Qualitative Analysis of Antenatal Care: BEP Insights

According to the PLOS ONE study on balanced energy and protein supplementation, routine antenatal care is a viable platform for BEP delivery, but implementation depends on clearer definitions, trained providers, reliable supplies, culturally appropriate demand generation, and routine monitoring.

• The PLOS ONE researchers conducted 13 key informant interviews and reviewed antenatal care guidelines from six countries between August and December 2023.
• The PLOS ONE study found that Ethiopia, Malawi, and Mozambique had revised national antenatal care guidelines to create an enabling environment for BEP introduction by November 4, 2026.
• The PLOS ONE study reported that 64% of pregnant women globally attended at least four antenatal care visits, supporting antenatal care as a potential delivery platform.
• A 2021 systematic review cited by the PLOS ONE study found reductions of 29% in small-for-gestational-age births, 40% in low birthweight, and 61% in stillbirth across 15 trials in nine low- and middle-income countries.
• The PLOS ONE researchers concluded that standardized BEP definitions, operational guidance, and monitoring indicators are needed for consistent country implementation.

The 2026 PLOS ONE landscape analysis found that the main barriers to BEP delivery through routine antenatal care were policy ambiguity, weak provider readiness, supply-chain problems, limited acceptability, sharing or selling of supplements, and inadequate monitoring.

The researchers used a mixed-methods design from August to December 2023. The study combined a review of national antenatal care guidelines in Colombia, Ethiopia, Ghana, Malawi, Mozambique, and Nepal with 13 semi-structured interviews involving global and country stakeholders. Three researchers independently analyzed transcripts with a collaboratively developed codebook in Dedoose version 10.0, resolving coding discrepancies through consensus.

The study defines BEP as a food or supplement in which protein contributes less than 25% of total energy. The cited expert consultation recommended 250 to 500 kilocalories, 14 to 18 grams of protein, and 3 to 33 grams of fat, showing why consistent terminology matters for implementation research.

Stakeholders described a practical knowledge gap. One multilateral organization stakeholder said, "If you look at the [WHO] guideline, it’s not clearly defined in terms of what the exact composition of BEP is." A global donor organization stakeholder separately emphasized, "It is important to ensure that there are capacity building activities as well as proper training to provide or support quality counseling [for BEP]."

Maternal health researchers should treat BEP implementation as a multi-level qualitative research problem rather than a product-distribution problem alone. The PLOS ONE study shows that successful introduction requires analysis of government commitment, provider skills, household norms, product characteristics, logistics, financing, and health information systems.

• For policy analysts, the PLOS ONE study indicates that coding national guidelines against a shared framework can reveal differences between formal recommendations and operational detail, such as eligibility criteria, product definitions, and reporting requirements.
• For implementation researchers, the PLOS ONE study identifies provider training, task shifting, counselling, and job aids as themes that should be tested across facility and community settings.
• For user researchers, the PLOS ONE study shows why interviews should explore taste, texture, smell, affordability, transport burden, household sharing, and the social meaning of eating alone.
• For monitoring and evaluation teams, the PLOS ONE study reports that none of the six reviewed countries routinely collected BEP data through health systems, making indicator design and reporting-flow research a priority.
• For cross-country researchers, the PLOS ONE study demonstrates the value of comparing countries with revised guidelines, including Ethiopia, Malawi, and Mozambique, with countries where implementation remains less established.

The qualitative evidence also warns against assuming that stated policy equals lived implementation. An NGO stakeholder in Mozambique described antenatal care and a nutrition rehabilitation program as "separate, parallel programs, " while a government stakeholder in Ghana said BEP indicators would need to be integrated into existing registers and reporting systems.

The November 4, 2026 PLOS ONE study shows that BEP delivery through routine antenatal care depends on more than nutritional formulation: implementation teams must understand policy, providers, households, logistics, financing, acceptability, and monitoring. AI-enabled qualitative research can help teams synthesize these connected perspectives across interviews and documents while preserving researcher oversight. Researchers who want to move from fragmented transcripts to auditable themes and cross-country findings can try Evidano for free.