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Care for pregnant women before and during birth and for mothers after birth have both a direct biological linkage to stunting reduction and are associated with improved ability for a mother to care for herself and her child.
Literature Review
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Complete antenatal care, particularly during the first trimester of pregnancy, has been identified as having a protective effect against stunting, while lack of antenatal care has been associated with higher stunting rates.1 2 However, data on quality of nutrition-specific interventions targeting pregnant women are limited.
Quantitative Analysis
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Based on the linear mixed effects regression, skilled birth attendance significantly influenced stunting prevalence in the expected direction. This correlation was significant at the 1 percent level but the effect size was small, at 0.07 Cohen’s F2 (compared with PAN, which had an effect size of 1.64).
Antenatal care, however, was not found to be a significant influencer of stunting prevalence.
Driven primarily by the contribution of skilled birth attendance, maternal care under the decomposition analysis is the largest driver of predicted HAZ-score over the 2000-2016 period and was also significant over the 2008-2016 period.
Qualitative Analysis
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Not mentioned specifically. However, maternal care was an important part of several key programs brought up and discussed in interviews (e.g., Juntos, PSMN).
Conclusion
A mother’s own care during pregnancy and delivery is unequivocally essential. The SBA and ANC4+ markers identified in this study extend beyond care for the mother-child pair during pregnancy and delivery (where she, for instance, receives the required knowledge, vaccines, supplements and appropriate hygienic care during these critical periods). SBA and ANC4+ are also markers of a mother’s broader health care knowledge and care-seeking behavior. As such, these prominent indicators could reflect healthier choices and disease prevention and treatment behaviors of the mother.
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1
Mariños-Anticona C, Chaña-Toledo R, Medina-Osis J, Vidal-Anzardo M, Valdez-Huarcaya W. Determinantes sociales de la desnutrición crónica infantil en el Perú. Rev peru epidemiol. 2014;18:1-7.
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2
Casapía M, Joseph SA, Núñez C, Elham R, Gyorkos TW. Parasite and maternal risk factors for malnutrition in preschool-age children in Belen, Peru using the new WHO child growth standards. Br J Nutr [Internet]. 2007;98:1259-66.