A mixed-methods study of pregnancy-centered antenatal care strategies for stunting prevention in Jepara Regency

Abstract

Background: Stunting remains a major public health challenge rooted in the prenatal period. Although antenatal care (ANC) coverage in Indonesia is high, gaps in ANC quality, nutrition counseling, and risk-responsive care limit its effectiveness for stunting prevention.Objectives: This study examined pregnancy-centered ANC strategies for stunting prevention in Jepara Regency using a mixed-methods approach integrating quantitative and qualitative findings.Methods: An explanatory sequential mixed-methods design was applied. The quantitative phase involved a cross-sectional survey of 212 pregnant women receiving routine ANC. ANC quality was assessed using the Content-Qualified Antenatal Care (ANCq) indicator, dietary diversity using the Minimum Dietary Diversity for Women (MDD-W), and stunting prevention knowledge and practices through structured questionnaires. Multivariable generalized linear models identified predictors of stunting prevention practices. The qualitative phase included in-depth interviews with 24 purposively selected pregnant women. Reflexive thematic analysis and narrative integration were conducted.Results: The mean ANCq score was 7.1 ± 1.8, indicating moderate ANC adequacy, while only 46.2% of participants achieved minimum dietary diversity (MDD-W ≥5). Higher ANCq scores (β = 2.84; p < 0.001), adequate dietary diversity (β = 5.96; p < 0.001), maternal education, and partner support were significantly associated with stronger stunting prevention practices. Qualitative findings revealed limited understanding of stunting prevention despite regular ANC attendance, a knowledge–practice gap caused by economic and pregnancy-related barriers, and the important role of family and health-system support.Conclusions: Pregnancy-centered stunting prevention is strongly influenced by ANC quality, dietary diversity, education, and partner support. Strengthening risk-responsive ANC and practical nutrition counseling may improve early stunting prevention outcomes.