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Maternal Nutrition Practices in Uttar Pradesh and Bihar

Complementary Feeding Practices in Bihar and Uttar Pradesh

Alive & Thrive Formative Research Top Line FindingsAlive & Thrive

PHASE 1: Determinants

• Quantitative• Qualitative

Aim: To design interventions

PHASE 2: Household trials

• Qualitative

Aim: To test interventions

Geographic scope

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The districts were selected by stakeholders to reflect socio-cultural and dietary variations

Findings

Timely Introduction of Complementary Feeding

• Both early and late introduction to complementary foods was reported across the two states.

• As early as four months and as late as ten months was reported by mothers interviewed across the two states.

• The “Annaprashan/mukh Jhuthhi” ceremonies at 6 months of age do not ensure proper complementary feeding practices. These are more of one time events.

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Determinants

• Gaps in Knowledge among mothers and influential

• Belief that a child that young cannot digest or benefit from the recommended foods

• Social norm on introducing food only when the child starts reaching out for food

• Frontline Workers as source of information but not enough was provided on diversity, frequency or quantity.

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Diet diversity in Complementary Feeding

• Only about 15% of the women interviewed gave their child the recommended at least four food groups.

• Animal protein foods such as fish, chicken or mutton were thought to be harmful and indigestible, whereas vegetables cooked at home was supposed to be hot and spicy.

• Therefore children were largely fed cereals, grains or lentils

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Common first foods

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Daal ka paani Daal bhaat Biscuits

Suji Halwa Doodh bhaat Dalia

Cerelac Meshed fruits Aloo Chokha

Cows milk Khichri Starched rice

Determinants

• Knowledge that it has benefits for child’s health and well being

• Perception and influence of family membersthat the child was too young to digest all kinds of foods

• Grandmothers mostly played a decision maker role in approving what could be fed to the child

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Dietary Diversity HH trials showed -

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Pre Trial

• Limited dietary diversity- low consumption of GLV, fruits and animal protein

• Low frequency of solid & semi solid food consumption

Post trial

• Increase in dietary diversity

• Increase in the consumption of animal protein

• Increase in the consumption of plant based proteins & fruits

Frequency and quantity HH trials

Facilitators• Child ate most of the food

given by the 7th day• Child felt satiated for

longer period of time• Child was more active and

better health• Family members

supported

Barriers

• Male members not around and therefore could not buy recommended items

• Perception that eggs/animal food will lead to stomach ache / liver problem

• Feeding the prescribed quantity is time consuming

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Address misconceptions related to dietary diversity; Detail out benefits, cost effective alternatives and importance of age appropriate quantity and frequency of food

• For timely initiation, the energy gap and growing child concept at 6 months to be highlighted and explained to mothers and influentials.

• The diversity, quantity and the frequency to be practiced and gradually the recommended quantity can be reached. Grandmothers, Fathers and Frontline workers have to be reached with proper messaging, since they are the key societal influencers.

• Misconceptions and perceived fear of the adverse side effects of introducing flesh foods, green or other vegetables etc. and the perception of ‘food is expensive’ are the barriers to practice. Messaging around these to be developed.

• Front line workers need to be correctly informed, equipped with logic and reason to address questions on diet diversity and alternatives of feeding. As the knowledge of the Community Influencers on complementary feeding practices was found to be sub-optimal, reaching them on correct Complementary feeding practices is of utmost importance.

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What can be done?

Role of fathers…

• Not to buy unhealthy snacks

• Procure locally available foods with high nutrient content such as eggs and fruits for the child

• Encourage the mother to practice proper feeding practices

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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

The bottom-line is…..With social support and timely

counseling, mothers in UP & Bihar demonstrated motivation and

confidence to improve complementary feeding practices