This study reports findings of a cluster-randomized evaluation of a set of Alive & Thrive maternal nutrition interventions in Uttar Pradesh, India. The interventions aimed to strengthen delivery of micronutrient supplements and intensify interpersonal counseling and community mobilization through government ANC services. The study demonstrates the feasibility and value of interventions to strengthen the integration of nutrition interventions into the local-level government ANC services, even in the context of evolving and ongoing national and state-level program improvements during the intervention period. The impacts observed were important but inadequate to achieve desired service delivery and uptake. Promoting and supporting change are possible but strengthening the delivery and use of maternal nutrition services integrated into ANC services in the health system is needed.