequate nutrient and energy density (i.e. not too dilute)
- Supplying tools and seeds to enable cultivation
- Strengthening links between livestock and nutrition programming
- M2MSGs focusing on positive behaviours from within the community.
- Vitamin A supplementation in pregnancy and within 6 weeks postpartum
- Iodization of all salt used in food distribution programs
- Counseling, advice and practical support for continued breastfeeding. Reassure mothers that their body stores are being used to maintain breastmilk so they need to eat to maintain their own nutrition status and reassure malnourished mothers with concerns that they are not producing enough breastmilk.

I hope this has helped answer your question

http://www.coregroup.org/storage/documents/Workingpapers/MaternalNutritionDietaryGuide_AED.pdf

http://www.ennonline.net/fex/47/maternal

A life cycle approach would be preferable that can break the inter-generation of malnutrition. As you may know throughout women's entire life cycle, their health and nutrition is affected by complex social, cultural, psychological, biological, and health service–related factors that are highly interrelated. Malnourished women are more likely to have miscarriages or stillbirths or to deliver babies with intrauterine growth retardation (IUGR) or low birth weight, which are linked, in turn, to increased risk of perinatal and infant mortality. An inter-generational cycle of ill health and growth failure in which under nutrition in childhood leads to small body size in adulthood. Poor health and nutrition are associated with repeated, closely spaced pregnancies that progressively reduce women's nutritional reserves and leads to nutritional depletion, known as the maternal depletion syndrome. Women's health and nutrition have to be considered as part of an intergenerational continuum under the reproductive and child health. (i.e., pre- and postnatal care, including family planning, child survival, child development, school health, and adolescent health).Hence the first 1000 days (window of opportunity) is critical time that we need to act to interrupt the intergeneration cycle of malnutrition. The seven essential nutrition action can be your best maternal interventions but as you sked Maternal nutrition only intervention that intended to address the underline and immediate cause of maternal malnutrition interventions are recommended. Of the interventions,
? Improve Micro-nutrients deficiency emphasizing on the common one (iron, iodine, vitamin A, zink,e.t.c
Dietary modification
Parasite control
Fortification
Supplementation
? Improving maternal weight through
Increase caloric intake
Reduce energy expenditure
Reduce caloric depletion
? Improve Maternal height through
Increase birth weight
Enhance infant growth
Improve adolescent growth
? Work on Optimal behaviors that support to improve women’s nutrition, like :
? Early infancy: Exclusive breast feeding to six months of age
? Late infancy and childhood:
- Appropriate complementary feeding from about six months
-Continue frequent on-demand breast feeding to 24 months and beyond
? Pregnancy:
-Increase food intake
-Take iron + folic acid supplements daily
-Reduce workload
? Lactation: -Increase food intake
-Take a high dose vitamin A at delivery
-Reduce workload
-Delay first pregnancy
-Increase birth intervals
? Prevention of Infection specially malaria
? FP
? Screen PLW for malnutrition and link with appropriate treatment and care
? Adolescent girls focused nutrition support
? Girls education and women empowerment
I hope it will help.
Regards
shewa