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Undernutrition among women of reproductive age (WRA)-an old problem-remains prevalent in South Asia, compromising their health, particularly during pregnancy and lactation. In low-income, gender-unequal settings where women typically eat last and least, dietary inadequacies continue to result in multiple nutrient deficiencies, contributing to the intergenerational cycle of maternal and child undernutrition, morbidity and mortality. Unfortunately, research and interventions for improving women's dietary quantity and quality are lacking, undermining efforts to secure nutrition, health, and survival of women and children. This dissertation comprises three studies with an overall aim of assessing deficits and correlates of women's dietary intakes and understanding contextual barriers and enablers in implementing maternal nutrition interventions in rural Bangladesh. In the first study, we assessed macro- and micronutrient intakes of WRA against reproductive-stage specific recommendations. Using a novel quantitative approach, we evaluated whether, at a population level, diets of pregnant or lactating women are statistically similar to that of non-pregnant, non-lactating (NPNL) women. We found that nutrient intakes of pregnant and lactating women were suboptimal as well as statistically similar to those of NPNL women. Next, we used panel data from 2012 and 2015 to assess whether relationships between household income and women's overall food intake, diet diversity and access to animal source foods varied by type of women's agency. We found that controlling for unobserved heterogeneity across women and other potential confounders, household income was positively and independently associated with women's dietary intakes on all three fronts, while women's intrahousehold agency, marked by self-determination, was positively and independently associated only with their dietary diversity. Finally, using focused ethnography, we drew insights from community health workers on factors that hinder or facilitate improvement of maternal diets and other behaviors that they promoted in a recent family-focused, comprehensive maternal nutrition trial. This exploration revealed that at the community-level, adoption and promotion of recommended maternal nutrition behaviors depends on the extent to which they are perceived as resource-intensive or non- normative. Our findings highlight that women remain at a dietary disadvantage, irrespective of their reproductive status. Without improvements in household income, nutrition knowledge, family support and gender-based norms, women's agency may be insufficient to improve their own dietary quantity and quality. More research is needed to improve nutrition-specific and nutrition-sensitive interventions focused on women.
