The South Asia region is falling significantly short of achieving the Sustainable Development Goal (SDG-2) nutrition targets by 2030 (1). While there has been some progress in the last decade in select nutrition indicators such as exclusive breastfeeding (2012: 47%, 2022: 60%) and stunting among children under five (2012: 40%, 2022: 30%), two barometers reflective of the state of women's nutrition have remain unchanged—children born with low birth weight (25%, 2012 and 2022) and women aged 15–49 years who are anemic (48%, 2012 and 2019) (1). South Asia still hosts 114 million underweight girls and women (50% of the global burden), while a rise in overweight and obesity now also affects 20% of this group in the region (2). Clearly, despite several bouts of intentional efforts by governments, multilateral organizations and civil society, progress to tackle poor maternal nutrition in South Asia has not been swift enough.

To restate the fundamentals, poor maternal nutrition is a key concern because it perpetuates multigenerational cycles of malnutrition. It is a key driver of in-utero malnutrition resulting in children born with low birth weight, which in turn is associated with faltered growth in infancy and future risks of developing diabetes and obesity (3). There is compelling evidence that poor maternal nutrition is caused by interrelated drivers rooted in social injustice—poverty, harmful social and gender norms, low status of women, and low women's self-efficacy are at play alongside the harsh realities of gender segregation in labor markets, wage gaps and time poverty. These experiences remain root drivers of unequal opportunities for women and girls, denying them the power and resources to access nutrition and health services and make choices about what and how much to eat—which is often last and least (4–7). To compound these difficulties, as many as 28 per cent of young women are married as children in South Asia and three in four child brides give birth while they are still adolescents, with these girls experiencing compromised agency and increased risks to birth outcomes and for their own nutrition (2, 8).

To achieve the goal of ensuring women have access to nutritious diets, nutrition services and positive nutrition practices, programmes should include a package of five essential nutrition actions: (i) access to fortified nutritious foods; (ii) micronutrient supplementation; (iii) nutrition information, education and counseling; (iv) safeguards against infections; and (v) healthy weight gain monitoring, nutrition risk screening and services for those most at-nutritional-risk at individual and population levels (cash, food vouchers, food rations and balanced energy and protein supplements). While most countries in the region do have strong policy and programme frameworks for delivering nutrition actions for pregnancy (Table 1), effective coverage of programmes remains low. About one in three women and girls in South Asia do not receive an antenatal check-up in the first trimester and in most countries in the region < 50% of women consume iron supplementation for at least 90 days of their pregnancy (9). Existing maternal service delivery platforms have programmatic challenges that constrain the availability of essential maternal nutrition services. To name but a few: (1) Priority is still accorded to reducing maternal mortality and not morbidity. Focus remains on delivering interventions to reduce child mortality and severe maternal anemia, but not on maternal morbidity or services available at women's life stages beyond pregnancy. (2) A lack of operational know-how on enacting time-efficient workflows to deliver all constituents of nutrition services at maternal and child contact points (10). (3) A cadre of trainers who understand nutrition and dietetics to support the maternal nutrition component of medical training is missing. (4) When nurses' and health providers' training takes place, the nutrition component is often weak or neglected (11). (5) Women who are thin, short, anemic, obese or with depression require “extra care” (12, 13) but this is often absent due to a lack of localized operational guidance for screening and management (10). At the planning level, there are opportunity gaps in including essential nutrition items (supplies, training, human resources, cadre, monitoring and research) in sectoral plans and budgets and missed opportunities to integrate height-weight gain monitoring, nutrition screening, macro and micronutrient supplementation, counseling and special care for nutritional risks for women into the same platforms that also reach children (14, 15). (7) Finally, despite increased attention to the need to address preconception nutrition, this is rarely provided owing to a lack of robust delivery platforms or large-scale implementation exemplars to provide the resources and programmatic know-how to cater for a large population in need.

To accelerate improvements in maternal nutrition—before, during and after pregnancy—the United Nations Children's Fund Regional Office for South Asia convened a regional conference on “Nourishing South Asia: Scaling-up equitable nutritional care for girls and women in South Asia,” from 18–20 September 2023 in Kathmandu, Nepal (16). The conference brought together 120 stakeholders from the eight countries that encompass the South Asia region (Afghanistan, Bhutan, Maldives, Bangladesh, Nepal, India, Pakistan and Sri Lanka) to take stock of countries' progress against regional commitments made in 2018 and discuss challenges and shifts needed to accelerate this progress. Details of the conference methodology have been described elsewhere (17). Briefly, the participants included senior government policy decision-makers, researchers, implementation champions, jurists, United Nations partners and development partners working on adolescent and women's nutrition (country delegations size was 6–16 per country). The conference format included 16 oral presentations, two panel discussions, a marketplace with 22 posters from the eight countries showcasing on-ground experiences and open space technology-based participatory group discussions. Each country delegations used open space methodology (18) methodology to discuss existing policies and programmes against each of the five essential nutrition actions. For those interventions which had a policy and programme, using a rubric provided (Supplementary File 1a) the country delegations identified systems bottlenecks in programme delivery, which have been described in Supplementary Files 1b–d; identified priority country actions and framework for action, which was consolidated into a call to action, which has been described below.

Each country identified their priority action(s) during the 2023 regional conference (17). UNCEF country offices with other development partners have been supporting national/sub-national governments to mobilize the required political, technical, and financial commitments to execute priority actions identified in regional conference (Supplementary Files 1c, d) through acceleration plans/strategies. In September, 2024—a year since the conference- UNICEF released a stock-take report—Progress and Promise: Nourishing girls and women in South Asia (26) to capture nineteen examples of on-ground implementation since the call to action. These examples serve as testimony to the ongoing efforts across the region to improve access to essential nutrition actions for accelerating maternal nutrition. Briefly, six countries in region have initiated integration of preventive multiple micronutrient supplementation in antenatal care (Afghanistan, Bangladesh, Bhutan, Nepal and Sri Lanka). Afghanistan and Pakistan have initiated cash transfer to women leveraging poverty alleviation platforms. Indian state of Maharashtra and Srilanka have strengthened and scaled-up preconception care programmes.

On-ground implementation was further propelled through launch of global maternal nutrition acceleration plan with assured financing through child nutrition matched fund (19) for 15 countries globally, which include five countries from South Asia.

South Asia remains the make-or-break region to turn around the global nutrition crises affecting girls and women and accelerate progress on the 2030 SDG nutrition targets. We urge governments in the region and their development partners to respond to the call to action and put “women at the centre” of convergent multi-sector nutrition solutions. Countries should seize the opportunity to tailor programmes to manage different nutritional risks, strengthen their focus on integrating preconception nutrition into maternal nutrition programmes, and address the gender inequalities that prevent women accessing nutritious diets, nutrition services and positive practices. Improving girls and women's nutrition is critical for accelerating progress on all SDG nutrition targets. We must not wait for another call to action to state once again what has already been asserted this decade—tackling women's malnutrition matters for nourishing South Asia!