By Daniel Kamara
Africa-Press – Uganda. Across Uganda, a major but often overlooked driver of premature birth is malnutrition. Beyond infections, hypertensive disorders and obstetric complications, maternal undernutrition and micronutrient deficiencies beginning long before conception and continuing throughout pregnancy create biological conditions that raise the risk of intrauterine growth restriction, low birth weight and preterm delivery.
Understanding malnutrition as an indirect yet modifiable cause of prematurity shifts the focus of prevention; reducing early births requires investing in women’s nutrition long before pregnancy begins.
The pathway from poor nutrition to preterm birth is often silent but significant. Malnutrition weakens a woman’s physiological reserves and disrupts biological processes that influence pregnancy outcomes.
Women who enter pregnancy underweight or with inadequate iron, folate, calcium or vitamin D stores struggle to meet the metabolic demands of fetal development.
Chronic energy deficits and inadequate protein intake impair placental formation and reduce uteroplacental blood flow. Micronutrient deficiencies also increase inflammation and oxidative stress, both known to trigger spontaneous preterm labour or necessitate early medical delivery.
In Uganda, widespread food insecurity, seasonal hunger, adolescent pregnancies and entrenched poverty mean many women conceive already nutritionally compromised.
Adolescents are particularly affected due to limited access to diverse diets and lower likelihood of receiving micronutrient supplements.
As a result, many pregnancies begin from a nutritional deficit, placing infants at heightened risk of prematurity or being born too small for gestational age.
Preventing prematurity in Uganda requires a shift from pregnancy-only interventions to deliberate preconception care. Preconception care focuses on the months or years before conception with the aim of improving nutritional status, managing chronic illness and addressing the broader social and economic influences on women’s health.
This approach involves routine nutrition assessment and counselling for women of reproductive age, including checks on body mass index, anaemia screening and personalised advice on diet quality and meal adequacy.
It includes ensuring appropriate micronutrient supplementation, particularly iron and folic acid to prevent anaemia, alongside calcium or multi-micronutrient supplements in populations with deficiencies.
Strengthening adolescent nutrition programmes is essential. School feeding, nutrition education and sexual and reproductive health services give young women a better chance to build nutritional reserves before their first pregnancy.
Family planning and healthy birth spacing give the body time to recover nutritionally between pregnancies. Stronger links with agriculture and social protection also help ensure that nutritious foods remain accessible throughout the year.
Preconception care is not confined to health facilities. It must be community-based, multisectoral and sustained, delivered through schools, community health workers, agricultural extension programmes, clinics and social-protection systems. It must reach young women before they plan or anticipate pregnancy.
Reducing the risk of prematurity also depends on practical nutrition actions that strengthen maternal health. Promoting dietary diversity using locally available foods such as pulses, leafy greens, nuts, small fish, eggs and fortified staples helps women meet essential nutrient needs. Routine iron–folic acid supplementation, combined with guidance on improving iron absorption, plays a vital role in preventing anaemia.
Community kitchens, home gardens and small animal rearing expand access to nutrient-dense foods throughout the year. Food fortification and biofortification broaden access to essential vitamins and minerals for populations at large.
Targeted nutritional support for adolescents and underweight women helps build stronger nutritional reserves well before conception.
To integrate preconception nutrition into Uganda’s broader efforts to reduce prematurity, health systems and policymakers must embed nutrition into reproductive health strategies and the continuum of maternal, newborn and child health.
Frontline health workers and community volunteers need skills to conduct nutrition screening and offer counselling for all women of reproductive age, not just pregnant mothers.
Better coordination between health, agriculture and social-protection sectors is essential to ensure nutritious foods remain accessible and affordable, especially in rural and drought-prone regions.
Expanding adolescent-focused programmes that combine nutrition, education and reproductive health is vital for preventing early pregnancy and improving nutritional status.
Robust data systems that track nutritional indicators among women of reproductive age and link them to birth outcomes are necessary to monitor progress and guide interventions.
Prematurity carries profound human and financial costs, contributing to newborn deaths, developmental challenges and long-term pressures on the health system.
The encouraging reality is that malnutrition, one of its underlying drivers, is preventable. By investing early in the nutrition of girls and women, ensuring food security, providing micronutrient support and empowering communities with knowledge, Uganda can significantly reduce the prevalence of preterm births.
Prevention begins long before pregnancy. Improving nutrition for adolescents and women of reproductive age is an investment in healthier pregnancies, stronger infants and a more resilient generation. For Uganda to sustainably reduce prematurity, maternal nutrition must be treated not as an optional addition but as the foundation of maternal and newborn health.
Daniel Kamara is a nutritionist at Bwindi Community Hospital
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