• Fiona Dykes, Monique Lhussier, Sonia Bangash, Mukhtiar Zaman, and Nicola Lowe.
• Maternal and Infant Nutrition and Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston PR1 2HE, UK. fcdykes@uclan.ac.uk
• Midwifery. 2012 Dec 1; 28 (6): 831-5.

Objectivesthe aim of this study was to explore and contextualise meanings, beliefs and practices surrounding maternal and infant nutrition in North West Pakistan and to use the findings to inform the development of a nutritional improvement programme adapted to local needs.Designthe Context-Mechanism-Outcome framework was used to gather contextual data, formulate questions and conduct focus groups to inform the design of a culturally appropriate nutritional health programme with the overall goal of improving practices related to maternal and infant nutrition. Two focus groups were conducted with the team of local lady health workers (n=16), one prior to implementing a nutritional improvement programme and one 6 months after implementation.Settingsthe study was conducted in communities surrounding and served by the Emergency Satellite Hospital (ESH) in Nahaqi in Khyber Pakhtunkhawa (KP) (formally known as the Northwest Frontier Province), Pakistan.Findingspoverty and specific cultural practices impeded the achievement of optimum maternal and infant nutrition. A nutrition support programme was implemented; it involved cookery demonstration kitchens and free food supplements, coupled with nutrition and health-care information-giving for pregnant and lactating women. Focus group discussions revealed that women had positive perceptions of the impact of the nutritional health improvement programme, feeling that knowledge and practices were enhanced. However, structural and cultural factors continued to have a powerful influence on their practices.Conclusions And Implications For Practicethis study highlights that despite structural, cultural and practical barriers, a culturally sensitive health improvement programme has the potential to enhance maternal and infant nutritional practices. However, we should not underestimate the powerful influence of poverty and culturally embedded norms upon women's decisions and practices.Copyright © 2011 Elsevier Ltd. All rights reserved.

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