Abstract
Despite poverty reduction and increased promotion of improved nutrition practices in the community, undernutrition in Ethiopia remains a concern. The present study aimed to explore the demand and supply side barriers that limit the uptake of nutrition services among pregnant women from the rural communities of the Tigray Region, Northern Ethiopia. A community-based qualitative study was conducted in December through January 2017. A total of 90 key informant in-depth interviews and 14 focus group discussions were undertaken. Study participants were purposively selected for specific characteristics, along with health professionals deployed at various levels of the health system, including health posts, health centers, woreda health offices, and the regional health bureau. Study participants were asked to identify the barriers and implementation challenges that limit access to nutrition services for pregnant women. Participants’ responses were transcribed verbatim, without editing the grammar, to avoid losing meaning. The data were imported to ATLAS.ti 7 (qualitative data analysis software) for coding and analyzed using a thematic content analysis approach. The study findings indicated that the dietary quality of pregnant women in the study area remains poor and in some cases, poorer quality than pre-pregnancy. Across study sites, heavy workloads, food taboos and avoidances, low husband support, lack of economic resources, lack of awareness, low educational level of women, poor dietary habits, increased expenditure for cultural and religious festivities, “dependency syndrome”, low physical access to health facilities, poorly equipped health facilities, focus on child health and nutrition, poor coordination among nutrition specific and sensitive sectors, and limited sources of nutrition information were identified as the demand and supply side barriers limiting the uptake of nutrition services during pregnancy. In conclusion, the community would benefit from improved social behavior change communication on nutrition during pregnancy and multi-sectoral coordination among nutrition-specific and nutrition-sensitive sectors.
Highlights
Appropriate nutrition during pregnancy is key to the wellbeing of both the mother and child [1].Undernutrition among pregnant women is clearly linked to negative maternal health outcomes, including the risk of maternal mortality and negative pregnancy outcomes [2]
Methods and Materials was to explore the demand and supply side barriers that limit the uptake of nutrition services during pregnancy among pregnant women from rural communities of Ethiopia
Maternal factors; household factors; community factors; and health/nutrition service factors were identified as the demand and supply barriers that limit the uptake of nutrition services during pregnancy
Summary
Appropriate nutrition during pregnancy is key to the wellbeing of both the mother and child [1].Undernutrition among pregnant women is clearly linked to negative maternal health outcomes, including the risk of maternal mortality and negative pregnancy outcomes [2]. Adequate weight gain during pregnancy is important for optimal fetal growth and development and for maternal fat store deposits [4]. Research indicates the outcomes associated with undernutrition during pregnancy include low birth weight, preterm birth, micronutrient deficiencies, low nutrient stores in infants, fetal growth restriction, perinatal mortality, child stunting, later adulthood chronic diseases, and maternal mortality [5,6]. One quarter of all newborn deaths related to undernutrition may be linked to poor maternal nutrition during pregnancy and fetal undernutrition [5,7]. Anemia during pregnancy has been identified as an underlying cause in approximately 20% of maternal deaths and is a key contributor to short stature (stunting) [8], a consequence of chronic undernutrition during early childhood [9]. Malnutrition during pregnancy has far-reaching consequences as it can serve as a fertile ground for perpetuating the intergenerational cycle of malnutrition in women and their newborn children [10,11]
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