Table 1.

Feasible evidence-based interventions for improving women's nutrition and birth outcomes in large-scale programs

	Efficacy, based on meta-analyses	Effectiveness of large-scale programs	Applicability
What works during and before pregnancy
To decrease risk of maternal anemia and intrauterine growth restriction (IUGR)/low birth weight (LBW): a) Iron or IFA or b) multiple micronutrient (MMN) supplementation c) Fortification with iron	Moderate quality evidence for impact on maternal anemia (29). MMNs as good as iron–folate for anemia (30), plus increased birth weight (31). Efficacy not assessed.	Examples: Nicaragua (5), Thailand, Vietnam (32). Supplementation considered successful, although worst off especially in rural areas may be missed. Case studiesa : iron supply and distribution was a major constraint at all levels; acceptability and awareness less so. Fortification of staples: mixed results.	Supplementation is universally applicable – should be early intervention in all populations in low- and middle-income countries (LMICs). Flour fortification can be expanded to more countries.
Balanced protein energy supplementation: to increase birth weight and reduce risks of IUGR/LBW and stillbirth	Moderate/high quality evidence for impact on birth weight, greater in undernourished women (33).	Examples: Tamil Nadu Integrated Nutrition Project; Madagascar (5). Case studies: used when food insecurity exists, such as periodically in Ethiopia; supplements are mandated in India, although coverage varies.	When substantial resources are available; usually targeted; requires considerable logistics.
Iodine fortification of salt (or supplementation in rare cases): to decrease risk of cretinism and improves cognition	High quality evidence for effects on cognitive development (34).	Examples: Thirty-six African countries have over 70% coverage of iodized salt (5). Case studies: in Ethiopia major supply problems, iodized oil capsules for mothers used; Nigeria high coverage; India varying implementation.	Universally applicable – should be implemented in all populations.
Conditional cash transfers: to provide cash, and a platform for education, supplement provision	Efficacy in terms of access to and use of services, nutritional status and health outcomes; may be attributed to cash or other components (35).	CCTs are implemented in an increasing number of countries, Brazil and Mexico as examples. Evidence in Mexico programme for impact on birth weight. Evidence from Brazil on reduction of infant deaths due to undernutrition. See also (36).	Provide much greater resources than other programs relevant to nutrition: when initiated should be built on.
What works before pregnancy
Increasing age at first pregnancy	Moderate quality evidence that young maternal age is risk for low birth weight and preterm birth; also for maternal anemia (37).	Interventions include legislation preventing marriage before 18 years, cash incentives, outreach programs to prevent harmful traditional practices. Effectiveness not reviewed. Case studies: India has legislation and incentives; Ethiopia also has combatting HTP outreach program	Basic intervention in most LMICs – should have legislation and outreach.
Increasing interpregnancy interval (IPI)	Moderate quality evidence that short IPIs are linked with preterm birth, LBW, and early neonatal mortality (38).	Family planning programs, not reviewed by us.	In family planning programs.

^aCase studies: see text.