Exploring maternal healthcare services and child feeding practices in Nepal: A scoping review

Abstract

Background:

Maternal healthcare services (MHS) include antenatal care (ANC), natal and postnatal care (PNC). Women engage with healthcare providers for self-care throughout the antenatal, natal and postnatal periods and receive guidance on recommended child feeding practices through MHS. Despite efforts, the role of MHS in shaping child feeding practices remains underexplored in Nepal.

Objectives:

To explore the effect of MHS on infant and child feeding practices for children under 5 years old and as well as the influence of both on child nutrition.

Eligibility Criteria:

Empirical studies addressing MHS and child feeding practices for children under 5 years old in Nepal between January 1, 2010 and January 27, 2025.

Sources of Evidence:

We searched the databases of CINAHL Plus with Full Text, Global Health, PubMed, Scopus, and WHO Global Medicos Index. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines to support our search process.

Charting Methods:

We created a data extraction matrix and included details such as authors, year, design, participants, type of MHS, infant feeding practices, and major results.

Results:

We have included 29 studies that met the inclusion criteria. We developed six themes after synthesizing the findings from these studies which are: (1) ANC utilization and child feeding practices (CFP); (2) PNC utilization and CFP; (3) location of delivery and CFP; (4) mode of delivery and CFP; (5) MHS and child feeding practices and their impact on child nutritional status; and (6) health education counseling during ANC and PNC visits, focusing on child feeding practices.

Conclusions:

Findings from this review highlight that recommended ANC and PNC visits positively influence child feeding practices and help combat malnutrition. To enhance the effectiveness of these visits, future research should aim to identify and evaluate the specific components including comprehensive health education programs focused on child feeding practices, and exploring the barriers to ANC and PNC visits. Additionally, cultural beliefs and practices that affect both attendance at ANC and PNC visits and adherence to recommended child feeding practices remain underexplored. Addressing this gap requires integrating culturally sensitive approaches into MHS.

Keywords

maternal healthcare services child feeding practices child nutrition scoping review Nepal

Background

Maternal healthcare services (MHS) encompass antenatal care (ANC), natal care, and postnatal care (PNC) services provided by skilled health professionals and are essential for ensuring the well-being of both mothers and newborns.¹ These services are designed to support women throughout the pregnancy, delivery, and postpartum periods, enabling optimal health outcomes and preventing complications. Effective maternal care addresses clinical needs and emphasizes respectful treatment and informed decision-making.²

Although MHS enhance health outcomes, MHS utilization differs markedly in developed and developing countries. In developed countries, targeted medical interventions during pregnancy and childbirth have significantly lowered maternal and newborn mortality rates.³ A cross-sectional study of 37 low- and middle-income countries (LMICs) revealed an MHS utilization prevalence rate of 33.7%.¹ MHS utilization in LMICs was higher among women who were wealthy, were over 25 years old, were educated, had their first child after age 25, had media exposure, and could make healthcare choices independently.^1,4

According to the Nepal Demographic Health Survey,⁵ 94% of women received ANC, and 80% had at least four ANC visits. Skilled providers managed 80% of deliveries, and 70% of mothers and newborns received PNC within 2 days of birth, although 28% missed a postnatal checkup during this period.⁵ A 2023 study in Nepal found that 80.5% of women had four or more ANC visits, 79.4% had institutional births, and 70.2% promptly received PNC; however, only 51.2% completed the full continuum of care.⁶

We defined the child feeding practices for this review based on the WHO recommendations on infant and young child feeding (IYCF) practice components such as early initiation of breastfeeding (EIBF), exclusive breastfeeding (EBF), the introduction of complementary feeding (CF), minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD).⁷ MHS programs and interventions can influence child nutrition and feeding practices. A scoping review of interventions supporting optimal breastfeeding in five South Asian countries found that consistently engaging women and their families starting from pregnancy enhanced EIBF and EBF outcomes.⁸ Additionally, findings have indicated a positive association between MHS and child feeding practices and further reported that MHS utilization increased child nutrition practices, especially EBF.⁹

Child malnutrition, which includes undernutrition (wasting (low weight-for-height), stunting (low height-for-age), and underweight) and inadequate vitamin or mineral intake, affects growth and development. Wasting indicates recent severe weight loss due to insufficient food or incapacitating but treatable illnesses, such as diarrhea.⁷ Stunting, which results from chronic undernutrition linked to poor socioeconomic conditions and maternal health, frequent illness, and inadequate feeding practices, limits physical and cognitive development.^7,10 A child may be underweight due to stunting, wasting, or both, reflecting an overall poor nutritional status.⁷

According to the 2022 Global Nutrition Report,¹¹ stunting has decreased over the past two decades but still affects more than 40% of children under the age of 5 in Southeast Asia. According to UNICEF,¹² approximately 33% of the world’s stunted children (56 million) and 50% of the world’s wasted children (33 million) resided in South Asia. Similarly, Nepal, 36% of children were stunted, 27% were underweight, and 10% exhibited wasting.¹³ Inadequate feeding practices during infancy increase the risk of nutritional disorders, which can extend into early childhood and have lasting effects throughout life.¹⁴ Breastfeeding is one of the most effective ways to ensure child health and survival. Although LMICs’ breastfeeding practices have gradually improved over the last decade, they do not meet WHO recommendations.¹⁵

Inconsistent feeding practices in LMICs are influenced by social structures, religious practices, and healthcare delivery systems, which collectively shape maternal care and infant feeding behaviors.¹⁶ In Nepal, only 23.2% of infants are exclusively breastfed until 6 months of age, while 28.2% and 48.6% are predominantly and partially breastfed, respectively.¹⁷ Regionally, partial breastfeeding rates range from 52.3% in the mid-western region to 44.4% in the eastern region,¹⁷ and MHS quality is inconsistent in the remote and mountainous regions. Limited accessibility, compounded by infrastructure and transportation challenges, hinders emergency obstetric service delivery and skilled birth attendant availability.¹⁸

Cultural norms, education and other sociodemographic factors, and MHS accessibility collectively shape ANC, natal care, and PNC visits.^19,20 Prevalent cultural practices in Nepal include administering janma ghunti (Ayurvedic tonic syrup) and Ayurvedic medicines to newborns to enhance immunity.²¹ There is also a common misconception that colostrum is harmful.²¹ Persistent gender disparities in infant feeding practices include introducing female infants to supplementary foods earlier than males, even though EBF is recommended for the first 6 months.²¹

In Nepal, cultural factors, financial constraints, insufficient maternal knowledge about proper feeding practices, low maternal literacy, ethnicity, and low socioeconomic status contribute to inappropriate child feeding practices and pose a major public health challenge.^22,23 Findings from a study in Nepal found that 57% of mothers initiated CF at 6 months but only 35% provided meal diversity and 33% met the MAD, exacerbating nutritional vulnerabilities.²⁴

Although Nepal has made commendable progress in promoting EBF through national policies and community-based nutrition programs, MHS’s role in shaping child feeding practices remains underexplored. A comprehensive analysis of MHS and its impact on infant feeding practices is essential to bridge this knowledge gap, provide deeper insights into the maternal factors influencing child feeding behaviors, and inform targeted interventions for strengthening MHS. We drafted the following research questions to guide this study: (1) How do MHS impact infant and child feeding practices, and (2) What is the subsequent effect of MHS on the nutritional status of children under 5 years of age in Nepal? The objective of this scoping review is to explore the effect of MHS on feeding practices for infants and children under 5 years of age and the influence of these practices on child nutrition. The review’s findings can guide MHS promotion and expansion, ultimately improving child feeding practices and health outcomes in Nepal.

Methods

Selection criteria

This study utilized a scoping review methodology to explore the role of MHS in shaping the feeding practices of children under 5 years of age in Nepal. The framework outlined by the Joanna Briggs Institute (JBI)^25,26 was followed to systematically map evidence from various research sources based on predefined criteria. The research team set the following inclusion criteria for this review: (1) quantitative, qualitative, or mixed method studies that focused on child feeding practices of children under 5 years old; (2) quantitative, qualitative, or mixed method studies focused on women of any age with a child under 5 years old; (3) quantitative, qualitative, or mixed method studies focused on women who have received ANC, natal care, and PNC; (4) full-text articles published in English; and (5) studies conducted between January 1, 2010 and January 27, 2025 in Nepal. This 15-year timeframe was selected to gather recent evidence on the role of MHS in infant feeding practices in Nepal as no such reviews are currently available. We plan to analyze past trends and the implemented changes in MHS and their impact on the feeding practices of children under 5 years old during this 15-year timeframe considering the updates to MHS and evolving WHO guidelines on IYCF practices. We defined the child feeding practices for this review based on the WHO recommendations on IYCF practice components such as EIBF, EBF, the introduction of CF, MDD, MMF, and MAD.⁷ Additionally, we considered factors such as low birth weight, underweight, stunting, and wasting. The exclusion criteria used were (1) articles not published in English, (2) conference abstracts and review articles, and (3) program evaluations that solely focused on IYCF practices without considering MHS.

Search process

The research team conducted the search process according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines.²⁷ The first and last authors developed the search plan with the assistance of a university librarian. We searched the databases of CINAHL Plus with Full Text, Global Health, PubMed, Scopus, and WHO Global Medicos Index using the following keywords: “maternal health services,” “antenatal, natal and postnatal services,” “infant and child feeding practices,” “child nutrition,” and “Nepal.” We customized these keywords based on the requirements of different databases. A summary of the search strategy is provided in Supplemental File 1.

To enhance the search process, the articles from the database searches were uploaded to Covidence,²⁸ an online software application. After removing duplicates, the first author reviewed the titles and abstracts of the articles to ensure that they met the inclusion criteria. All full-text articles that matched the inclusion criteria were retained for review. The last author reviewed and verified the retained full-text articles. After this process, the first and last authors reached a consensus on the final article selections. Additionally, a manual search was conducted using the references of the selected articles resulting in the addition of three more articles. The attached PRISMA (Figure 1) diagram summarizes the search process.

Figure 1.

PRISMA flow diagram.

Data extraction and analysis

The research team created a data extraction matrix based on the JBI scoping review guidelines. This matrix included details such as authors, year, design, participants, type of MHS (ANC, natal care, and PNC), infant feeding practices, measurements, and major results. After reading the full text of the selected articles, the second author independently extracted the data. Later, the third and last authors independently validated the extracted data. Any discrepancies identified in the data abstraction were resolved via discussion between the second, third, and last authors. Table 1 summarizes the data extraction matrix.

Table 1.

Data extraction matrix.

First author, yearDesign	Participants	Type of maternal care services	Infant feeding practices	Measurements	Major results
Acharya, 2018²⁹ Clustered RCT	Mothers from 15 to 49 years of age n = 402	Antenatal services	Birth weight Normal birth weight defined as ⩾2500 g lbw <2500 g	Used NDPHS to collect data Birth weight of neonates collected at the time of birth as ⩾2500 or <2500 g ANC: ANC visits, IFA supplementation, TD immunization, sufficient rest and sleep, deworming, and using extra food during pregnancy	Significant association noted between lbw and ANC visits (p = 0.002). Higher odds of having an lbw baby was noted among the mothers who did not receive ANC care (p = 0.029) in comparison to the mothers who received ANC care ⩾4 times.
Acharya, 2019³⁰ Descriptive cross-sectional study	Mothers having a child ⩽1 year old n = 207	ANC visits PNC visits MCH services	EIBF	Maternal care utilization pattern and socioeconomic factors were collected	Out of 207 woman, 47.3% of them began BF during the first hour postpartum. 97% of the participants had ⩾4 ANC visits; however, BF information was not provided to 61% of the mothers during ANC visits. Mothers who underwent a cesarean surgery (p = 0.019), had >1 PNC visit (p = 0.027), or had an lbw child (p = 0.027) were less inclined to begin BF within the initial hour after birth.
Adhikari, 2021³¹ Descriptive cross-sectional study	Women who had a child under 2 years old n = 360	ANC visit PNC visit Place of delivery Type of delivery	IYCF practices: Indicators of IYCF as per WHO: EIBF, EBF, Introduction of CF, MDD, MMF, MAD	Adapted NDHS survey tool with necessary modification to collect MHC and IYCF practices	Only 49.7% of the mothers had ⩾4 ANC visits. Only 37.5% of the mothers had ⩾2 PNC visits. 83.3% of the participants had a baby at a healthcare facility. 95.6% of the mothers breastfed their children. 69.2% began breastfeeding within an hour of childbirth. Women who delivered their child via natural birth were more inclined to follow (p = 0.029) EBF. Women who received guidance on nutrition were more inclined (p = 0.015) to start CF at the appropriate time. Maternal nutrition counseling was associated with MAD consumed by the infants (p = 0.005). No association noted between IYCF practices and ANC and PNC visits.
Dhakal, 2022³² Cross-sectional study	Mothers with children between 6 and 24 months n = 362	Location of delivery Type of delivery	EIBF, EBF, colostrum feeding	Structured questionnaire using IIFAS, BSES-SF, EBSSS	Nearly 64% of the infants were exclusively breastfed. There was no significant relation of EBF with location of delivery and types of delivery. The factors influenced the EBF social support scale included mothers who delivered at a healthcare center (p = 0.001) and those who fed their newborns colostrum (p = 0.003)
Dhungana, 2017³³ Cross-sectional study	Mothers with children between 6 and 59 months n = 1353	Location of delivery	BF, EBF, colostrum feeding HFA, WFA, WFH	Sociodemographic variables, breastfeeding, and infant feeding practices were collected	About 59% of the children were exclusively breastfed and 90.4% received colostrum feeding. A total of 10.6%, 53.9%, and 20.8% children were wasted, stunted, and underweight, respectively. Compared with the mothers who breastfed their child for ⩾6 months, mothers who breastfed children for <6 months increased likelihood to have wasted children (p = 0.045). Compared to children who were born in a hospital, those who were born at home have a higher chance to becoming underweight (p = 0.001).
Dulal, 2022³⁴ Retrospective study (cross-sectional analysis) using the data from a community based RCT	Mothers with children of 7–62 months n = 1352	ANC visits	WHO indicators to assess IYFC practices	Adapted WHO-IYFC practices and MICS-4 survey tools	Only about 16% of the mothers practiced EIBF followed by 67% Colostrum feeding. A total of 89% children were exclusively breastfed. TICF was found among 56% and MDD among 49% of children. Higher likelihood of timely initiation of CF among the children whose mothers visited the ANC clinics either ⩾4 or 1–3 times in comparison to the mothers who did not visit the ANC clinics.
Ghimire, 2019³⁵ Retrospective study using 2016 NDHS data	Mothers of 15 years and above n = 1978	ANC visits Location of childbirth Type of delivery	EIBF	Collected socioeconomic factors and health information such as FP, fertility, mortality rates, MCH status, and nutrition data extracted from NDHS 2016	55% of mothers began breastfeeding within 1 h of giving birth Mothers who gave birth at a health facility (p < 0.001) and had a natural child birth (p < 0.001) had a higher likelihood to practice EIBF.
Hollow, 2023³⁶ Secondary data of NDHS 2016	Mothers having children of age 0–23 months n = 1938	ANC visits Location of childbirth Type of delivery	EIBF Age appropriate feeding practice	MCH indicators from NDHS 2016	A total of 55.4% mothers had initiated BF within 1 h of delivery and 85.9% mothers fed age appropriate feeding to their child. Significant association was noted between EIBF and type of delivery (p < 0.001) as well as with delivery location (p < 0.001). A significant association was noted between EIBF with breastfeeding guidance from any healthcare professional within the first 2 days after delivery (p = 0.002).
Joshi, 2012²⁰ Secondary data analysis of NDHS 2006	Children aged 6–23 months n = 1428	ANC visit Place of delivery PNC visits	Introduction of CF, MDD, MMF, MAD	CF Indicators extracted from the NDHS data	CF was introduced to 70% of infants between the ages of 6 and 8 months. 76% of the mothers had attended at least one ANC visit. Higher MDD rate (p = 0.000), higher MMF rate (p = 0.006), and higher MAD rate (p = 0.000) were noted among the infants whose mothers visited ANC clinics ⩾4 times in comparison to the infants whose mothers never visited the ANC clinics. Infants whose mothers had a PNC checkup ⩾7 days had a higher MDD rate (p = 0.000), higher MMF rate (p = 0.05), and higher MAD rate (p = 0.000) compared to the mothers who had no PNC checkups.
Karkee, 2014³⁷ Prospective cohort study	Pregnant women of ⩾5 months of gestation were followed up till 22 weeks of postpartum n = 639	ANC visits Location of delivery Type of delivery	EBF	Breastfeeding practices and maternal factors	29.7% of the 22 weeks old infants were exclusively breastfed. 73% women had ⩾4 ANC visits. Cesarean delivery was found to be factor associated with discontinuation of EBF.
Karki, 2024³⁸ Cross-sectional study	Mothers with children between 6 and 24 months n = 381	ANC visits	CF practices such as: time of introduction, MMF, MDD, MAD	Researcher developed questionnaire which assessed the CF practices and maternal factors	The majority (65.1%) of the mothers began CF at 6 months. Infants of mothers who had completed the ANC visits ⩾4 times had increased likelihood to engage in the recommended CF practice compared to infants of mothers who had not completed ANC visits (p = 0.025).
Khanal, 2013a³⁹ Secondary data from 2011 NDHS	Mothers of age 15 years and above n = 3948	ANC visits Location of childbirth	Prelacteal feed	Prelacteal feeding indicators of NDHS 2011	Prelacteal feeding was reported by 26.5% of mothers. Higher likelihood of giving prelacteal foods to the children were noted among the mothers who never visited the ANC clinics (p < 0.001) or visited the ANC clinics 1–3 times (p < 0.001) in comparison to the mothers who visited the ANC clinics ⩾4 times.
Khanal, 2013b⁴⁰ Secondary data from NDHS	Mothers with children between 6 and 23 months n = 698	ANC visits	IYFC indicators: MDD, MMF, MAD	IYFC indicators extracted from NDHS 2011	A total of 30.4% children had achieved MDD, 76.6% had followed MMF, and 26.5% had consumed MAD. Compared to the infants whose mothers had no ANC visits, higher likelihood of MMF (p = 0.002) and higher MAD (p = 0.003) were noted among the infants whose mothers had ⩾4 ANC visits.
Khanal, 2014⁴¹ Cross-sectional study	Mothers with children between 12 and 23 months n = 190	ANC visits Location of childbirth	EIBF EBF	Adapted WHO LQAS tool	45.3% children received EIBF. 63.2% of children received EBF. 92.6% of the women had at least one ANC visits. Significant association was noted between ANC visits, location of childbirth (p = 0.001), and support during childbirth (p = 0.001). Significant association was noted between support during childbirth and EIBF (p = 0.035).
Khanal, 2014⁴² Secondary data analysis of NDHS 2006 and 2011	Under five children n = 2845	ANC visit	Birth weight	Secondary data of NHDS 2006 and 2011	Nearly 12% of delivered children had low birth weight. Higher likelihood of delivering an lbw child noted among the mothers who never visited the ANC clinics (p < 0.001) or visited the ANC clinics 1–3 times (p < 0.001) in comparison to the mothers who visited the ANC clinics ⩾4 times.
Khanal, 2015⁴³ Prospective cohort study	Mother infant pair of infant aged <30 days n = 724	ANC visit Type of delivery	EIBF Prelacteal feed	Adapted Nepali version of standardized questionnaire and collected data on sociodemographic variables, maternal factors, and infant feeding practices	Nearly 42% of the mother have initiated early breastfeeding, 92.4% initiated colostrum feeding, and 30.2% provided prelacteal feeding. In comparison to mothers who had normal vaginal birth, there was lower chance to initiate EIBF (p = 0.001) among mothers who had a cesarean surgery. Compared with the children who received prelacteal feed, there was higher likelihood of EIBF (p = <0.001) among children who did not receive prelacteal feed. There was no significant association between EIBF and ANC visit.
Na, 2017⁴⁴ Secondary data from 2001, 2006 and 2011 NDHS	Mothers with 6–23 months of children n = 6205	ANC visit Location of childbirth Type of delivery PNC visit	WHO-UNICEF CF indicators: TICF, MMF, MDD, MAD	NHDS survey of 2001, 2006 and 2011, MICS of 2014	About 72% of children had TICF, 82%, 36%, and 35% had received MMF, MDD, and MAD, respectively. Mothers who never visited the ANC clinics or visited the ANC clinics 1–3 times—were less inclined to meet the recommended MMF (p ⩽ 0.05 for both), MDD (p ⩽ 0.01 for both), MAD (p ⩽ 0.001 for both) practices in comparison to the mothers who visited the ANC clinics ⩾4 times. PNC visits were not found to be an independent predictor of CF.
Neupane, 2014⁴⁵ Secondary data from 2006 NHDS	Women between the ages of 15 and 49 who have given birth within the past 3 years n = 4136	ANC visit Initiation of prenatal care Location of child birth	EIBF	NDHS survey tool 2006	Mothers who had more than 3 ANC visits are more inclined practice EIBF (p < 0.001) than the mothers who did not have ANC visits.
Pandey, 2010⁴⁶ Secondary data analysis of NDHS 2006	Less than 2 years old children n = 1906	ANC visit PNC visit Location of delivery Type of delivery	EIBF EBF TICF	Breastfeeding and infant feeding practices, maternal factors, and sociodemographic variables	35.4% of the children began breastfeeding within an hour after delivery. Compared with the mothers with no ANC visit, there is lesser likelihood of EBF among mothers with 1–2 ANC visits (p < 0.05).
Paudel, 2012⁴⁷ Community based case control study	Children of age 6–59 months n = 236 (118 in each case and control group)	ANC visits	EBF FF DD	Measured the height of the children Socioeconomic factors and feeding practices were collected among the mothers	Stunted growth was more likely to occur in children who were not exclusively breastfed, received FF <4 times a day, and had DD below WHO standards. Mothers who had <4 ANC visits were more inclined toward having stunted children.
Paudel, 2020⁴⁸ Cross-sectional study	Children under 24 months of age n = 426	ANC visit PNC visit Location of delivery	Nutritional status (HFA, WFA, WFH as per WHO)	Utilized baseline data of CBNIP in rural Nepal	50.6% of the children were moderately wasted and underweight. A higher likelihood of having a malnourished child was noted among the mothers who had the ANC services <4 times (p < 0.001) in comparison to the mothers who had the ANC services ⩾4 times. A higher likelihood of having a malnourished child was noted among the mothers who had not attended the PNC clinics (p < 0.001) in comparison to the mothers who visited the PNC clinics at least once. A higher likelihood of having a malnourished child was observed among the woman (p < 0.05) who delivered their baby at home in comparison to the woman who delivered in a healthcare institution.
Pokhrel, 2016⁴⁹ Cross-sectional study	Mothers with children between 6 and 23 months n = 400 mother child dyad	ANC visit PNC visit	ICFI Nutritional status (WFA, HFA, WFH)	Structured questionnaire based on WHO questionnaire for IYFC and nutritional status	Children whose mothers did not follow ANC visits had significantly lower ICFI scores at 6–11 months (p = 0.005) and at 12–23 months (p = 0.011). Children whose mother did not receive PNC service had significantly lower ICFI scores <12 months of age (p < 0.001) as well as <24 months of age (p < 0.001). In comparison to the woman who attended ANC clinics ⩾4 times, mothers with no ANC visit have a higher chance of having underweight children aged <12 months of age (p < 0.05) as well as <24 months of age (p < 0.01). Compared with the mothers who had ⩾4 ANC visits, mothers with no ANC visits have a higher chance of having stunted children aged <12 months of age (p < 0.001) as well as <24 months of age (p < 0.01). Compared with women who had done 3 PNC visits, women who had no PNC visits have a higher chance of having underweight children at age 12–23 months (p < 0.001) Compared with women who had done 3 PNC visits, women who have no PNC visit have higher chance of having stunted children aged <12 months of age (p < 0.01) as well as <24 months of age (p < 0.01).
Sanjel, 2018⁵⁰ Cross-sectional and descriptive study	Women who have Children less than 1 year of age, n = 362	ANC visit Location of delivery	EIBF	Structured questionnaire based on indicators for neonatal care practices	65.5% mothers followed EIBF. When compared with women who delivered at home, women who have delivered at a health institution were)more inclined to follow EIBF (p < 0.001). A higher likelihood of initiating breastfeeding within 1 h of delivery was observed among the woman who were provided with breastfeeding guidance during ANC visits in comparison to the woman who were not provided with breastfeeding guidance (p = 0.001). ANC visit is not significantly associated with EIBF.
Sharma, 2015⁵¹ Retrospective cross sectional study	Singleton newborn babies delivered at term n = 465 (case = 155, control = 310)	ANC visit	Birth weight	Maternal factors, medical records, and anthropometric measurements	There was no significant association between ANC visit and lbw. 97% women had ⩾4 ANC visits.
Sigdel, 2020⁵² Case control study	Children less than 5 years of age n = 279 (93 cases and 186 control)	ANC visit PNC visit	Underweight (low WFA), EIBF, EBF	Adapted from NDHS 2011 and similar study	Children whose mothers had fewer than three PNC follow-ups had a higher chance of becoming underweight compared to those whose mothers completed three or more PNC follow-ups (p < 0.05). No significant association was noted between under nutrition with ANC visit, EIBF, or with EBF.
Singh, 2024⁵³ Secondary data analysis of NDHS 2022	Less than 6 months (0–5 months) infant n = 540	ANC visit PNC visit Location of delivery Type of delivery	EBF IBF	Secondary data of NDHS 2022	About 57.46% of the infants were exclusively breastfed. Compared with the mothers who have low ANC visits, there was higher inclination of EBF practices among mothers who have either moderate (p < 0.001) or high (p < 0.01) ANC visits (⩾4 ANC visits for both).
Shrivastava, 2013⁵⁴ Cross-sectional study	Mother-infant visiting healthcare facility’ n = 508	Location of delivery Type of delivery	EIBF EBF Prelacteal feed and colostrum feed	Breastfeeding practices, anthropometry of the baby, and sociodemographic variables were collected using a questionnaire	Nearly 56% of the infants were exclusively breastfed. Practice of EBF was found to be progressively declining with increasing age such as EBF at 1 month was 18.6%, at 1–3 months was 37.3% and at 3–6 months was 35.4%. Infants receiving prelacteal feed and colostrum feed was found to be 17.9% and 92.9%, respectively. A significant association was noted between EIBF and type of child birth (p < 0.001).
Sunuwar, 2023⁵⁵ Cross sectional study	Children between age 6 and 23 months n = 318	ANC visit Location of delivery	IYCF Child feeding practice MDD, MMF, MAD, CF	Child feeding practices, sociodemographic variables, and nutrition-related factors were considered	Among the children between 6 and 23 months, the children who did not meet MDD, MMF, MAD, and suggested CF practice were 47.2%, 46.9%, 57.2%, and 96%. A higher likelihood of suboptimal child feeding behaviors was noted among the mothers who delivered at home in comparison to the mothers who gave birth in a health institution (p = 0.045).
Ulak, 2012⁵⁶ Cross-sectional study	Infants, n = 325	Type of delivery ANC visit	Prelacteal feed, BF, EIBF, colostrum feed	Structured questionnaire Used UNICEF electronic pediatric scale to measure weight and local made wooden board to measure length	79% of infants were introduced to CF before 6 months. Except 7, all other women had an ANC visit; however, BF information was not provided to 72% of the women during ANC visits. An increased likelihood of having a shorter child was observed among the infants who received CF at 2 months of age in comparison to the infants who did not receive CF during initial 2 months (p = 0.006).

RCT: randomized control trial; lbw: low birth weight; ANC: antenatal care; IFA: iron and folic acid supplementation; TD immunization: Tetanus and diphtheria immunization; PNC: postnatal care; MCH: maternal and child health; EIBF: early initiation of breastfeeding; IYCF: Infant and young child feeding; MHC: maternal healthcare practices; EBF: exclusive breastfeeding; MDD: minimum dietary diversity; MMF: minimum meal frequency, MAD: minimum acceptable diet; DD: dietary diversity; BF: breastfeeding; WHO: World Health Organization; LQAS: Lot Quality Assurance Survey; TICF: timely introduction of complementary foods; MICS: Multiple Indicator Cluster Survey; FF: Food frequency; DD: dietary diversity; HFA: height for age; WFA: weight for height; WFH: weight for height; CBNIP: community based nutritional intervention project; ICFI: infant and child feeding index; ICF: introduction of complementary feeding; IIFAS: Iowa Infant Feeding Attitude Scale; BSES: SF: Breastfeeding Self-efficacy Scale Short Form; EBSSS: Exclusive Breastfeeding Social Support Scale; CF: complementary feeding.

Results

Study characteristics

We identified 29 studies that adhered to the inclusion criteria. All the studies were of quantitative nature and the designs varied from cross-sectional, retrospective, prospective, and case–control studies. There were a total of 32,973 participants in these studies. Refer to Table 1 for the details of the studies. After pooling the evidence from these 29 studies, we synthesized 6 themes based on the aim of this review which are described below.

Theme 1: ANC utilization and child feeding practices

According to the WHO, IYCF practices include the following six components: EIBF, EBF, the introduction of CF, MDD, MMF, and MAD.⁷ Of the 29 reviewed studies, only 6^20,29–44 collected data on ANC visits and all 6 IYCF practice components.

Out of these 6 studies, only 2 studies have reported about the rate of ANC visits which were 49.7% out of 360 women²⁹ and 76% of the mothers had attended at least 1 ANC visits out of 1429 mothers.²⁰ Findings from three studies have indicated that compared to mothers who did not have any ANC visits, mothers who completed the recommended number of ANC visits (⩾4) were more likely to follow the IYCF practice components.^20,40,44 This trend was particularly true for MDD, MMF, and MAD practices.^20,40,44 However, ANC visits were not associated with IYCF practices in one of the cross-sectional studies reviewed.²⁹

The breastfeeding practices observed varied among the six studies which evaluated ANC and IYCF practices. Of the 360 mothers, 95.6% breastfed their children, and 69.2% began breastfeeding within an hour of childbirth.²⁹ In a retrospective study of 1,352 mothers, 89% practiced EBF, 16% practiced EIBF, and 67% practiced colostrum feeding. A total of 89% children were exclusively breastfed.³⁴ An association was noted between the pattern of CF practices and ANC visits in two of the reviewed studies. Infants of mothers who had completed ANC visits were more likely to engage in the recommended CF practice than infants of mothers who had not completed the ANC visits.^34,38

Out of all the six components of the IYCF practices, some studies only evaluated certain IYCF practice components in relation to ANC visits. Findings from the several studies indicated that the recommended ANC visits influenced the outcomes of many infant feeding practices, such as EIBF, EBF, and infant and child feeding index (ICFI), as well as the introduction of prelacteal feeds.^39–53 Findings from the three of the reviewed studies highlighted that mothers who had more than three ANC visits were more inclined to practice EIBF (p < 0.001) and EBF than mothers who did not have any ANC visits.^45,46,53 Additionally, children whose mothers did not follow the ANC visit recommendations had significantly lower ICFI scores at 6–11 months (p = 0.005) and 12–23 months (p = 0.011).⁴⁹

However, findings from a retrospective study reported an association between attending fewer than the recommended number of ANC visits and negative infant feeding practices, such as prelacteal feeding. Specifically, mothers who had one to three ANC visits or did not have any visits (p < 0.001 for both) were more likely to give their children prelacteal food than mothers who had four or more ANC visits.³⁹ Although a cross-sectional study with 325 participants reported that 98% of the participants had ANC visits, 72% did not receive any information regarding BF during the visits.⁵⁶ Meanwhile, contrary to the findings of the aforementioned studies, a prospective cohort study did not find a significant association between EIBF and ANC visits.⁴³

Theme 2: PNC utilization and child feeding practices

Among the 29 studies reviewed, 4 specifically highlighted the relationship between PNC visits and IYCF practices.^20,44,30,31 Out of four studies, only the findings from one study have mentioned the PNC visit rate, reporting that 37.5% of 360 mothers had these visits.²⁹ The reviewed studies presented mixed findings regarding the relationship between PNC visits and IYCF practices. Although the findings from two studies found no association between PNC visits and IYCF practices,^29,44 a secondary data analysis revealed a significant association between PNC visits and certain IYCF components, such as MDD, MMF, and MAD.²⁰ Mothers who had a PNC checkup after 7 days of childbirth had a significantly higher rates of MMD (p = 0.000), MMF (p = 0.05), and MAD (p = 0.000) compared to mothers who did not have any PNC visits.²⁰ This suggests that frequent PNC visits may positively influence the dietary practices of infants and young children. Only one study examined the relationship between EIBF and PNC visits, and it found a negative association between them.³⁰ Mothers who had at least one PNC visit were less inclined (p = 0.027) to begin breastfeeding within the first hour of life.³⁰

Theme 3: natal details (location of delivery) and child feeding practices

Five of the reviewed studies addressed natal details (i.e., place of delivery) and any form of IYCF practices in Nepal.^32–55 According to three of these studies, 56% to 63% of mothers engaged in EBF practices.^43,33,54 However, none of these five studies observed significant relationships between EBF and location of delivery or type of delivery. However, institutional delivery was a determinant of EBF social support scale in one study.³²

Seven of the reviewed studies addressed EIBF after childbirth, with EIBF rates ranging from 35.4% to 69.2%.^{29,46,43,30,35,50,41} The reviewed studies indicate a significant relationship between the place of delivery and IYCF practices. Mothers who delivered at healthcare facilities were more likely to practice EIBF compared to those who delivered at home.^35,50 Similarly, in a retrospective study that used secondary data from NDHS also found a statistically significant relationship between EIBF and institution delivery (p < 0.001).³⁶ In alignment with the above findings, institutional delivery was associated with higher birth weight, as children born in hospitals were more likely to have greater birthweight compared to those born at home (p = 0.001).³³ Although the findings of a cross-sectional study reported a high rate of institutional delivery (83% of 360 mothers), it did not address the relationship between institutional delivery and IYCF practices.²⁹

Similar to the IYCF practices, place of delivery was also associated with inappropriate child feeding practices and child malnutrition. A significant association was noted between inappropriate child feeding practices and home delivery in which compared to mothers who delivered at home instead of at a health institution were more likely to follow inappropriate child feeding practices (p = 0.0045).⁵⁵ Similarly, women who gave birth at home had a higher chance of having a malnourished child than those who gave birth in a healthcare facility (p < 0.05).⁴⁸

Theme 4: mode of delivery and child feeding practices

The reviewed studies evaluated several aspects of breastfeeding such as EBF, EIBF, and CF revealing a range of findings. The rate of EBF varied significantly among the studies ranging from 29.7% to 63.2%.^{53,32,50,33–41} Notably, results from one study indicated that EBF rates declined as children aged; the rate was 78.6% at 1 month, peaked at 37.3% between 1 and 3 months, and slightly decreased to 35.4% during 3–6 months.⁵⁴ The range of EIBF practices varied from 35.4% to 69.2% among the reviewed studies.^{29,46,43,30,35–50,41} In contrast, a slightly higher rate (more than and equal to 67%) of colostrum feeding was noted within three of the reviewed studies that collected data on colostrum.^34,33,41 These findings highlight the variability in breastfeeding practices and suggest that although EBF and EIBF rates show significant variation, colostrum feeding appears to be more consistently practiced.

Some studies evaluated prelacteal and CF practices which provide a comprehensive understanding of the varied approaches and outcomes associated with infant nutrition and early feeding behaviors. Only three studies collected data on prelacteal feeding, and it ranged from 17.9% to 30.2%.^39,43,54 Additionally, an association was noted between prelacteal feed and EIBF in which compared to children who received prelacteal feed, children who did not had a higher likelihood of EIBF (p = <0.001).⁴³ Regarding CF, there is a notable trend of early CF introduction among infants with significant variations in the age of initiation observed in the reviewed studies. Findings from a study report CF initiation before 6 months,⁵⁶ whereas others indicate initiation between 6 and 8 months.^20,38 Additionally, findings from a cross-sectional study indicated that infants who received CF during their initial 2 months of life were significantly shorter than those who did not (p = 0.006).⁵⁶

The reviewed studies yielded mixed findings regarding breastfeeding practices and their associations with delivery mode. Evidence from a cross-sectional study and a retrospective study showed that mothers who had natural vaginal births were more inclined to practice EBF (p = 0.029)²⁹ and EIBF (p < 0.001).³⁵ In contrast, Dhakal et al.³² did not observe any significant relationships between EBF and mode or place of delivery.

Findings from three studies found a negative association between cesarean sections (C-sections) and EIBF.^43,30,37 Findings from a prospective study found that mothers who underwent C-sections were less likely to initiate EIBF than those who had vaginal deliveries.^43,30 Similarly, another group of researchers³⁷ cited C-section delivery as a factor in EBF discontinuation.

Theme 5: MHS and child feeding practices and their impact on child nutritional status

The findings from the reviewed studies by Dhungana and Paudel et al. provide valuable insights into the relationship between breastfeeding practices and child malnutrition. Evidence from these studies indicated that breastfeeding for less than 6 months and not engaging in EBF or colostrum feeding increased the risk of child malnutrition.^33,47 Evidence from a cross-sectional study indicated that the odds of having wasted children were higher among mothers who breastfed their children for less than 6 months compared to those who breastfed for 6 months or more (p = 0.045); however, this study did not assess ANC visits.³³ Meanwhile, a community-based case–control study indicated that children who were not exclusively breastfed had significantly higher odds of being stunted, and mothers who had fewer than four ANC visits were more likely to have stunted children.⁴⁷

Five of the reviewed studies evaluated the risk of child malnutrition such as low birth weight, child stunting, malnutrition based on WHO guidelines (regarding height for age, weight for height, and weight for height), and lower IYCF scores in relation to ANC visits.^{49,30,48,47,73} Specifically, findings from these studies indicated that, compared to mothers who had four or more ANC visits, mothers who did not utilize ANC services had a higher chance of having babies with a low birth weight, malnourished children (according to the WHO guidelines), stunted and underweight children.^{49,30,48,47,73} Similarly, findings from a cross-sectional study reported that children whose mothers did not have ANC visits had significantly lower ICFI scores at 6–11 months (p = 0.005) and 12–23 months (p = 0.011)⁴⁹ Conversely, results from a retrospective study indicated that although 95% of the women had more than four ANC visits, no significant association was noted between ANC checkups and low birth weight.⁷²

Three articles mentioned PNC visits and the nutritional status of children.^49,48,52 These studies focused on the influence of PNC visits on underweight, malnutrition, and stunting among children younger than 5 years old. Out of these, analysis of the two studies indicated that, compared with women who had three or more PNC visits, women who did not have any PNC visits had a higher chance of having underweight children (p < 0.001 and p < 0.05, respectively). Similarly, compared with mothers who had at least one PNC visit, mothers who did not have any PNC visits had a significantly higher risk of having a malnourished child (p < 0.001)⁴⁸ or a stunted child from 6 to 23 months of age (p < 0.01).⁴⁹ This suggests that frequent PNC visits may positively influence the dietary practices of infants and young children.

Theme 6: health education counseling during ANC and PNC visits focusing on child feeding practices

Out of the 29 studies reviewed, only 7 studies explored the health information and education counseling that mothers received during ANC or PNC visits.^{29,56,30,32,36,50,37} This indicates a limited focus on this aspect in the broader research landscape. Six of these studies reported that 29% to 94.2% of mothers received education on breastfeeding during ANC visits.^{56,30,32,36,50,37} However, findings from one of the cross-sectional studies indicated that, out of 360 mothers, 44.7% received nutritional counseling from health personnel; however, the study did not clearly address the timing of nutritional counseling. In other words, it was unclear whether this counseling happened during ANC or PNC visits.²⁹

Regarding IYCF practices, Hollow et al. found a significant association between EIBF and breastfeeding guidance from healthcare professionals within the first 2 days after the delivery (p = 0.002).³⁶ Results from a cross-sectional study indicated that mothers who received breastfeeding counseling during ANC were more likely to initiate breastfeeding within 1 h of birth than those who did not receive counseling.⁵⁰ However, Dhakal et al. did not find a significant association between antenatal breastfeeding education and EBF practices.³² This suggests that although ANC education may influence the initiation of breastfeeding, it may not necessarily impact the continuation of EBF.

Discussion

The objective of this scoping review is to explore the effect of MHS on feeding practices for infants and children under 5 years of age and the influence of these practices on child nutrition. We mapped the evidence from 29 published studies about MHS and their influence on feeding practices among the children under 5 years old in Nepal. The findings from this review highlighted the underutilization of maternal services and the current gaps in their utilization, affecting IYCF practices and their relation to the nutritional status of children under 5 years old in Nepal. We synthesized six themes by pooling the evidence from the reviewed studies: (1) ANC utilization and child feeding practices; (2) PNC utilization and child feeding practices; (3) natal details (location of delivery) and child feeding practices; (4) mode of delivery and child feeding practices; (5) MHS and child feeding practices and their impact on child nutritional status; and (6) health education counseling during ANC and PNC visits, focusing on child feeding practices.

MHS and feeding practices among the children under 5 years old play a vital role in growth and development of the children. Despite the progress in MHS, sociocultural practices such as prelacteal feeding, avoiding colostrum, and early introduction of CF persist in Nepal. These practices indicate a gap in MHS knowledge and child feeding practices. Addressing these gaps requires continuous efforts to improve MHS, enhance community engagement, and implement effective interventions.

Findings of this review underscore the critical role of ANC in promoting optimal infant feeding practices. Women who attended the recommended ANC contacts (⩾4 ANC checkups) demonstrated better adherence to the components of IYCF practices such as MDD, MMF, and MAD, more likely to practice EIBF and EBF, and follow the recommended CF for their children compared to those who had no ANC visits. These findings suggest that the recommended ANC visits enabled the mothers to follow and adopt the recommended feeding practices early and highlight the importance of comprehensive ANC in ensuring that mothers are well-informed about the appropriate timing and methods for introducing CF to their infants. Our findings are in consistent with several studies from different regions. Findings of a study from Ethiopia reported that ⩾3 ANC visits by pregnant women were significantly associated with EBF practices in mothers regardless of their employment status⁵⁷, whereas in India woman with regular ANC appointments were more likely to introduce CF at the appropriate time to their infants compared to the mothers who did not attend ANC clinics.⁵⁸ Similar to our review, results from a multi-country study in South Asia and India revealed that mothers who did not attend ANC clinics were found to have a delayed initiation of breastfeeding.^58,59 WHO also recognizes the importance of supportive women’s health services such as ANC visits as a key strategy for promoting breastfeeding practices.⁷

Analysis from our review indicated that there is a notable positive association between the recommended PNC visits and specific IYCF components such as MDD, MMF, MAD and CF, and EBF. This implies that PNC visits can play a crucial role in improving dietary diversity, meal frequency, overall diet quality, and appropriate CF for infants and children under 5 years old. Our findings matched with previous studies indicating that mothers who attended more than four PNC appointments are more likely to practice appropriate CF compared to those who never attended PNC clinics.^60,61 Results from previous studies also reported an association between inadequate PNC checkups and poor dietary diversity in CF⁶² as well as an association between recommended PNC visits and a reduced chance of providing inappropriate CF.⁶³ UNICEF has integrated up to three PNC visits in Gaza, Palestine, incorporating strategies to improve breastfeeding such as guidance on proper breastfeeding techniques which resulted in improved EBF practices among 80% of women who received a PNC visit within the first week after childbirth.⁶⁴ None of the reviewed studies address the association between PNC visits and EBF. However, one of the objectives of PNC visits is to promote EBF. This indicates a gap in the literature that needs to be addressed to better understand how PNC visits influence EBF practices.

Evidence from this review suggests that institutional delivery is positively associated with better IYCF practices and improved child health outcomes. Specifically, delivering at a healthcare facility significantly increases the likelihood of practicing EIBF and reduces the chances of inappropriate child feeding practices. These findings are supported by the previous studies indicating that EIBF is positively associated with deliveries in maternity wards compared to other hospital wards in Mozambique.⁶⁵ WHO also advocates for the baby-friendly hospital initiative, which includes EIBF within 1 h of birth, immediate skin-to-skin contact between mother and newborn, responsive feeding based on the infant’s cues, refraining from offering additional fluids or supplements unless medically indicated, and enabling 24-h rooming-in. These practices are typically feasible only in institutional delivery settings.⁷ Conversely, studies in India and Bangladesh found that EIBF was more common among mothers who delivered at home compared to those in health institutions.^66,67 Similarly, findings of this review did not support the association between institutional delivery and EBF practices.

Based on the observations of this review, institutional delivery is linked to higher birthweights and lower rates of malnutrition among children. Our findings align with previous studies, which indicate that the likelihood of delivering underweight babies is higher for home births compared to those born in health facilities. Similarly, the chances of having a stunted child are higher among those born at home.⁶⁸

Evidence from these reviewed studies show that mothers who did not attend ANC services are more likely to have children with adverse health outcomes, including low birth weight, malnutrition, stunting, and being underweight, compared to those who attended four or more ANC visits. Similar results were reported by studies conducted in other LMICs where ANC visits and nutritional counseling have improved child nutrition.^69,70 One possible explanation is that well-nourished women are more likely to give birth to children with adequate nutritional status. Recognizing the link between maternal and child malnutrition, UNICEF is implementing an initiative to enhance maternal nutrition through micronutrient supplementation delivered via ANC services in 16 developing countries, including Nepal by the end of 2025.⁷¹

The reviewed studies present mixed findings regarding breastfeeding practices and their association with the delivery mode (vaginal birth versus cesarean). Overall, although some studies highlight the positive impact of vaginal births on EIBF practices, others indicate that cesarean sections may hinder these practices. These findings correspond with a previous study that noted a statistically significant association between mode of delivery and breastfeeding initiation, with delayed initiation of breastfeeding more common among women who had cesarean deliveries (p = 0.001).⁷²

Findings from this review highlight a significant association between health education received from healthcare personnel during ANC or PNC periods and IYCF practices. Our findings match with a study conducted in Indonesia, which found that postnatal counseling (p = 0.006) and ANC visits are significantly associated with the success of EBF.⁷³ The 2022 UNICEF Global Annual Results Report also highlights that IYCF counseling has significantly increased the global rate of EBF by 37% since the year 2000.⁷⁴ Similar to this study, a study done in Burkina Faso indicated that the facility-based personalized maternal nutrition counseling was significantly associated with an improved IYCF practices.⁷⁵ These findings underscore the importance of integrating comprehensive BF education into ANC services to promote better breastfeeding practices. The Academy of Breastfeeding Medicine recommends structured breastfeeding education during the ANC period as a form of anticipatory guidance.⁷⁶ This recommendation is based on evidence that women who receive breastfeeding education during ANC are more likely to adopt recommended breastfeeding practices, leading to improved child health outcomes.⁷⁶ The Academy also emphasizes the integration of community health workers in delivering such education and the importance of tailoring content to the cultural context of pregnant women, an approach that is particularly relevant to settings like Nepal.

Implications for practice and research

The findings of this review did not support the association between institutional delivery and EBF practices followed by the women in Nepal. This suggests several potential areas for improvement in maternal health services in Nepal. It indicates that women may not be receiving adequate health education on EBF practices during their time in healthcare institutions for childbirth. This gap in education could be addressed by implementing structured and comprehensive health education programs focused on EBF after the delivery in Nepal. Additionally, none of the reviewed studies have comprehensively covered all components of maternal health services and child feeding practices, nor their impact on child nutritional status. A national-level survey is required to make validated recommendations, and to develop policies and protocols to strengthen MHS and child feeding practices in Nepal.

None of the reviewed studies provide the details of the mechanisms or components through which ANC, natal, or PNC visits influence child feeding practices. Understanding the specific components of ANC, natal, or PNC visits that contribute to these outcomes would be valuable for designing effective interventions. Additionally, none of the reviewed studies account for cultural factors that may influence both the likelihood of attending ANC, natal, and PNC visits and adherence to feeding practices. By addressing these gaps, future research can provide more robust evidence and insights into the role of these visits in promoting optimal child feeding practices in Nepal.

Another implication of the finding of this review is that all the reviewed studies were of quantitative design, and the perceptions of the mothers regarding MHS and child feeding practices are missing which suggests that there is a significant gap in understanding the subjective experiences and insights of mothers. This lack of qualitative data may hinder the development of comprehensive and effective MHS and child feeding programs that are responsive to the needs and preferences of mothers. Therefore, future research should incorporate qualitative methods to capture these valuable perspectives and inform more holistic and mother-centered healthcare interventions.

Strengths and limitations

The strength of this scoping review is that we followed the rigorous methodology using PRISMA-ScR and JBI methodology. These frameworks enabled us to comprehensively capture evidence on the influence of MHS on infant and child feeding practices for children under 5 years old, and as well as the influence of both on child malnutrition. Even though we searched for studies from Nepal that matched our inclusion criteria in many prominent databases, some published studies from Nepal may not have been indexed in these databases. This leads to the possibility of missing a few articles. Another limitation is related to the scoping review methodology itself. Scoping reviews typically do not include an assessment of the quality or risk of bias of the included studies, which limits the ability to evaluate the strength of the evidence.

Conclusion

The focus of this scoping review is to identify the role of MHS in child feeding practices and their relation to the nutritional status of the children. We pooled evidence from 29 studies and identified 6 key themes such as ANC utilization and child feeding practices, PNC utilization and child feeding practices, location of delivery and child feeding practices, mode of delivery and child feeding practices, MHS and child feeding practices, and their impact on child nutritional status and health education counseling during ANC and PNC visits, focusing on child feeding practices. The subsequent analysis of these key themes indicated a significant association between the utilization of MHS and various child feeding practices among the under 5-year old children in Nepal. The findings from this review will contribute to the analysis of factors that need to be strengthened within MHS to achieve optimal feeding practice guidelines for the children under 5 years old in Nepal.

Supplemental Material

sj-docx-1-whe-10.1177_17455057251374502 – Supplemental material for Exploring maternal healthcare services and child feeding practices in Nepal: A scoping review

Supplemental material, sj-docx-1-whe-10.1177_17455057251374502 for Exploring maternal healthcare services and child feeding practices in Nepal: A scoping review by Subasna Shrestha, Bhawana Shrestha, Sita Karki, Geeta Kamal Shrestha, Kunta Devi Pun, Prabha Shrestha and Suja P. Davis in Women's Health

Supplemental Material

sj-docx-2-whe-10.1177_17455057251374502 – Supplemental material for Exploring maternal healthcare services and child feeding practices in Nepal: A scoping review

Supplemental material, sj-docx-2-whe-10.1177_17455057251374502 for Exploring maternal healthcare services and child feeding practices in Nepal: A scoping review by Subasna Shrestha, Bhawana Shrestha, Sita Karki, Geeta Kamal Shrestha, Kunta Devi Pun, Prabha Shrestha and Suja P. Davis in Women's Health

Footnotes

Acknowledgements

The authors thank Jamie Conklin, Health Sciences Librarian at the University of North Carolina at Chapel Hill, NC, United States for her support with the database search.

ORCID iD

Suja P. Davis

Ethical considerations

Not applicable.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Author contributions

Subasna Shrestha: Conceptualization; Formal analysis; Writing – original draft.

Bhawana Shrestha: Formal analysis; Data curation; Writing – original draft; Methodology.

Sita Karki: Formal analysis; Data curation; Writing – original draft.

Geeta Kamal Shrestha: Methodology; Writing – original draft.

Kunta Devi Pun: Formal analysis; Writing – original draft; Supervision.

Prabha Shrestha: Formal analysis; Writing – original draft.

Suja P. Davis: Conceptualization; Supervision; Writing –review & editing; Formal analysis.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data availability statement

Not applicable.

Supplemental material

Supplemental material for this article is available online.

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