Separate indications of low maternal nutritional and health status during pregnancy - low birth weight of child during birth, maternal short stature and low BMI - are evident in 11 to 14 percent of children under the age of 2 and are strongly associated with mother’s education and family income. For example, the prevalence of LBW is 19 percent among children whose mothers completed elementary school at most, compared to 12 percent of children whose mothers went to college. The association of educational attainment and maternal short stature is even stronger. Of these three indicators, the prevalence of low BMI is most weakly associated with income and mother’s education.

Nationally, the utilization of antenatal health care and care during delivery is common. The mothers of over 80 percent of children under-2 attended at least four antenatal visits and 85 percent received assistance during delivery by a skilled practitioner. Disparities in maternal prenatal care associated with income and education, however, are very high. For example, while 95 percent of mothers with college education had skilled assistance during delivery, only 62 percent of mothers with elementary education or less had skilled assistance.

Overall, 57 percent of children under-2 have strong evidence of an adequate antenatal environment leading up to their birth. Children in the richest income quintile are about 1.5 times as likely to have adequate prenatal conditions than children in the poorest income quintile. Children whose mothers have college education are 1.6 times as likely to have adequate prenatal conditions than children whose mothers had at most an elementary education.

# **_5.3 Measures of childcare and feeding practices at home_**

Early childhood nutritional intake is directly dependent on the feeding practices adopted by parents in the home, including whether mothers decide to breastfeed, for how long, and for older children, what kinds of solid foods are given, how frequently and how diverse they are. The WHO recommends exclusive breastfeeding for children between the ages of 0 and 5 completed months of age, the introduction of solid or semi-solid foods between the ages of 6 and 8 completed months and continued breastfeeding along with complementary foods through 2 years of age. The WHO also has guidelines on dietary frequency and diversity for children above the age of 6 months. Other important and related aspects of childcare in the home include the hygienic preparation of food and whether the child receives cognitive stimulation. A set of six indicators were identified in the NNS data that map to childcare and feeding practices at home, of these two are considered necessary evidence of an adequate childcare and feeding environment at home: the child is age-appropriately (breast) fed and the mother always handwashes before food preparation and feeding, before and after eating and after toilet use (Table 4). Three ideal indicators of child feeding practices that were not available for this study include minimum meal frequency, minimum dietary diversity and minimum acceptable diet for children 6 months and older.

**Table 4**

|**Category**|**Dataset**|**Driver**|**Definition**|**Available**<br>**in NNS**<br>**dataset?**|**Required**<br>**for**<br>**adequacy**<br>**in**<br>**domain?**|
|---|---|---|---|---|---|
||||**Mom always handwashes**|||
|Hygiene|NNS Form<br>3.1|**Handwashing habit**|**before food prep and feeding,**<br>**before and after eating and**|**Yes**|**Yes**|
||||**after toilet use**|||

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