Eliana Mukashyaka is pregnant with her second child. During a recent consultation at Ngeruka Health Centre in Bugesera District, accompanied by her husband, Mukashyaka, 30, said antenatal care visits during her first pregnancy helped prevent the risk of stunting.

"My daughter is three years old now. During my pregnancy, healthcare providers advised me on how to prepare a balanced meal, and always be vigilant about any unusual signs. And this has helped me keep my daughter healthy,” she said.

She added that she got ion and folic acid tablets during the pregnancy. These tablets help women to prevent anemia and stunting of baby during their pregnancy.

Mukashyaka’s husband, Julian Munyentabana, takes pride in accompanying her to the health centre.

"Every man should be passionate about supporting his wife during pregnancy and after the child is born,” he said. "Of course, no one is happy when their son or daughter is undernourished.”

Under a World Bank-sponsored project, and with the help of more than 200 community health workers in Ngeruka, pregnant women are guided in the very early stages, and those in the former first and second Ubudehe categories are given ‘Shisha Kibondo’, a porridge flour that is packed with nutrients.

When the baby is six months old, they are given the flour until the age of two.

Bugesera District’s target is to reach at least 12,000 women who receive pregnancy care every year.

In Ngeruka, 800 to 1,017 pregnant women attend antenatal services at Ngeruka Health Centre, according to Ibrahim Nshizirungu, its head.

Antenatal care services have been very critical in addressing stunting and we have the community health workers at the village level, who help in sensitising pregnant women about the benefits of getting pregnancy care,” Nshizirungu said.

Bugesera District authorities say antenatal care services, along with interventions like the fortified flour, have been critical in reducing stunting from 39 per cent in 2015 to 26 per cent in 2020. The target is to reduce it to 19 per cent in 2024.

In October 2022, the government increased the number of antenatal care visits from four to nine times during pregnancy, a target Ruth Kemirembe, the director of health in Bugesera District says will lead to greater results.

"The eight visits will be crucial in detecting any issues affecting a pregnant woman. With four visits, some of the problems were hard to detect, but if the woman comes to the health centre every month, most of the shortcomings are treated earlier on,” she said.

During antenatal visits, women are also taught how to prepare a balanced diet with the available resources.

Nshizirungu said the stunting levels will continue to decline with help of parents themselves.

"The fortified flour, the early childhood development (ECD) centres, and other concerted efforts they put in the past gave us good results in stunting reduction. If we were able to reduce the stunting rate by 13 percentage points in five years, there is no doubt that we will be able to reach the targeted 19 per cent in 2024,” she said.

On her first antenatal care visit, 22-year-old Maria Mushimiyimana, who’s pregnant with her first child, said she was expecting healthcare workers to advise her on the balanced diet during her pregnancy. "I will put in practice all the advice they give because I can’t afford to give birth to a child who is unhealthy,” she said.

Mothers like Mushimiyimana who are ready to do everything possible to prevent their children from stunting are the ones that help drive change of perceptions about stunting as an issue that ‘affects only households with limited resources’.

Nationwide, stunting rates declined from 38 per cent in 2015 to 33 per cent in 2020. The government's target is to reach 19 per cent in 2024.