(P07-011-25) Appropriateness of Different Targeting Criteria for Balanced Energy Protein in Rural Bangladesh: Perceptions of Women and Their Family Members

Objectives: Antenatal fortified Balanced Energy Protein (BEP) supplements are an approach that can address maternal undernutrition and low birth weight (weight < 2.5 kg). BEP, however, has relatively high costs, raising the question of whether targeting could improve its cost:benefit ratio. A cluster-randomized controlled trial in northern Bangladesh is examining the impact on birth outcomes of targeting BEP based on maternal low body mass index ( < 18.5 kg/m2) and inadequate gestational weight gain vs a control or untargeted supplementation. Perspectives on the appropriateness of targeted supplementation among trial participants and their families were explored.

Methods: Qualitative in-depth interviews were conducted with 32 women following childbirth. Group interviews were also conducted with 12 husbands and mothers-in-law (MILs) (n=24). Picture cards were used to rank the types of women who could most benefit from BEP, and participants explained their opinion.  Card-ranking data were analyzed for frequency of each card in participants’ top 3 and bottom 3, and qualitative data were analyzed thematically.

Results: Participants resisted the concept of targeting, noting that “All pregnant women need this… Whoever takes it will benefit.  Those who don’t will suffer.” When asked to rank targeting criteria, top responses included poverty (in 57% of women’s top 3) and insufficient diets (55%).  Husbands and MILs also prioritized poverty (in 64% of top 3s), linking poverty with being “unable to afford good food” in interviews.  

Families and women differed on the use of anthropometric targeting.  Targeting based on underweight ranked in the top 3 cards of 57% of the husband and MIL group interviews but only in 15% of women’s. Targeting to screen out overweight exhibited the opposite pattern; 28% vs. 85% respectively.  While women felt that body size was caused by God, asking “what does nutrition have to do with it?” husbands felt, “Those who weigh less should get [BEP] first.” 

Conclusions: Anthropometric criteria are often used to target nutrition interventions but the rationale may not be understood or supported by local populations. In Bangladesh, diet quality and poverty might be more salient and acceptable methods for targeting.

Funding Sources: This work was supported by the Bill and Melinda Gates Foundation.