Assessing maternal nutrition policy and programmatic landscape in India: a qualitative study

Introduction Maternal nutrition is fundamental to the health of mothers and children. Over the years, the Indian government introduced several programs and policies to support women’s nutrition during pregnancy and improve maternal and child health outcomes. However, significant contextual differences remain in service provisions and access across states. This study explores expert perspectives on factors that impact the implementation and reach of maternal nutrition services in India. Methods The study was conducted in two phases. The first phase consisted of contextual mapping through desk review of policy documents, government reports, published literature, and descriptive secondary data from NFHS-4 and NFHS-5 to map maternal nutrition indicators and provide contextual evidence. In the second phase, fifteen national- and state-level experts from across policy, implementation, and research fields were purposively selected for semi-structured interviews. Following this, interviews were transcribed, coded and analyzed using a reflexive thematic analysis. Results The desk review indicated that maternal nutrition programs in India are implemented through multiple local and centralized institutions and show substantial variation across states. State-specific initiatives to strengthen maternal nutrition were identified in 35 of the 36 Indian states and union territories. Qualitative findings complemented the desk review. Thematic analysis of expert interviews indicated that despite numerous maternal nutrition programmes in effect in India, effective implementation was constrained by three interconnected mechanisms: weak governance and health system capacity to translate policy into consistent frontline practice; fragmented monitoring systems that limit routine, data-driven course correction; and sociocultural norms that impact household decision-making and the reach and acceptability of maternal nutrition services. Discussion Experts emphasized that strengthening implementation within existing government programmes, rather than introducing additional schemes, is central to improving maternal nutrition services and, ultimately, maternal health outcomes in India.