The failure of fetal growth in the pregnancy period is significantly related to stunted child growth . Pregnant women have central plays in achieve optimal growth since this critical period [4, 30]. Of 194 pregnant women who participated in this study have a high risk of having stunted children, generally. They live in rural areas with low socioeconomic levels that are related to a lack of food availability in the household [31, 32]. Another study among pregnant women in rural Punjab showed that education and parity were associated with knowledge, attitude, and dietary practices significantly [33, 34]. World Health Organization (WHO) reported that mothers with low income and a low level of education experience more difficulty affording adequate food that will provide a nutritious and diverse diet . The findings of this study also indicate that about one-third of them (33.0% and 28.9% in IG and CG, respectively) also have a short stature (less than 150 cm), which is at risk of having stunted children [36–38]. A 19-year-old woman with a height less than − 2 standard deviation (SD) (less than 150 cm) had short stature according to WHO provision . Javid and Pu were showed the Pakistan Demographic and Health Survey of 2012–13 that short stature mothers (height less than 150 cm) were about 2.0 times more likely to have a stunted child compared to tall stature mothers . They also have not utilized health services optimally. More than a third of participants who have given birth delivered their babies at home and helped by traditional birth attendants. They did not receive adequate health care in the early life of the baby as a crucial stage associated with pregnancy outcomes. This condition indicates a low quality of maternal health care, which may significantly affect child stunting [40, 41].
The knowledge, attitude, and practices regarding nutrition and reproductive health are the main factors that can influence pregnancy outcomes [42, 43]. The finding of this study indicates that participants have a lack of knowledge, attitude, and practices regarding nutrition and reproductive at baseline. In this study, the knowledge, attitudes, and practices mean were highly significantly (P < 0.001) improve after education in the IG. In the CG, there was no significant difference (P > 0.05) improvement mean of knowledge, attitude, and practices regarding nutrition and health reproductive between pretest and posttest. This study also proves that education intervention effectively provides a significant (P < 0.05) difference between the mean knowledge, attitude, and practices between the IG and CG at the end line. About 82.1 and 55.9, 49.0 and 40.5, and 40.2 and 36.3, respectively of the IG and CG between pretest and posttest. Similarly, a cluster randomized control trial study among pregnant women in Northeast Ethiopia shows that nutrition education improved significantly (P < 0.001) mean nutritional knowledge in the intervention group, about 6.9 at baseline to 13.4 after nutrition education. There was a significant difference (P < 0.001) in mean nutritional knowledge between the intervention group and control group at baseline. The study also shows that proportion of healthy dietary practices significantly different (P < 0.001) between pregnant women who were given nutrition education in the intervention group compared to the control group at the end line . A study among pregnant women in Addis Adaba shows that nutrition knowledge improved after the nutrition education program from 53.9–97.0%, whereas dietary practice during pregnancy increased from 46.8–83.7% . These studies reinforce the evidence that nutrition education has a positive effect in improving the knowledge, attitude, and practices of pregnant women.
Nutrition and health reproductive education is a specific intervention in The Global Nutrition target in 2025  to reach the target of 40% reduction in the number of children under-5 who stunted. This intervention can be delivered effectively through community health workers who have a high potential to improve maternal and child health among the hard-to-reach population, particularly in rural areas . A study in Bangladesh shows that maternal counseling using a framework of essential health care (EHC) can improve knowledge and dietary practices on child feeding to reduce the stunting prevalence effectively . The study in West Gojjam Zone, Ethiopia, shows that pregnant women who had given nutrition education are 2.02 times more likely to improve their dietary practices than those who have not given nutrition education . Furthermore, the proper knowledge and the dietary practices simultaneously influence gestational weight gain, degrade the risk of anemia in the last trimester of pregnancy, improved the baby's birth weight, and reduce the risk of preterm birth . This study strengthens scientific evidence that nutrition and reproductive health education during pregnancy improved the knowledge, attitude, and practices of pregnant women, which contribute to increased maternal and neonatal health and reduce childhood stunting [29, 30, 47, 48].
Nutrition and reproductive health knowledge on pregnant women that related to stunting improved significantly by education intervention [29, 40]. A formative research study conducted in 10 provinces in Indonesia which implemented the National Nutrition Communication Campaign (NNCC) showed that only 2.1% of 3150 mothers had known about stunting, and about two-thirds of them assumed that stunting was caused by heredity . Nevertheless, a study among childbearing age women in Lagos State, Nigeria, reported that 61.89% and 86.89% of them had accomplished knowledge and positive attitude regarding nutrition, respectively . The finding of this study shows that the number of participants who answered correctly for all questions increased significantly (P < 0.001) in IG. In parenting knowledge, almost 100% of participants knew the ways to improve 'bonding' between mothers, fetus, and fathers during pregnancy (90.7%), and the consequences of not providing psycho-emotional parenting since pregnancy period towards the baby’s growth and development (93.8%). A previous study shows that maternal depression is associated with child stunting, psychological and intellectual development. The lack of psycho-emotional parenting since the pregnancy period weakens ‘mother-child’ attachment that affects the nutritional status and development of children [49, 50]. In nutrition parenting, almost 100% of participants correctly answered the question about the timing of complementary feeding for babies (93.8%), a dietary source of macronutrients rich foods for babies > 6 months old (95.9%), and dietary source of micronutrients rich foods for babies > 6 months old 96.9%. Mistry et al. show that maternal counseling is associated with improving feeding practices in the early life of a child, which decreased stunting prevalence significantly . The participants improved their knowledge about nutrition during pregnancy, stunting, and immunity after education. Most of the participants knew about: a balanced diet (85.6%), the benefit of a balanced diet during pregnancy for fetus and mother (84.55%), the dietary source of macronutrients rich foods (92.8%), understood about stunting (94.8%), synergetic effect of nutrition and infection towards stunting (82.5%), and the benefits of immunization in childcare (92.8%). A study in Dissie Town, Northeast, Ethiopia, shows that the number of participants who answered correctly increased after nutrition education. Almost all of the participants knew about a balanced diet (95.7%), the benefit of a balanced diet for fetus and mother (89.9%), and the synergetic effect between nutrition and infection (97.1%). Also, all participants (100%) knew about the dietary source of macronutrients and micronutrients rich foods . Generally, the increase in the number of participants who answered correctly in Dissie Town is higher than in this study. The participants live in urban areas, so they get better access to health facilities. They also have a higher socioeconomic status, for example, education, occupation, family income. Other than that, this finding study also shows that the number of participants who answered correctly in reproductive health knowledge. As much as 92.8% of participants knew the benefits of antenatal care for maternal and baby health after education. Similarly, a quasi-experimental study in Brebes District, Central Java in Indonesia, shows that reproductive health education improved the knowledge among brides and grooms . Another evidence in Somalia shows that they have a lack of knowledge about reproductive health that confirmed the need for proper nutrition education . Reproductive health during the pregnancy period is fundamental to ensuring all women have access to respectful and high-quality maternity care to increase maternal health and pregnancy outcomes .
This study contributes to increasing intensive nutrition and reproductive health education efforts implemented for the wider community. These provide scientific evidence as consideration for policymakers, researchers, program practitioners and implementers, non-governmental organizations, health workers, community health workers, and the entire community to increase knowledge, attitudes, and practices regarding nutrition and reproductive health to reduce the prevalence of stunting from 27.7–14% in 2024 as the national target in Indonesia, and achieved The Global Nutrition target in 2025 to reach the target of 40% reduction in the number of children under-5 who stunted.