Sadia smiles but speaks sparingly — until you hit on the right topic. Ask about tips for a healthy pregnancy, and the 20-year-old is a wellspring of information. She shares advice with close friends and family in her village, recommending what foods to eat and which supplements to take. She isn’t a doctor, but through her own experience, she knows how important it is for expectant mothers to take care of themselves.

For women in her community, this can be a challenge. Many families in rural Bahawalpur, Punjab face economic hardship, often working in agriculture or low-paying jobs, and with limited access to public amenities and healthcare. Though malnutrition is widespread across Pakistan, women and girls are hardest hit. The 2018 National Nutrition Survey revealed that 42% of women of reproductive age experience malnutrition, while half of all pregnant women are anaemic, leading to adverse outcomes for both maternal and child health.

Sadia first sought help at the basic health unit in Bahawalpur after struggling to conceive. Living in a joint family with in-laws, her mother-in-law, father-in-law, husband, and his two brothers and their families, she felt pressure that she hadn’t yet had a child. Sadia’s husband, however, was a source of comfort and hope, and he encouraged her to seek medical advice. This is how she came to meet Dr. Yusra Baloch and learn about the vital connection between maternal health and nutrition.

An experienced physician, Dr. Yusra understands the health concerns of Bahawalpur’s rural communities and, more recently, deepened her knowledge to strengthen the support she provides. In 2023, she participated in training offered by the NourishMaa campaign, which is building the capacity of healthcare providers to integrate maternal nutrition counselling into their practices. NourishMaa currently operates in the provinces of Sindh, Punjab and Khyber Pakhtunkhwa. The initiative is a collaborative effort by Nutrition International, Pakistan’s Ministry of National Health Services, Regulations & Coordination, provincial health departments, and professional medical associations such as Society of Obstetricians and Gynecologists of Pakistan and Pakistan Medical Association, with support from the Bill & Melinda Gates Foundation.

For Dr. Yusra, participating in training provided through the NourishMaa program significantly enriched her knowledge and skills in maternal nutrition counseling. “The in-person counseling sessions have been particularly valuable,” she says, “allowing me to engage directly with patients and offer personalized advice.”

Her first meeting with Sadia began with a thorough history and blood test, which revealed that Sadia was anaemic. Dr. Yusra asked Sadia to describe her diet in detail and explained that improving her nutritional intake could help to improve her health and enhance her chances of maintaining a healthy pregnancy. She provided Sadia with iron and folic acid supplements, explaining the benefits, as well as the appropriate cadence to take them. Dr. Yusra also suggested practical ways for Sadai to diversify her meals using locally available foods, such as lentils, leafy greens, and milk or yogurt. Together, they created a realistic plan tailored to Sadia’s needs.

This collaborative approach, which is at the heart of the NourishMaa campaign, supports healthcare workers to offer nutrition advice that responds to each patient’s unique circumstances. Aiming to reach 6,000 service providers, the program offers two training streams; one for doctors and nurses from health facilities, the other for community outreach frontline workers, who are often the first point of contact between the healthcare system and the community. NourishMaa emphasizes the importance of interpersonal counselling to promote patient adherence to nutrition and antenatal care guidelines. Through one-on-one sensitization sessions and workshops, participants explore the determinants of maternal malnutrition, nutrition across life stages, and dietary diversity.

Dr. Yusra feels that the comprehensive resources provided by the NourishMaa campaign have been crucial in educating her patients and their families about the importance of a balanced diet. “Overall, these resources have significantly improved my ability to support patients like Sadia in achieving better health outcomes through targeted nutritional interventions,” she says.

Sadia committed to returning to see Dr. Yusra, and with her husband’s help, she was able to access the necessary foods to follow her nutrition plan. On her third visit to the clinic, she discovered that her haemoglobin levels had improved. When, eventually, she learned that she was pregnant, the happy news strengthened her resolve. Sadia visited Dr. Yusra eight more times during her pregnancy, determined to ensure the healthiest possible outcome for her baby. Dr. Yusra guided and advised Sadia, including providing her with iron and folic acid supplementation throughout her pregnancy and counselling her on adequate and appropriate diet and nutrition.

As her due date approached, she was no longer anaemic.

Sadia gave birth to a baby girl at the clinic in Bahawalpur, where she had taken her first steps toward better health. She regularly attended postnatal appointments, during which Dr. Yusra emphasized the importance of breastfeeding and provided nutritional guidance for optimal growth and development.

“The nutritional counselling that I received from Dr. Yusra was life changing,” says Sadia. “It helped me understand how to nourish my body properly. This was essential for me to have a healthy pregnancy.”

Sadia smiles and bounces her baby girl on her lap. “I feel more knowledgeable in taking care of myself and my daughter,” she says.

Since the launch of the NourishMaa campaign, nearly 2,800 healthcare providers and frontline health workers have been educated through sensitization seminars, over 6,000 were sensitized through one-on-one sensitization visits, and specialized trainings were provided to over 1,200 healthcare providers and one-day training to over 1,500 frontline workers. Thousands more have engaged with the program’s educational content through social media, TV and radio spots, and podcasts.

In a significant move toward improving maternal and child health outcomes nationwide, the government of Pakistan, alongside key organizations, signed the Bhurban Declaration: Advancing Maternal Nutrition in Pakistan. On August 27, 2024, signatories pledged to ensure that every woman of reproductive age receives the essential nutrition, healthcare and support required to safeguard her health and the wellbeing of future generations. The declaration is the result of sustained advocacy efforts led by Nutrition International in collaboration with Pakistan’s Ministry of National Health Services, Regulations and Coordination.

The most successful initiatives will be those that promote guidelines that are both relevant and meaningful for the women they serve. Through the NourishMaa campaign, women like Sadia and doctors like Dr. Yusra, demonstrate the difference this can make.

Learn more about our work in Pakistan.

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