Engagement of Husbands in a Maternal Nutrition Program Substantially Contributed to Greater Intake of Micronutrient Supplements and Dietary Diversity During Pregnancy: Results of a Cluster-Randomized Program Evaluation in Bangladesh

Background: Although husbands may provide support during pregnancy, limited evidence exists on how to promote husbands\u27 engagement and what impact it has. Alive & Thrive integrated nutrition-focused interventions, targeting both wives and husbands, through an existing Maternal, Neonatal, and Child Health (MNCH) platform in Bangladesh. Objectives: We evaluated 1) the impact of a nutrition-focused MNCH program, compared with the standard MNCH program, on husbands\u27 behavioral determinants (i.e., awareness, knowledge, self-efficacy) and support to wives to adopt optimal nutrition practices and 2) how much of the previously documented impact on women\u27s supplement intake and dietary diversity was explained by husbands\u27 behavioral determinants and support. Methods: We used a cluster-randomized design with cross-sectional surveys at baseline (2015) and endline (2016) (n = ∼1000 women and ∼700 husbands/survey). We used mixed linear regression accounting for clustering to estimate difference-in-differences (DIDs) for impact on husbands\u27 behavioral determinants and path analysis to examine how much these determinants explained the impact on women\u27s nutrition behaviors. Results: Of husbands in the nutrition-focused MNCH group, 62% were counseled by health workers, 66% attended a husbands\u27 forum, and 34% saw video shows. The nutrition-focused MNCH, compared with the standard MNCH group, resulted in greater husbands\u27 awareness (DID: 2.74 of 10 points), knowledge (DID: 1.31), self-efficacy and social norms with regard to optimal nutrition practices (difference: 1.08), and support to their wives (DID: 1.86). Husbands\u27 behavioral determinants and support explained nearly half of the program impact for maternal supplement intake and one-quarter for dietary diversity. Conclusions: A nutrition-focused MNCH program that promoted and facilitated husbands\u27 engagement during their wives\u27 pregnancies significantly improved husbands\u27 awareness, knowledge, self-efficacy, and support. These improvements substantially explained the program\u27s impact on women\u27s intake of micronutrient supplements and dietary diversity. Targeting wives and husbands and designing activities to engage men in maternal nutrition programs are important to maximize impact. This trial was registered at www.clinicaltrials.gov as NCT02745249