# Reducing anemia among young, preconception women in Nepal through a household level group norm and behavior change intervention and micronutrient supplementation

> **NIH NIH R01** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2024 · $603,124

## Abstract

ABSRACT
 Preconception micronutrient status (including anemia) is a critical determinant of maternal, newborn, and
child health that remains undervalued in Nepal. However, providing micronutrient supplements (MMS) alone is
not enough. In the Nepali context, the gap between marriage and the first birth is short and newly married
women have the lowest household status. Addressing the intersectional barriers to health for newly married
women, including inequitable gender norms and women’s empowerment, household relationships, nutrition
knowledge and practices—is essential for improving maternal and infant outcomes in Nepal. To mitigate the
community, household, and individual factors resulting in poor nutrition, our team developed and pilot-tested an
educational group intervention (Sumadhur, meaning “Best Relationship”) for newly married women, husbands,
and mothers-in-law triads. Sumadhur aims to provide information on nutrition and women’s health, address
inequitable gender norms and practices, strengthen household relationships and communication, and improve
the household status of newly married women. The pilot study of Sumadhur brought triads of several
households together for 16 interrelated sessions over four-months. Findings suggest that participants (N=90)
found the intervention to be highly feasible and acceptable and nutritional norms and practices improved.
 We propose to test the effectiveness of Sumadhur on maternal health and nutrition outcomes using a 2-arm
cluster RCT (cRCT). The intervention participants will receive the Sumadhur group intervention and will be
provided MMS directly at group sessions. In control villages who do not receive the Sumadhur group intervention,
we will facilitate access to MMS at primary health centers. We will randomize 70 villages to each arm (with one
group per village). Each village has one group of five women (total of 700 women). Newly married women, their
husbands and mothers-in-laws (total=2,100), will be followed four times for 18 months post-intervention through
surveys, hemoglobin tests and blood draws (women only). Our specific aims are to estimate the effectiveness of
Sumadhur on women’s anemia and micronutrient status, including the cost-benefit of the intervention (Aim 1);
explore the impact on intermediate outcomes such as gender norms, household relationships and eating
practices and characterize the individual and household-level mechanisms of impact (Aim 2); understand triadic
experiences and impact over time of Sumadhur (Aim 3).
 Accomplishing these aims will provide evidence for how to improve micronutrient and anemia status among
women before they become pregnant—thereby ensuring that women are not deficient in the critical early
phases of pregnancy. These findings will also advance the field by testing novel approaches (household and
community level behavior and norm change intervention) that, when combined with supplements, may lead to
better adherence, uptake, and, ultimately, hea...

## Key facts

- **NIH application ID:** 10993336
- **Project number:** 1R01HD114798-01A1
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** NADIA GRIFFI DIAMOND-SMITH
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $603,124
- **Award type:** 1
- **Project period:** 2024-09-01 → 2029-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10993336

## Citation

> US National Institutes of Health, RePORTER application 10993336, Reducing anemia among young, preconception women in Nepal through a household level group norm and behavior change intervention and micronutrient supplementation (1R01HD114798-01A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10993336. Licensed CC0.

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