A number of implementation challenges exist for micronutrient supplementation. Access to care is often associated with socioeconomic status and may influence women's access to and use of supplementation programs. For instance, in one study, the highest wealth quintile of pregnant women had the highest use of iron and folic acid supplementation during antenatal care (33). However, even for women who have access to micronutrient supplements, the coverage and quality of micronutrient supplementation programs were limited (39). Incorrect doses, inadequate supplies, and incomplete adherence were major limitations (33), and poorly performing programs had limited impact on nutrition outcomes (59). Integration of supplementation programs with behavior change interventions improved knowledge, adherence, and coverage of supplementation interventions (32, 33, 60). The use of local micronutrient-rich foods can also help overcome limitations associated with supplement provision. In Nepal, improvements in the dark adaptation of night-blind pregnant women did not differ significantly between food and synthetic sources of vitamin A (61). When available, consumption of micronutrient-rich foods can be as effective as micronutrient supplements.
Family planning and birth spacing can influence the nutrition of adolescent girls, women of reproductive age, and women with young children by reducing the number of adverse outcomes associated with pregnancy and abortion. For adolescent girls, in particular, pregnancy is associated with increased risk of birth complications, anemia, hindered linear growth, and loss of educational attainment (8, 107). Delaying early child marriages and providing access to family planning, particularly for young wives, allow girls to achieve their maximum growth potential (8, 142). However, for women with young children, there was scarce evidence from observational studies to suggest that greater birth spacing had any impact on anthropometric status (BMI, weight), micronutrient status (anemia, as well as serum zinc, copper, magnesium, and folate), and maternal mortality outcomes (13, 107, 143–147). Findings were mixed, which was attributed to sample size and other confounding factors such as maternal age, breastfeeding status, and supplementation status (146, 147). The strongest evidence of the impact of birth spacing on women's nutrition was related to increased risk of preterm delivery and maternal anemia in interpregnancy intervals <6 mo (14, 146, 147) and increased risk of pre-eclampsia in intervals >5 y (107).

 Income-generation activities 	Home visits 	 	↑ health knowledge, ↑ health care utilization, ↓ poverty 	↑ nutrition and knowledge, ↓ anemia, ↓/NC night blindness, ↑ intake of vitamin A–rich foods, ↑/NC intake of vegetables, ↑ intake of ASF, ↓ underweight, ↑ health care utilization, ↓ poverty 	↑ health knowledge, ↑ health care utilization, ↓ poverty 

Good sources of iron include liver, kidneys, red meat, poultry, eggs, peas, legumes, dried fruits and dark, green leafy vegetables. Three ounces of cooked chicken liver contains 7.2 mg of iron; a cup of cooked spinach contains 6.4 mg. Your health care professional will probably recommend iron supplements during pregnancy (probably starting at 30 mg per day).
Research from Tufts University nutrition scientists shows that Americans are drinking so much soda and sweet drinks that they provide more daily calories than any other food. Obesity rates are higher for people consuming sweet drinks. Also watch for hidden sugar in the foods you eat. Sugar may appear as corn syrup, dextrose, fructose, fruit juice concentrate or malt syrup, among other forms, on package labels.
A 45-year-old woman who gets less than 30 minutes of daily physical activity in addition to her normal routine should consume six ounce of grains; two and a half cups of vegetables; one and a half cups of fruit; three cups of milk; five ounces of meat and/or beans; five teaspoons of oil; and just 195 calories of additional fat and sugar. With a higher level of daily activity (30 to 60 minutes), this woman would be able to consume a little more in certain food groups: her fruit intake could rise to two cups; meat and beans to five and a half ounces; oils to six teaspoons; and extra fat and sugar to 265 calories.

The new guidelines encourage eating more nutrient-dense food and beverages. Many of us consume too many calories from solid fats, added sugar and refined grains. The guidelines promote a diet that emphasizes vegetables, fruits, whole grains, fat-free or low-fat dairy products, seafood, lean meat and poultry, eggs, beans and peas, and nuts and seeds.
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