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.
KEYWORD: antenatal care quality; dietary diversity; Indonesia; mixed-methods;
pregnancy-centered care; stunting prevention