Opportunities and challenges for introduction of balanced energy protein supplementation through routine antenatal care
- 1Kavle Consulting, Gigiri, Nairobi, Kenya
- 2Save the Children US, Washington, D.C., United States of America
- 3Kavle Consulting, Washington, D.C., United States of America
Abstract
Background: The World Health Organization (WHO) recommends balanced energy and protein (BEP) supplementation during pregnancy in contexts where prevalence of maternal underweight, defined as body mass index (BMI) < 18.5 kg/m2, is ≥ 20%. Evidence shows that BEP supplementation in underweight pregnant women reduces the risk of low birthweight, small for gestational age, and preterm birth. Yet little is known about how to introduce BEP through routine antenatal care (ANC). This paper explores challenges, opportunities, and recommendations for successful introduction of BEP supplementation through ANC service delivery. Methods: From August – December 2023, a mixed-methods landscape analysis was carried out, which comprised of a review of country antenatal care guidelines, as well as key informant interviews (KIIs) with thirteen global and country stakeholders. KIIs were recorded, transcribed, and analyzed by themes and subthemes using Dedoose qualitative software 10.0. Results: Findings revealed confusion around the definition of BEP, coupled with low awareness of the WHO ANC guideline on BEP supplementation among country stakeholders. Provider capacity for BEP provision is weak. Sharing, selling, and stockouts of BEP supplies are common. Data on the feasibility and cost-effectiveness of the introduction of BEP at country level is critical to inform implementation. Conclusion: Successful introduction of BEP as part of ANC service delivery requires country program implementers to consider government commitments, health provider training, demand generation, compliance, supplies and logistics, local production, and routine monitoring of BEP indicators. Globally, standardized BEP guidance, indicators, and definitions are critical to support quality country implementation. For sustainability, emerging concerns around reductions in global health funding should be addressed in future program design and implementation.
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BibTeX
@article{waithira2026opportunities,
title = {{Opportunities and challenges for introduction of balanced energy protein supplementation through routine antenatal care}},
author = {Ruth Waithira and Habtamu Fekadu and Joseph Gaithuma and Justine A. Kavle},
journal = {PLOS One},
year = {2026},
month = nov,
doi = {10.1371/journal.pone.0361896},
url = {https://doi.org/10.1371/journal.pone.0361896},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Opportunities and challenges for introduction of balanced energy protein supplementation through routine antenatal care
AU - Ruth Waithira
AU - Habtamu Fekadu
AU - Joseph Gaithuma
AU - Justine A. Kavle
PY - 2026
DA - 2026/11/04
JO - PLOS One
DO - 10.1371/journal.pone.0361896
UR - https://doi.org/10.1371/journal.pone.0361896
AB - Background: The World Health Organization (WHO) recommends balanced energy and protein (BEP) supplementation during pregnancy in contexts where prevalence of maternal underweight, defined as body mass index (BMI) < 18.5 kg/m2, is ≥ 20%. Evidence shows that BEP supplementation in underweight pregnant women reduces the risk of low birthweight, small for gestational age, and preterm birth. Yet little is known about how to introduce BEP through routine antenatal care (ANC). This paper explores challenges, opportunities, and recommendations for successful introduction of BEP supplementation through ANC service delivery. Methods: From August – December 2023, a mixed-methods landscape analysis was carried out, which comprised of a review of country antenatal care guidelines, as well as key informant interviews (KIIs) with thirteen global and country stakeholders. KIIs were recorded, transcribed, and analyzed by themes and subthemes using Dedoose qualitative software 10.0. Results: Findings revealed confusion around the definition of BEP, coupled with low awareness of the WHO ANC guideline on BEP supplementation among country stakeholders. Provider capacity for BEP provision is weak. Sharing, selling, and stockouts of BEP supplies are common. Data on the feasibility and cost-effectiveness of the introduction of BEP at country level is critical to inform implementation. Conclusion: Successful introduction of BEP as part of ANC service delivery requires country program implementers to consider government commitments, health provider training, demand generation, compliance, supplies and logistics, local production, and routine monitoring of BEP indicators. Globally, standardized BEP guidance, indicators, and definitions are critical to support quality country implementation. For sustainability, emerging concerns around reductions in global health funding should be addressed in future program design and implementation.
SN - 1932-6203
ER -