Pregnancy is the most momentous nutritionally challenging phase of every woman’s life. During pregnancy, several physiological, anatomical and biochemical changes transpires in women’s bodies [1, 2]. Due to these biological changes, women’s bodies require enough nutrients. The high demand for growth of new tissue, growth of existing maternal tissues makes them highly vulnerable to malnutrition in pregnancy period [3]. That’s why pregnant women should maintain optimal dietary practices and thereby should eat diversified foods containing sufficient amounts of carbohydrates, fiber, protein, vitamins and minerals etc [4, 5].
Dietary practice is normally defined as one’s sentient, collective and observable repetitive behaviors in terms of selecting and consuming certain foods and water [6]. The dietary practices can be classified as good dietary practices and poor dietary practices. The occurrence of nutrient inadequacies in women’s body as a sequel of poor dietary patterns is frequent during pregnancy as compared to any other phase of life circle. Most of the time, nutrients intakes of mothers are not satisfactory to meet their high nutrient demands [7, 8]. Globally, the number of pregnant and breastfeeding women suffering from acute malnutrition has been soared from 5.5 million in 2020 to 6.9 million in 2023, as per recent estimates shown by UNICEF [9]. The majority of pregnant women in lower and middle-income countries like India suffers from nutrient inadequacies in comparison to the standard recommendations of World Health Organizations [10].
Inadequate intake of required nutrients including energy, vitamins, iron, protein, minerals, carbohydrates along with different environmental and socio-economic factors ensue different pregnancy related complications such as pre-eclampsia or eclampsia, anaemia, and sometimes maternal mortality [11, 12]. Not only that, it also adversely gives birth the low birth weight of babies, intrauterine growth retardation, child malnutrition and child mortality also [13, 14]. Apart from reproductive and child health aspects, deficiencies of nutritious diet causes suffering from different chronic illnesses such as type-2 diabetes, hypertension, cardiovascular disease and nowadays frequent multimorbidity of reproductive women which in turn may lead to critical reproductive and child health issues in the early as well as later phases of life cycle [15, 16].
Nutritional knowledge, dietary information, different maternal and child health care practices including attending antenatal care, breastfeeding practices; access to healthcare services, assistance received from Governmental schemes and policies, maternal education, age, monthly income, family size, mass media exposure, husband’s occupation, poverty, household food security, environment etc. are some of the important determining factors influencing dietary intake among the reproductive women [17, 18, 19, 20, 21, 22].
The factors associated with the dietary intake practices of reproductive women can be discussed by separating into two distinguished period or phases; one is antepartum period that extends from conception to birth and another one is post-partum period that begins immediately after child birth and typically lasts six to eight weeks. Among the above mentioned different factors, some are closely related to antepartum period and some are of post-partum period with definite socio-economic characteristic background of individual women for both the periods.
Attending antenatal care is crucial antepartum maternal healthcare service whereas breastfeeding practices are post-partum period child healthcare practices and in fact both the mentioned one have large influence on dietary intake practices of reproductive women. In India the ASHA community worker constantly executes their services to the women during both in antepartum and post-partum period. Accredited Social Health Activists (ASHAs) are culturally sensitive trained volunteers and educators whose main intent is to improve maternal and child healthcare services by arriving at the doorstep of marginalized communities especially in rural areas that do not commonly avail any health care services, helps pregnant women by accessing antenatal care visit and make them comply with right nutritional intake during antepartum and postpartum period, providing cash incentives to the poorest populations [23, 24]. Financial assistance from Janani Suraksha Yojana (JSY) scheme are also received during post-partum period by the women, have an influence on appropriate nutritional intake of pregnant women. Janani Suraksha Yojana (JSY) is basically a maternity benefit scheme launched by the Government of India in 2005 under the National Rural Health Mission (NRHM). It aims to reduce maternal and neonatal mortality by strengthening healthcare infrastructure at grassroots levels. It provides cash incentives to pregnant women, especially those from below poverty line (BPL) families, scheduled caste (SC) and scheduled tribe (ST) families. The financial assistance received from JSY helps low-income women so that they can afford nutritious foods.
Earlier literature highlighted factors influencing maternal dietary intake practices for different country context but limited studies explored this vital issue in Indian context since, India is currently facing a growing burden of maternal undernutrition. Even, whatever studies done so far in India, mainly concentrated only the socio-economic factors associated with the pattern of maternal dietary intake. Although requiring special attention on this issue, there are till now a very few studies found in India focusing on various identifiable factors basically rely on different maternal and child healthcare support and practices of antepartum and post-partum period on dietary intake pattern. Creating nutritional awareness and to provide basic health care among the rural and socio-economically poor reproductive women, the role of ASHA worker can’t be ignored. This study also attempts to highlight the role of ASHA in improving the nutritional status of mothers. Not only this, despite of adopting different maternal health schemes and programmes by the Indian Government (Govt.), poor nutritional status of pregnant women still continues to be a serious maternal health issue in India. So, it is becoming necessary to unfold this particular domain holistically keeping the importance of antepartum and post-partum health care support and practices on dietary intake practices. Therefore, this present study aims to determine the association of different antepartum and post-partum health care support and practices with dietary intake of the reproductive-age women in India who had a live birth in five years preceding the survey.
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