Only 40% slum-dwelling women receive recommended antenatal checkups: Study

More than half of all households in Bangladesh's urban slums face food insecurity, and nearly half of children are stunted. Only 40 percent of slum-dwelling women receive the recommended four or more antenatal checkups, compared to over 53 percent in non-slum areas. 

A new study conducted by the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) highlights these alarming disparities, and also offers a path forward.

In a seminar today at Sasakawa Auditorium in Mohakhali, researchers shared evidence from the Bauniabadh slum in Dhaka, where a locally led, integrated nutrition and hygiene programme known as Nutri-CAP has significantly improved the health of pregnant women, adolescent girls, and young children.

Between November 2021 and February 2022, researchers assessed the nutritional status of slum residents through a targeted intervention involving over 16,000 households. Among them, 721 pregnant women, 4,200 adolescent girls, and nearly 2,500 children under the age of two were directly engaged in the programme.

Despite a median household income of Tk21,000, nearly one in four families reported borrowing money for food. Overcrowding was common; 39 percent of households had more than three people per sleeping space. Women contributed to family incomes in 42 percent of cases, and just over a third of household heads had completed primary education.

The Nutri-CAP intervention provided monthly home-based counseling for pregnant women, along with nutritional supplements (iron, folic acid, calcium, vitamin D), and regular monitoring of weight, blood pressure, haemoglobin, and blood sugar. 

These women experienced an average pregnancy weight gain of 8.9 kg – higher than the 7.5 kg seen in the comparison group. They were also more likely to deliver in health facilities and had fewer adverse pregnancy outcomes. The risk of babies being born small-for-gestational-age decreased by 16 percent.

Adolescent girls participating in the programme saw an increase in haemoglobin levels from 12.0 to 12.8 g/dL. Although dietary diversity remained stagnant – likely due to food price inflation – awareness of nutrition improved. Prevalence of thinness among adolescents was recorded at 14.9 percent, with 12.6 percent classified as overweight.

For children under two, there was a marked reduction in growth faltering. Biological markers showed improved gut health and immune function among those in the intervention group. Households also reported lower out-of-pocket healthcare expenses, particularly for mothers and young children.

Dr Mustafa Mahfuz, Principal Investigator of the study, attributed the success to the programme's community-centric design. This model worked because it listened to the community, trained local women, and addressed multiple barriers at once.

Dr Tahmeed Ahmed, Executive Director at icddr,b, emphasised the model's scalability: "Slum dwellers are underserved when it comes to primary healthcare. With its adaptable and locally driven design, the Nutri-CAP model is not only effective but ready to scale."

Mr Edward Cabrera, First Secretary of Development (Health), Global Affairs Canada, said, "By better understanding the crucial nutrition challenges impacting adolescent children and pregnant women among persons living in underprivileged neighbourhoods in urban areas, this project will be able to provide concrete evidence on effective interventions that can lead to better decision-making at the policy level."