Delivering balanced energy and protein (BEP) supplements to pregnant and breastfeeding women in low- and middle-income countries: A scoping review
8 affiliations
- 1Healthy Mothers Healthy Babies Consortium, Micronutrient Forum, Washington, District of Columbia, United States of America.
- 2Independent Consultant, Ripple Global Health International, London, United Kingdom.
- 3UNICEF Regional Office for South Asia, Kathmandu, Nepal.
- 4NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal.
- 5Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland.
- 6Division of Human Nutrition and Health, Global Nutrition and Health Group, Wageningen University & Research, Wageningen, The Netherlands.
- 7UNICEF, Lilongwe, Malawi.
- 8Nutrition Division, World Food Programme HQ, Rome, Italy.
Abstract
In settings where more than 20% of women of reproductive age are classified as underweight, the World Health Organization recommends balanced energy and protein (BEP) supplementation during pregnancy to reduce adverse birth outcomes. However, guidance on contextually acceptable and feasible supplement delivery platforms remains limited, posing critical challenges for implementation. We synthesized literature on acceptable and feasible delivery platforms for BEP supplementation (direct evidence), as well as iron and folic acid (IFA) or multiple micronutrient supplements (MMS; indirect evidence) to pregnant and breastfeeding women (PBW) to broaden the search scope. A systematic search was conducted across five databases and grey literature to identify studies that addressed the acceptability and feasibility of BEP supplement delivery platforms in low- and middle-income countries (LMICs), at facility and community levels. We identified 48 studies conducted in LMICs: 22 specifically evaluated BEP supplement delivery, while 26 evaluated IFA or MMS. In the direct evidence, home delivery (11/22) was the most frequently mentioned delivery platforms of BEP supplements followed by community-level feeding centers (provided cooked meals or take-home rations) anchored by frontline community health workers (8/22 studies) and antenatal care (ANC) at health facilities (6/22; some studies assessed multiple delivery platforms). Only four studies assessed preferred BEP delivery platforms, and PBW favored home over facility-based delivery. Authors attributed this preference to the comprehensive nutrition education and behavior change communication (BCC) provided during home delivery. Indirect evidence showed that enhancing delivery of IFA or MMS at health facilities (not specific) through strategies such as BCC and home visits may improve supplement compliance. Overall, limited evidence exists regarding market-based approaches for delivering any of these interventions. Based on existing evidence, scale-up delivery of BEP supplementation through ANC at health centers, enhanced by community health workers may be feasible in reaching PBW, especially when combined with BCC.
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BibTeX
@article{kissell2026delivering,
title = {{Delivering balanced energy and protein (BEP) supplements to pregnant and breastfeeding women in low- and middle-income countries: A scoping review}},
author = {Mihaela C Kissell and Isabel Potani and Carolina Pereira and Elisabeth T Mukendi and Vani Sethi and Filomena Gomes and Rimu Byadya and Lisa M Rogers and Saskia J M Osendarp and Charity Zvandaziva and Saskia de Pee and Martin N Mwangi},
journal = {PLOS Global Public Health},
year = {2026},
month = nov,
doi = {10.1371/journal.pgph.0007539},
url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007539},
note = {CC BY},
}
RIS
TY - JOUR
TI - Delivering balanced energy and protein (BEP) supplements to pregnant and breastfeeding women in low- and middle-income countries: A scoping review
AU - Mihaela C Kissell
AU - Isabel Potani
AU - Carolina Pereira
AU - Elisabeth T Mukendi
AU - Vani Sethi
AU - Filomena Gomes
AU - Rimu Byadya
AU - Lisa M Rogers
AU - Saskia J M Osendarp
AU - Charity Zvandaziva
AU - Saskia de Pee
AU - Martin N Mwangi
PY - 2026
DA - 2026/11/02
JO - PLOS Global Public Health
DO - 10.1371/journal.pgph.0007539
UR - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007539
AB - In settings where more than 20% of women of reproductive age are classified as underweight, the World Health Organization recommends balanced energy and protein (BEP) supplementation during pregnancy to reduce adverse birth outcomes. However, guidance on contextually acceptable and feasible supplement delivery platforms remains limited, posing critical challenges for implementation. We synthesized literature on acceptable and feasible delivery platforms for BEP supplementation (direct evidence), as well as iron and folic acid (IFA) or multiple micronutrient supplements (MMS; indirect evidence) to pregnant and breastfeeding women (PBW) to broaden the search scope. A systematic search was conducted across five databases and grey literature to identify studies that addressed the acceptability and feasibility of BEP supplement delivery platforms in low- and middle-income countries (LMICs), at facility and community levels. We identified 48 studies conducted in LMICs: 22 specifically evaluated BEP supplement delivery, while 26 evaluated IFA or MMS. In the direct evidence, home delivery (11/22) was the most frequently mentioned delivery platforms of BEP supplements followed by community-level feeding centers (provided cooked meals or take-home rations) anchored by frontline community health workers (8/22 studies) and antenatal care (ANC) at health facilities (6/22; some studies assessed multiple delivery platforms). Only four studies assessed preferred BEP delivery platforms, and PBW favored home over facility-based delivery. Authors attributed this preference to the comprehensive nutrition education and behavior change communication (BCC) provided during home delivery. Indirect evidence showed that enhancing delivery of IFA or MMS at health facilities (not specific) through strategies such as BCC and home visits may improve supplement compliance. Overall, limited evidence exists regarding market-based approaches for delivering any of these interventions. Based on existing evidence, scale-up delivery of BEP supplementation through ANC at health centers, enhanced by community health workers may be feasible in reaching PBW, especially when combined with BCC.
SN - 2767-3375
ER -