The delivery of nutrition education reached women across all life stages and through many platforms. Many nutrition education studies that targeted pregnant and lactating mothers reported on women's outcomes, but the primary focus of many of these studies was child health outcomes (13, 14, 19, 21, 24, 28); few studies focused on dietary outcomes and behaviors of pregnant and lactating women themselves (17, 20, 23). There were some studies evaluating the impact of nutrition education on the practices and outcomes of school-age children and adolescent girls (15, 18, 27, 29, 34), as well as older women (16, 22, 25, 30). Many of the nutrition education interventions were clinic-based (17–20, 23, 24). However, nutrition education was also delivered through community-based programs, including home visits (16, 21), community centers (15, 16, 20, 21), worksites (25), and schools (25, 27, 30, 34).
Our review highlighted how a focus on delivery platforms could indicate who is missed by different nutrition interventions, by evaluating where there is overlap or divergence in where interventions are delivered (as represented in the Venn diagram in Figure 1). Our findings showed that a large proportion of nutrition-specific interventions were delivered at clinic-based settings or community-based health posts. Health centers are important delivery platforms, particularly for pregnant and lactating women (113, 210). However, only half of women worldwide even attend the appropriate number of antenatal care visits (with nearly 86% of women attending 1 visit) and only 59% receive appropriate postnatal care (211). Other delivery platforms, such as schools and universities, were more effective at reaching some adolescents and women of reproductive age. However, interventions delivered at “facilities” (schools, health clinics, health posts) require participation with those facilities, and participation is often limited because of time, costs, distance, and other responsibilities, including work and childcare (116). Facilities-based care is also more likely to miss certain groups, including older women.
Community centers ↑ MN provision, ↑ health care utilization, ↑ knowledge about FP, ↑/NC use of FP ↑ MN provision, ↑ health care utilization, ↑ knowledge about FP, ↑/NC use of FP ↑ knowledge about nutritional needs, ↑ MN provision, ↓/NC maternal mortality, ↓ parasitemia, ↑ health care utilization, ↑ hospital deliveries, ↑ knowledge about FP, ↑/NC use of FP, ↑ STI testing
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There has been an international effort to reduce this practice, and in many countries eighteen is the legal age of marriage. Organizations with campaigns to end child marriage include the United Nations and its agencies, such as the Office of the High Commissioner for Human Rights, UNFPA, UNICEF and WHO. Like many global issues affecting women's health, poverty and gender inequality are root causes, and any campaign to change cultural attitudes has to address these. Child marriage is the subject of international conventions and agreements such as The Convention on the Elimination of All Forms of Discrimination against Women (CEDAW, 1979) (article 16) and the Universal Declaration of Human Rights and in 2014 a summit conference (Girl Summit) co-hosted by UNICEF and the UK was held in London (see illustration) to address this issue together with FGM/C. Later that same year the General Assembly of the United Nations passed a resolution, which inter alia
Our findings identified gaps and limitations in the evaluation, scope, targeting, and delivery platforms of nutrition interventions in low- and middle-income countries. First, the monitoring and evaluation of nutrition programs that reported on women's nutrition outcomes was generally inadequate. Many of the studies we identified included small-scale efficacy trials. Although there were many large-scale programs that targeted women and adolescent girls with nutrition-specific and nutrition-sensitive approaches, they lacked rigorous evaluation. Whether the evidence about women's outcomes was limited because they are not systematically measured or because they are not well reported is not clear. Negative results are often not published, and many evaluations of nutrition interventions that are conducted by the same groups responsible for implementing them are typically presented positively. This may have also skewed our findings. More intentional research-quality program evaluation, including of large-scale programs, would provide a stronger evidence base. Of the studies identified in this review, many reported on short-term findings such as changes in knowledge, dietary behaviors, and program coverage. They were limited in their ability to report clinical and anthropometric outcomes for women, the duration of those outcomes, and the feasibility of scaling up programs. There is also a need for systematic, long-term evaluations of interventions whose effects on nutrition outcomes are more distal (e.g., nutrition education compared with micronutrient supplementation). The effects of multisectoral interventions are even more complex to measure. However, frameworks exist to evaluate complex interventions (102) and could be utilized to evaluate the impact of interventions across the life course.