Strengthening access to nutrition and healthcare services for pregnant women and newborns

Supporting SDG 3: towards universal coverage

Nutrition International is focused on improving nutrition for the world’s most vulnerable, especially women and girls. This includes helping more pregnant women and their newborns receive access to essential health care services, medicines and other commodities, including vitamins and minerals.

In collaboration with governments and key partners, and through support from the Government of Canada through Global Affairs Canada, we undertook an extensive five-year research project in four African communities to increase access to antenatal care (ANC), birth care and postnatal care (PNC) for pregnant women and their newborns.

The challenge in Zinder, Niger

Malnutrition among pregnant women is believed to be a serious problem in Niger, but there is only limited information available about their nutritional status and about the factors that contribute to the problem.

As an indication of the scope of the problem, the results of a 2008 nutrition survey showed that 46% of all women in the country were anaemic. Given the greater nutritional needs during pregnancy, it is assumed that this rate is considerably higher among pregnant women.

The Ministry of Health of Niger has in place a set of policies related to maternal nutrition that are well-aligned with global best practice. But without thorough data about the current health and nutritional status of pregnant women, it is not known whether the prescribed interventions meet the current needs.

More information is needed about the risk factors among pregnant women, the barriers that prevent them from receiving care, the quality of services, and the adoption of health and nutrition practices. With this data, appropriate and effective interventions need to be developed and implemented.

Project overview

A comprehensive study and pilot project was undertaken to strengthen uptake, quality of care and access to antenatal care (ANC) in rural Niger that will ultimately guide the government of Niger’s development of a revitalized maternal health policy.

2,305 women were reached through this in-depth research study. Niger’s Ministry of Health is currently working on a five-year strategic plan for nutrition. The findings of the research study should guide the development of this plan.

Key Components

  • Qualitative assessment of belief, barrier, and enabler factors for ANC and pregnancy outcomes and the quality of prenatal care services evaluated at the health centre.
  • Baseline survey to assess the nutritional status (weight, height, presence of anaemia, and biomarkers of iron and vitamin A status) and stage of pregnancy in pregnant women.
  • Optimization strategy to improve antenatal care uptake and quality implemented in project districts, which included:
    • ensuring full supply of materials and essential commodities for ANC at health facilities;
    • training pf health facility providers for improved counselling and skills;
    • community volunteers disseminated behaviour change messages for improved uptake of ANC to pregnant women, their families, and community influencers.
  • A rigorous evaluation of the strategy, including an assessment of the nutritional status of pregnant women.

Our impact

  • Promotion of iron and folic acid (IFA) supplements, provided at facility-based ANC, to decrease the prevalence of anaemia in pregnancy at term.
  • Gestational weight monitoring and nutrition counseling throughout pregnancy to ensure adequate gestational weight gain.
  • Promotion of early and adequate ANC visits to increase the percentage of pregnant women who attend at least four ANC visits
  • Malaria prevention



  • The baseline and impact surveys are currently being implemented in all 12 intervention villages and 922 pregnant women have been enrolled.
  • There are 172 community volunteers implementing the Behaviour Change Communication (BCC) component of optimization strategy.
  • Adequate supplies of core commodities provided to all health centers after the facility assessment identified large gaps in the availability of commodities
  • Operational research at the community level assessed knowledge, motivation and job satisfaction of community volunteers as can be seen by the 148 interviews with community health workers trained to conduct BCC sessions
  • Qualitative study is complete and revealed high demand/importance for ANC, but also found issues with quality of care and supply of commodities.
  • The project has leveraged additional financial support from UNICEF to include an iodine intake assessment in both pregnant women and school-aged children, undertaken by UC Davis.
  • The project has generated significant interest from the Ministry of Health, which has taken an active role in overseeing implementation and utilizing results and has resulted in a Project Steering Committee being formed.