Research shows that delivering balanced energy and protein supplements to pregnant women’s homes through trained community health workers is more effective than clinic-based delivery. According to Gram Research analysis of 48 studies in low-income countries, home delivery was the most common successful approach, mentioned in 11 of 22 studies. Women preferred home delivery because they received nutrition education and personal support during visits, which helped them actually use the supplements and improved outcomes for their babies.
Pregnant and breastfeeding women in low-income countries often don’t get enough food, which can harm their babies. The World Health Organization recommends special supplements with balanced energy and protein to help. According to Gram Research analysis, a new review of 48 studies found that delivering these supplements directly to women’s homes works better than giving them at clinics. Community health workers who visit homes and provide nutrition education help women actually use the supplements. The research shows that combining home delivery with health center visits and good communication about nutrition is the most practical way to help these women and their babies.
Key Statistics
A 2026 systematic review of 48 studies in low- and middle-income countries found that home delivery was the most frequently used platform for balanced energy and protein supplements, appearing in 11 of 22 studies that specifically evaluated these supplements.
Among the four studies that directly asked pregnant and breastfeeding women about their preferences, women consistently favored home-based supplement delivery over facility-based delivery, citing comprehensive nutrition education as a key reason.
Community health worker-led feeding centers providing cooked meals or take-home rations were the second most common delivery approach in the 2026 review, mentioned in 8 of 22 studies evaluating balanced energy and protein supplements.
Research reviewed by Gram found that adding behavior change communication and home visits to facility-based supplement delivery improved how often women actually took iron and folic acid supplements, suggesting this approach works across different supplement types.
The Quick Take
- What they studied: The best ways to deliver nutrition supplements to pregnant and breastfeeding women in countries where many women don’t have enough food to eat.
- Who participated: Researchers looked at 48 studies from low- and middle-income countries. Twenty-two studies specifically looked at balanced energy and protein supplements, while 26 studies looked at iron, folic acid, or other vitamin supplements for pregnant and breastfeeding women.
- Key finding: Home delivery of supplements by community health workers was the most common and preferred method. Women liked home delivery better than going to clinics because they received nutrition education and support during visits. Only four studies directly asked women which delivery method they preferred, but those studies showed women chose home delivery over facility-based options.
- What it means for you: If you live in a country where many women are undernourished, this research suggests that having trained community health workers bring supplements to your home and teach you about nutrition is more likely to work than asking you to pick them up at a clinic. This approach may help more pregnant women get the nutrition they need for healthier pregnancies and babies.
The Research Details
This was a scoping review, which means researchers searched through many published studies to find patterns and common themes. They looked through five major research databases and also searched for unpublished reports and studies. They were looking for research that tested different ways to deliver nutrition supplements to pregnant and breastfeeding women in low- and middle-income countries. The researchers wanted to understand which delivery methods were acceptable to women and which ones actually worked in real-world settings.
The review included both direct evidence (studies specifically about balanced energy and protein supplements) and indirect evidence (studies about iron, folic acid, or multiple vitamin supplements). This broader approach helped the researchers understand general principles about supplement delivery that might apply across different types of supplements. They looked at delivery methods used both at health facilities and in communities.
Understanding how to deliver supplements effectively is just as important as knowing which supplements to give. A supplement only helps if women actually receive it and use it. This review is important because it shows that the way you deliver a supplement affects whether women will use it. The research suggests that one-size-fits-all approaches don’t work. Instead, programs need to match delivery methods to what women actually prefer and what’s practical in their communities.
This review looked at 48 different studies, which gives it a broad foundation. However, only four studies actually asked women which delivery method they preferred, so the evidence about women’s preferences is limited. The review included both published research and unpublished reports, which reduces bias. The researchers looked at studies from multiple countries and settings, making the findings more broadly applicable. The main limitation is that most studies were not designed specifically to compare different delivery methods, so the evidence is somewhat indirect.
What the Results Show
Home delivery was the most common supplement delivery method mentioned in the studies, appearing in 11 out of 22 studies that looked at balanced energy and protein supplements. Community-level feeding centers, which provided cooked meals or take-home rations and were run by community health workers, were the second most common approach, mentioned in 8 studies. Health facility-based delivery during antenatal care visits was mentioned in 6 studies.
When researchers actually asked women which method they preferred, women consistently chose home delivery over facility-based options. The studies suggested that women liked home delivery because they received comprehensive nutrition education and behavior change communication during home visits. This personal education and support appeared to be a key factor in women’s preference.
The indirect evidence from studies about iron and folic acid supplements showed that adding behavior change communication and home visits to facility-based delivery improved how often women actually took their supplements. This suggests that the personal touch and education component matters across different types of supplements.
The review found very limited evidence about market-based approaches, such as selling supplements through shops or stores. Most successful programs used direct delivery through health systems or community workers rather than relying on women to purchase supplements themselves.
The research showed that community health workers played a crucial role in successful supplement delivery programs. These frontline workers, who are often from the communities they serve, helped make supplements accessible and built trust with pregnant women. Programs that combined multiple delivery approaches, such as home visits plus health facility visits, appeared more successful than single-method approaches. The review also noted that behavior change communication, which means teaching women about nutrition and why supplements matter, was consistently associated with better supplement use.
This review builds on previous research by specifically looking at how supplements are delivered, not just whether they work. Earlier research established that balanced energy and protein supplements help reduce poor birth outcomes in undernourished populations. This new review takes the next step by asking how to actually get these supplements to women in practical, real-world settings. The findings align with general principles from public health research showing that how you deliver health interventions matters as much as what you deliver.
The review has several important limitations. Only four studies directly asked women which delivery method they preferred, so conclusions about women’s preferences are based on limited evidence. Most studies were not designed to directly compare different delivery methods, so the evidence is somewhat indirect. The review did not find much information about newer approaches like using markets or private sector delivery. The studies came from different countries and settings, which means what works in one place might not work exactly the same way in another. Finally, the review looked at studies published up to a certain point, so very recent innovations in supplement delivery may not be included.
The Bottom Line
Based on moderate evidence, programs should prioritize home delivery of balanced energy and protein supplements by trained community health workers, combined with nutrition education and behavior change communication. Health facilities should also be involved to provide antenatal care and reinforce supplement use. This combined approach appears most feasible and acceptable to pregnant and breastfeeding women in low- and middle-income countries. Programs should avoid relying solely on women picking up supplements at clinics without additional support.
This research matters most for health programs and governments in low- and middle-income countries where many women are undernourished. It’s relevant for international health organizations planning nutrition programs for pregnant women. Community health workers and clinic staff who deliver these programs should understand these findings. Pregnant and breastfeeding women in these settings should know that home-based delivery with education support may be available. This research is less directly relevant for women in wealthy countries where malnutrition is less common.
Women who receive supplements through home delivery with education support may see benefits during their pregnancy and breastfeeding period. Babies may show improved birth weight and health outcomes. However, the full benefits depend on consistent use of supplements throughout pregnancy and breastfeeding, which typically lasts several months. Programs need time to train community health workers and establish delivery systems, so implementation may take several months before reaching many women.
Frequently Asked Questions
What’s the best way to give nutrition supplements to pregnant women in poor countries?
Home delivery by community health workers combined with nutrition education works best. A 2026 review of 48 studies found this approach was most common and preferred by women because it provided personal support and education about why supplements matter.
Do pregnant women actually use supplements if they have to go to a clinic?
Less often than with home delivery. Research shows women prefer having supplements brought to their homes with education support. Adding home visits and nutrition education to clinic-based delivery improves how often women take supplements.
Why do community health workers help more than just giving supplements at a hospital?
Community health workers provide nutrition education and behavior change communication during home visits, which helps women understand why supplements matter and builds trust. The 2026 review found this personal education was a key reason women preferred home delivery.
Can you buy these supplements at stores instead of getting them from health programs?
The research found very limited evidence about market-based approaches. Most successful programs used direct delivery through health systems or community workers rather than relying on women to purchase supplements themselves.
How long does it take to see benefits from these supplements during pregnancy?
Benefits develop over the course of pregnancy and breastfeeding, which typically lasts several months. Consistent use throughout this period is important for seeing improvements in maternal health and baby outcomes.
Want to Apply This Research?
- Track supplement intake frequency by recording each time you take your balanced energy and protein supplement, noting the date and time. Set daily reminders for supplement consumption and log completion in the app to monitor adherence over your pregnancy and breastfeeding period.
- If you’re pregnant or breastfeeding in a low-income setting, ask your local health center or community health worker about home-based supplement delivery programs. Request nutrition education during supplement delivery visits. Use the app to set reminders for taking supplements and to track your nutrition goals alongside supplement use.
- Track supplement adherence weekly and review patterns monthly. Monitor any changes in energy levels, appetite, or how you feel. If using the app with a community health worker, share your tracking data during home visits to discuss barriers to supplement use and adjust the delivery approach if needed.
This research summary is for educational purposes and should not replace professional medical advice. Pregnant and breastfeeding women should consult with their healthcare provider or local health clinic about appropriate nutrition supplements for their individual situation. Supplement recommendations vary based on local nutritional status, health conditions, and individual needs. This review reflects evidence from low- and middle-income countries and may not apply to all settings. Always follow guidance from your healthcare provider regarding supplement use during pregnancy and breastfeeding.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.