Health promotion includes any actions of individuals, community, and organisations aimed at improving health and healthy life.Health promotion at the community level and its general principles were briefly discussed in module 2. Thus in this session, we will try to focus on the main issues related to pregnancy and ANC.

As a HEW, you will be expected to promote, educate, and advocate health issues related to both individual and the community. The followings are selected and addressed seen from the angle of their importance for the wellbeing of the pregnant woman and the fetus.

Nutrition During Pregnancy

A pregnant woman should take maximum care of her diet as balanced food contributes to building the normal development the fetus including his/her brain and another part of the body (see figure 7.1, below). It also strengthens the mother to carry and deliver the baby. Moreover, balanced food will assist the woman to produce adequate breast milk after birth. Therefore, those involved should be encouraged to support pregnant mothers with intake of the balanced food.

a) Eating well

To eat well means, to eat a variety and enough balanced food. This combination helps a pregnant woman and her baby stay healthy and strong because it:

  • Helps a woman resist illness during pregnancy and after birth.
  • Keeps a woman's teeth and bones strong.
  • Gives a woman strength to work.
  • Helps the baby grow well in the mother's uterus.
  • Helps a mother recover her strength quickly after the birth.
  • Supports production of sufficient quality breast milk to nourish the baby.

Fig. 7.1. A variety of foods that needs to be eaten by pregnant mothers.

b) Talking to women about food

When you see pregnant women in ANC in the clinic, at village meetings and celebrations or in the market place, try to find out her food habit and encourage her to correct it. The earlier pregnant women start eating healthy foods, the better chance they will have to stay healthy and have normal babies.

Remember that education about food is not enough on its own to change the eating behaviour of the pregnant mothers. That is, a woman may know the best foods for her health and the health of her baby. But, that does not mean she will eat balanced food simply because she may not like the taste of the food or she may not afford to buy the required variety of foods. Hence, to help a woman eat better, suggest healthy foods that she can afford and will choose to eat.

The biggest cause of poor nutrition is poverty. For this, the best remedy is to make wise use of what the family has without wasting a bit of it. For example, the father, instead of spending his money on alcohol, tobacco and "chat" (or khat) could buy nutritive food for his family, or he can as such, buy a hen and let the family eat the eggs. With the same token, a mother who buys her children sweets or soda pop could instead buy eggs, beans or other low-cost and healthful foods for the family. Besides eating good food, the following are some of the activities that help the pregnant mother and her family including the baby to stay healthy and safe.

Hygiene During Pregnancy

During pregnancy, women should be especially careful about personal hygiene. Pregnant women sweat more and have more vaginal discharge than non-pregnant women due to hormonal changes, and they may be more vulnerable to infections by germs in the environment. Keeping the body clean helps prevent infection. Even hand washing with soap is the most important hygienic action a pregnant woman can undertake especially before preparing food and after going to the toilet. If possible, a pregnant woman should wash her body every day with clean water including her genital area.

Dental hygiene is also important during pregnancy because increased oestrogen levels can cause swelling and increased sensitivity in the gum tissues. Whether she cleans her teeth with a dental stick or a toothbrush and toothpaste, the pregnant woman should do it regularly.

Living a Healthy Lifestyle

As well as eating well and keeping clean, pregnant women need to get enough sleep and rest every day. This will help her to:

  • Avoid developing high blood pressure and edema or swelling of the feet and ankles due to fluid collection in the tissues).
  • Stay strong and gives the fetus a better chance of being born healthy.

The followings are some of the issues that HEWs should teach pregnant mothers and their families to stay healthy and productive.

  • Decreasing workload and increasing rest.
  • Getting enough sleep during the night as well as during the day.
  • Avoid cigarette smoke, alcohol and illegal drugs such as opium, heroin, cocaine and barbiturates as they are dangerous for anyone and especially to the developing fetus.
  • Avoid lifting heavy things/materials.
  • Stay away from sick people particularly if they have vomiting, diarrhea or rashes.
  • Avoid strong chemicals or their fumes (e.g. chemicals used to kill pests and insects in the fields and in the house).
  • Pregnant woman should take care not to use non-essential medicines such as cough syrups, laxatives and pain relievers that have not been prescribed by a health worker.

Vaccination Against Tetanus

Tetanus caused by bacteria is a very serious, life-threatening infection, which damages the nervous system. Tetanus toxoid immunization (TT) is the best protection against tetanus both for the woman and her baby. Therefore, it is very important for pregnant woman to get immunized according to the schedule on her card.

Benefits of Early and Exclusive Breastfeeding

Appropriate positions and attachment of the baby are vital during breastfeeding among others. Although you will learn in detail about it in the Postnatal Care (PNC) and Integrated community case management (ICCM) modules, our responsibility in this session is to focus on the education and counselling of the pregnant women regarding the advantage and disadvantage of breastfeeding as opposed to substitutes for human milk for which the decision is hers. The followings are the benefits in feeding breast milk.

  • Is ready made and natural food.
  • Provides the best nutrition for the newborn.
  • Is easily digestible and efficiently used by the baby.
  • Protects against infection and other illnesses because it contains antibodies.
  • Is cost-effective and affordable.
  • Promotes mother-baby bonding.
  • Provides the mother as a contraceptive method (LAM) if she is exclusively breastfeeding until her first menstrual period returns.

For a Mother With HIV


As breast milk is natural and best food for the infant and there is no food which is 100% similar to it. However, the type of feeding is based on the mother's decision and economic status. The recommended options were: exclusive breastfeeding for the first 6 months and switching to exclusively supplementary feeding after 6 months of age or exclusive formula feeding. But recent research shows that infant mortality rate is high not because of HIV/AIDS but more due to diarrhea, malnutrition and other illnesses.

According to the 2010 Guideline on HIV and infant feeding practice, the recommended approach is to feed the infant exclusive breastfeeding for the first six months of life and continue with the same and supplementary feeding until the baby is 2 years of age. Breastfeeding would be stopped only when a nutritionally adequate and safe diet without breast milk can be provided.

Last modified: Sunday, 26 February 2017, 5:39 PM