INEQUALITY IN IRON FOLIC ACID CONSUMPTION AND DIETARY DIVERSITY IN PREGNANT WOMEN FOLLOWING EXPOSURE TO MATERNAL NUTRITION INTERVENTIONS IN THREE LOW- AND MIDDLE-INCOME COUNTRIES.

Abstract

Research is available on improved coverage and practices from several large-scale maternal nutrition programs, but not much is known on change in inequalities. This study analyses wealth- and education-inequality using Erreygers and Concentration indices for four indicators: adequate IFA consumption, women's dietary diversity, and counseling on IFA and dietary diversity. A pretest-post-test, control group design. Maternal nutrition intervention programs conducted in Bangladesh, Burkina Faso, and Ethiopia during 2015-2022. Recently delivered women (RDW) and pregnant women (PW). Statistically significant reductions in education inequality were observed for adequate IFA consumption, counselling on IFA and dietary diversity in intervention areas of Bangladesh, and for adequate IFA consumption in intervention areas of Burkina Faso.A significant decrease in wealth inequality was observed for adequate IFA consumption in the intervention areas of Bangladesh whereas a significant increase was observed in the non-intervention areas for counselling on IFA in Ethiopia and for dietary diversity in Burkina Faso. The results can be attributed to the extensive delivery system at community level in Bangladesh and being predominantly facility-based in the Burkina Faso and Ethiopia. COVID-19 disruptions (in Burkina Faso and Ethiopia) and indicator choice also had a role in the results.The main take-aways for nutrition programs are a) assess equality issues through formative studies during designing, b) monitor inequality indicators during implementation, c) diligently address inequality through targeted interventions, setting aside resources and motivating frontline workers to reduce disparities, and d) make equality analysis a routine part of impact evaluations.