Alive & Thrive

BREASTFEEDINGMaternal Nutrition Practices(Diet Diversity) in Bihar & UP

Formative Research Top Line FindingsAlive & Thrive

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Objectives of Formative Research

To identify:

• Current MIYCN & S/H practices

• Determinants including barriers and facilitators

• Willingness to change

• Who are the influential ?

• High reach platforms: programs, media

• How mothers can be supported in focused way thru existing platforms for

Larger and faster impact

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PHASE 1: Determinants

• Quantitative• QualitativeAim: To designinterventions

PHASE 2: Household trials

• QualitativeAim: To test interventions

Methods:In-depth interviewsSmall Group discussions ObservationsRapid Household trials

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Six districts Rural: Gaya, Bhojpur, Saharsa, Purnea & Gopalganj

Urban: Patna

Bihar - Geographical Scope

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UP- Geographic scope

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Lucknow

Three High Priority Districts

Rural: Allahabad, Shahjahanpur, Siddharthnagar

Urban: All districts

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Priority Behaviour Studied for Maternal Nutrition

• IFA & Ca supplement

• Dietary diversity

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Findings: Maternal Diet Diversity

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Current dietary diversity :Practices & perceptions

• 9% Pregnant women & 14% lactating women who consumed at least 5 specified food groups

• Diet Predominantly starchy staples followed by vegetables, pulses and dark green leafy vegetables(GLV)

Knowledge/Perception sof Family members• PW should eat GLVs, milk, fruit, dal, roti ,meat fish, egg and nuts• PW should avoid cold food, stale food, fried spicy food, unripe

papaya, fish, meat & egg• Perceived Benefits- mother-child healthy, active, avoid

complications during pregnancy and at the time of delivery• Perceived Risks- stomach upset & adverse effect on child, fear of

miscarriage • FLWs claimed to know about diet diversity: Starch, GLV, pulses -

important component of daily meal, very few mentioned flesh foods

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Results of rapid household trials

Most complied to increasing quantity and frequency of food & adding GLV– awareness leading to practice

Possible for majority to increase frequency and quantity & add nutritious foods such as GLV & fruits in their diet

Most could not comply to the recommendation of adequate rest due to busy schedule

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20

40

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Increasequantity

Increasefrequency

Add GLV Add Fruit Add Dairy Add Fleshfoods

Take rest

RESPONSIVENESS TO DIETARY RECOMMENDATIONS

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Formative research conducted by CMS, 2015-2016

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Barriers/ Challenges

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– Loss of appetite–Unaware of unique benefits and specific

nutrients in each food category –Absence of male members hindered procuring

special items (eggs/fruits/ GLVs)/Distance of Market

– Some food items unaffordable , culturally not acceptable

– Food cooked only twice

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Barriers /Challenges

• Vegetarian family diet • Lack of awareness among Mothers-in-laws primary

decision makers on frequency of meals & choice of food

• No proper counselling to pregnant women • Low coverage of timely contacts by ASHA, AWWs• Specific knowledge and skills not provided by FLW

during Home Visit• Rigorous supervision and monitoring not in place• No continuous refresher training/mentoring &

monthly meetings where feedback given and FLW difficulties addressed

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Maternal Nutrition: Facilitators

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–Counseling led to practice–Awareness of how mother’s health can

impact her child’s health–Availability of food items in household– Family members supported by:

– reminding to eat the recommended food items

–procuring fruits and eggs from the market

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Influentials: Key to social &

behavior change

• Husbands• Mothers in law• Front Line

Workers

Can best be reached through mobile phone, TV and home visits

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Opportunities

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• Mothers’ willingness to improve behaviors • Confidence they can include GLV, lentils and milk/milk

products in diet; (increase animal protein content in Bihar)• Community able to arrange for green leafy vegetables in

the daily diet of pregnant women• Husband’s ability to support, procure food & IFA• VHNDs potentially effective• Availability of water for hand-washing• Mobile phone available at HH level• Influentials and decision makers reachable through TV and

print media• Optimizing existing contacts by FLWs

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Formative research identifies which practices, what limitations and opportunities to address, what can

family/community members do, how to reach them

Outcome of FR: Prioritized SBC Strategy

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With social & systems support and timely counseling, pregnant women in

UP & Bihar demonstrate motivation and confidence to adopt recommended nutrition practices during pregnancy

Thank you