**Background:** Anemia is a major public health problem in India, particularly among tribal women, with poor diet being the primary cause in over 60% of cases. In Andhra Pradesh, 57.8% of urban and 59.3% of rural non-pregnant women aged 15–49 years are anemic. The state per capita median daily iron consumption is 14 mg/day but varies widely (7–21 mg/day). Existing fortification-based interventions have limited sustainable evidence for ground-level replication. This study evaluated whether weekly local mothers' kitchen recipe talks—a novel behavior-change approach—could improve dietary iron intake and hemoglobin levels among tribal lactating mothers.
**Methods:** A community-based prospective cohort study was conducted from June 2021 to April 2022 in the Guntur district of Andhra Pradesh, India. Using a list of scheduled tribe women with at least one child under 1 year, 10 clusters (5 urban, 5 rural) were randomly selected from ICDS project sites. The sample size was 340 lactating mothers (34 per cluster). Urban clusters were Mangalagiri, Guntur, Tenali, Amruthalur, and Repalle; rural clusters were Bollapalli, Prathipadu, Chilkapuripeta, Amaravati, and Pedakkani. Data collection included a questionnaire, three non-consecutive 24-hour dietary recalls, and on-the-spot hemoglobin estimation using Hemocue 301. Weekly local recipe talks in mothers' kitchens were conducted for 12 weeks, with 5–10 participants per session and three sessions per week per cluster to ensure each woman could attend at least once weekly. Repeat hemoglobin estimation and 24-hour recall were done after 3 months. DietCalc software was used for iron intake estimation. The exposure was attendance at ≥10 sessions; the outcome was anemia and dietary iron intake. Statistical analysis used paired t-tests, z-tests, and relative risk calculations with P<0.05 considered significant.
**Key Results:** The overall response rate was 73.6% with 7.3% attrition (final n=315). Mean age was 23.51±3.62 years; 41.8% of mothers were not literate or had less than primary education; 80.3% belonged to lower or lower-middle socioeconomic strata. At baseline, 96.7% (329/340) had dietary iron intake below the estimated average requirement (<16 mg/day). Mean daily iron intake was 9.04±3.18 mg/day (median 9 mg, IQR 4). Baseline anemia prevalence (Hb <12 g/dL) was 63.8% (217/340), highest among Chenchu women (72.6%). Among the 55 mothers who attended ≥10 sessions, mean dietary iron intake increased significantly from 9.27±3.34 to 10.36±2 mg/day (P=0.036). After excluding IFA tablet consumption, the increase was from 9.07±3.41 to 10.44±2.11 mg/day (P=0.019). Mean hemoglobin among ≥10 attendees increased from 10.08±1.6 to 11.46±1.44 g/dL (P=0.005). Anemia prevalence in this group dropped from 72.73% to 63.64% (relative risk 0.84, 95% CI 0.67–1.04, P=0.05). Severe anemia decreased significantly from 7.27% to 0% (P=0.04) among ≥10 attendees. Among those attending <10 sessions, anemia prevalence increased from 62.31% to 74.62% (P=0.002).
**Clinical Implications:** Weekly local mothers' kitchen recipe talks significantly improved dietary iron intake and reduced severe anemia among tribal lactating mothers who attended at least 10 sessions over 12 weeks, even after excluding IFA tablet consumption. The intervention leverages existing ICDS infrastructure and functionaries, making it scalable and sustainable in resource-limited settings. The approach addresses the gap between nutrition education and practical skill translation—a limitation of traditional health education. The study's limitations include a relatively short follow-up (3 months), which may be insufficient to fully reflect hemoglobin improvements given the 120-day lifespan of red blood cells, and that most kitchens were conducted in Anganwadi centers rather than participants' homes due to COVID-19 restrictions. Integration of this evidence-based intervention into routine ICDS services and primary care anemia consultations could benefit early-aged, low-literate, inexperienced, and financially poor mothers by providing practical, culturally tailored cooking skills to improve dietary iron intake.