Advocacy

Public Attention

Alive & Thrive supported six provinces in organizing eight breastfeeding events in August 2013 as part of World Breastfeeding Week. Each event attracted 80-200 pregnant women, mothers, and caregivers with their young children and featured musical performances, contests, presentations by health professionals, and on-site counseling. Women also shared their breastfeeding experiences.  Representatives from the People’s Committee and People’s Council attended and gave opening speeches at the events, which were covered in the media, including a live broadcast on Thanh Hoa’s provincial television channel. These events were an extension of Alive & Thrive’s advocacy work to increase nutrition knowledge and empower provincial leaders to take positive action towards improving nutrition.

In addition to the events, A&T collaborated with UNICEF and the Center for Health Education (MOH) to organize a field trip to five provinces for reporters from Viet Nam Television (VTV) and several key newspapers to observe infant and young child feeding counseling services at the Mat Troi Be Tho franchises and to visit lactation rooms at business enterprises. The visits resulted in two TV reports and more than 30 published articles.

Reference:
Alive and Thrive. (2013). A&T Viet Nam celebrates World Breastfeeding Week 2013 

In 2012, New York City Mayor Michael Bloomberg announced that the city would launch a campaign through which participating public and private hospitals will take steps to encourage new moms to breastfeed their babies. Latch On NYC is a citywide initiative designed to support mothers who choose to breastfeed. Through a voluntary commitment, hospitals provide additional support to breastfeeding mothers and minimize practices that can interfere with that choice such as supplementing breastfeeding infants with formula, unless medically indicated or at the mother's specific request. Hospitals also pledge to end the distribution of promotional formula and materials during the hospital stay and at discharge. (Reference #1)

The initiative included a public awareness campaign highlighting the health benefits of breast milk, such as reducing the risk of ear infections, diarrhea and pneumonia.

In addition to a pro-breastfeeding public transport poster campaign, voluntarily complying hospitals will:

  • Enforce the New York State hospital regulation to not supplement breastfeeding infants with formula unless medically indicated and documented on the infant's medical chart;
  • Limit access to infant formula by hospital staff;
  • Discontinue the distribution of promotional or free infant formula;
  • Prohibit the display and distribution of infant formula advertising or promotional materials in any hospital location; and
  • Nurses must document the dispensing of formula, citing a medical reason for its necessity.

Three news media outlets- Washington Post, CNN and Huffington Post- have national coverage, and reported on this launch. Although this event took place in New York City because it's the biggest city in the US, it made national news. (Reference # 2,3,4)

This was a planned event, orchestrated by the New York City Department of Health and Mental Hygiene and led by the Mayor - the most public of New York's city government officials- so this initiative would have been very visible. The Press Release and campaign was intended to achieve high level news coverage.
 
Other major events might be unplanned and reactionary but can provide an environment for advocacy, civic and/or government groups to spurn positive media coverage.  An example of this is the video of a woman verbally abused for breastfeeding in a Target store in Connecticut, and the employees and customers who came to her aid.  The video went viral and caused a massive backlash against the perpetrator, thereby raising awareness of the right to breastfeed in public. (Reference #5) President Obama reacted to it and publicly praised Target and it’s breastfeeding friendly policies and urged support for companies that are creating workplace policies to work for everyone.

The Washington Post wrote “It looks like this week Team Target played their role exactly the way that Obama urges. This video of a sea of Target employees protecting a breast-feeding mother being harassed in their store is a remarkable example of an integrated cultural mandate — one that exists both on paper and in real time. In this case, it happened at the café of a Torrington, Conn., Target store. At time of publishing this piece, this video shot by the nursing mother had over 5 million views.” (Reference #6).

References:

  1. New York City Department of Health and Mental Hygiene. (2012). Latch On NYC.  
  2. Huget, J. L. (2012). NYC to launch “Latch On NYC” breastfeeding campaign. Washington Post. Retrieved from https://www.washingtonpost.com/blogs/the-checkup/post/latch-on-nyc-breastfeeding-campaign-draws-attention-but-is-hardly-unique/2012/08/13/57700cf4-e591-11e1-9739-eef99c5fb285_blog.html
  3. Newman, T. (2012). Latch on NYC (It's going to be okay, people). CNN. Retrieved from http://www.cnn.com/2012/08/17/living/parenting-latch-on-nyc/index.html
  4. Oh, I. (2012). Bloomberg’s Breastfeeding Program, ‘Latch On NYC,’ Wants Hospitals To Change Baby Formula Protocol. Huffington Post. Retrieved from http://www.huffingtonpost.com/2012/07/30/bloombergs-breast-feeding-latch-on-nyc-hospitals-hide-baby-formula_n_1718664.html
  5. Bowerman, M. (2016). Mom verbally attacked for breastfeeding in Conn. Target store. USA Today
  6. Beck, J. (2016). Obama urges changing our workplaces as Target employees show us how it’s done. Washington Post. 
Alive & Thrive’s (A&T) guide Engaging the Media: A practical guide to meeting child nutrition advocacy goals through working with journalists is based on their experience with a media engagement and capacity building program in Bangladesh, specifically around child nutrition.  The guide provides a step-by-step roadmap of activities, recommendations, and best practices for conducting media outreach. Media advocacy can be an effective tool to raise awareness, increase dialogue, and shift opinion leader perceptions on child nutrition.

 In 2009, the IYCF Alliance were undertaking collaborative efforts to improve child nutrition across a range of interventions. Opinion leader research with government leaders, NGO representatives, and business, religious, and academic leaders revealed that key decision-makers did not have access to information on infant and young child feeding/nutrition and few grasped the impact of child undernutrition on the social and economic development of the country. Research found that the media was an effective communication channel to reach policymakers and a media assessment identified the need improving journalists’ knowledge of IYCF issues and their importance, thereby increasing media attention to these issues.  The list below show the steps taken to engage the media and are detailed more fully in this guide:

Step 1: Assess the need and opportunity for media engagement

Step 2: Conduct a media landscape analysis

Step 3: Develop and execute a media engagement and capacity building program

Step 4: Monitor and evaluate program results

Details on activities are included throughout this guide, with specific insights on implementation throughout and a summary chart on pages 24-25.

Reference:

  1. Alive and Thrive. (2013). Engaging the Media: A practical guide to meeting child nutrition advocacy goals through working with journalists.   

Individual Champions Theme

Alissa Milano, a 43-year-old actress in US, uses social media to promote breastfeeding.  She calls herself “a breastfeeding advocate” and uses the hashtag #normalizebreastfeeding to tweet and post on Facebook and Instagram about breastfeeding issues. Milan is also vocal through television shows and popular magazines. Normalizebreastfeeding.org is a media campaign organized by a group of mothers and lactation educators to support families that breastfeed and advocate to remove the social taboo attached to breastfeeding.

References:

  1. Tempesta, E. (2016). Mother-of-two and 'breastfeeding advocate' Alyssa Milano hits back at Wendy Williams after TV host criticized women who nurse in public saying she 'doesn't want to see that' Daily Mail. 
  2. http://normalizebreastfeeding.org/
  3. http://www.parentherald.com/articles/9908/20150910/alyssa-milano-ups-breastfeeding-advocacy-saying-shell-nurse-until-daughter.htm

Social Cohesion/Mobilization Theme

Brazil, in the 1970’s, went through a process of creating a policy environment which enabled the scale up of breastfeeding advocacy and promotion at the national level. (Reference #1) In 1981, they launched a national BF program based on extensive formative research. It has been described as follows: "the national BF program began with a mass media campaign that was designed to sensitize the public and government to the need for and types of major structural and behavioral changes needed to promote, protect, and support BF in Brazil (Pérez-Escamilla, 2012)". Using the results of the extensive formative research phase, three essential elements of a successful national breastfeeding program were identified: (1) national coordination; (2) social mobilization of all possible actors in the field; and (3) use well-designed media campaigns to promote the breastfeeding program. The article by M.F. Rea demonstrates the importance of extensive formative research which is then used to design and implement a well-coordinated national breastfeeding program, anchored in a mass media campaign.

References:

  1. Rea, M. F. (2003). [A review of breastfeeding in Brazil and how the country has reached ten months' breastfeeding duration].Cad Saude Publica, 19(Suppl 1), S37-45. Epub 2003 Jul 2021. 
  2. Perez-Escamilla, R., Curry, L., Minhas, D., Taylor, L., & Bradley, E. (2012). Scaling up of breastfeeding promotion programs in low- and middle-income countries: the "breastfeeding gear" model. Adv Nutr, 3(6), 790-800. doi:10.3945/an.112.002873

With their work in infant and young child feeding, Alive & Thrive (A&T) employed a systematic process for undertaking research and using the data to develop an effective, sustainable advocacy strategy.  Evidence-based advocacy design can positively impact national policies, investments, and commitment to implementation and scale up. (Reference #1)

Methods
To determine the advocacy goals, strategies and potential partners for protecting, promoting, and supporting IYCF programs in Viet Nam, Bangladesh and Ethiopia, A&T followed these steps:

1. Situational analysis:

A&T teams carried out desk-based research on existing documentation of the policy environment, review of policy documents, overview of the key actors, and compilation of data on IYCF practices from secondary sources such as Demographic Health Surveys. The findings were then analyzed and organized based on the major themes of the conceptual framework for this literature review.  Data on IYCF practices from both government and NGO sources were used. (Reference #2)

The reviews had three objectives:

  • To document the patterns and trends in IYCF;
  • To review the barriers and facilitators to IYCF practices; and
  • To review policies and programs related to IYCF.

Literature search methods:

  • Electronic databases – PubMed and Google Scholar;
  • Official websites of organizations for non-peer reviewed papers and program reports;
  • Unpublished reports from the government and NGO libraries;
  • Studies/reports - survey and surveillance reports; descriptive studies on IYCF practices and nutrition; studies on interventions to improve IYCF practices; and
  • Official documents describing the policies and programs from the Ministry of Health (MoH).

Data extraction methods:

  • Demographic Health Survey (DHS):  for example, in Viet Nam the DHS is a nationally representative survey of ever-married women 15-49 years old selected from sampling clusters throughout the country;
  • NIN surveillance- nationally representative surveillance data collected to assess status and trends in the nutritional status, quality of child feeding, and health care for children under 5 years of age; and
  • Viet Nam Multiple Indicator Cluster Survey - nationally representative surveys and data/information on the situation of children and women in Viet Nam.

The information on government programs, policies, and strategies in relation to IYCF was organized chronologically to depict the evolution of IYCF policy in-country. 

Conceptual framework:
The conceptual framework used for this review was adapted from Labbok and Taylor (Reference #7) and sets out the main factors that influence IYCF.  In Viet Nam, these are:

  • Political/social factors - national health, nutrition policy, and international support;
  • Health care providers’ knowledge, attitude, and level of support for optimal IYCF practices;
  • Community/family influence on IYCF based on cultural beliefs, ethnicity, and food availability; and
  • Mothers/caregivers decisions - based on knowledge, education level, socioeconomic status, age, occupation, and health status.

To identify the barriers and facilitators to IYCF practices all the gathered information was synthesized around these four themes - see Table 3 of Reference #2.

2. Formative and opinion leader research:

  • Media/landscape Analysis:
    • Vietnam: an independent media agency undertook a media audit to evaluate the extent of marketing and advertising of breastfeeding, infant formula, and related products. The audit identified typical violations and gaps in enforcement of the Milk Code (Decree 21).
    • Bangladesh: a comprehensive media scan helped to understand the demographic reach of national media outlets and the extent of marketing of breastmilk substitutes. Further media analysis and one-on-one interviews with reporters, media experts, and NGO leaders provided a deeper understanding of the existing coverage on IYCF and what opportunities were available to improve both the quantity and the quality of public information.
  • Local research agencies were contracted to design and conduct opinion leader research:
    • Measure current awareness of nutrition among key influencers (political, cultural, and health);
    • Identify national and sub-national priorities;
    • Identify policy barriers and opportunities to improve IYCF policies, programming, and investments;
    • Determine motivations and messages to increase support for IYCF;
    • Identify appropriate messengers, communication channels, and points of engagement with opinion leaders. (See page 6 for more in-country detail)
    • Lessons learned: Research agencies need strong country knowledge, a good reputation, and established government relationships.  Alive & Thrive provided strategic technical assistance with design of the research tools and interpretation and presentation of findings. (See Other Resources for useful guides).

3. Stakeholder consultations and analysis:

  • Rounds of discussion with government partners and other stakeholders to better understand the current status of IYCF advocacy initiatives, successes or failures with previous efforts, risks, areas of potential interest and collaboration among partners.
  • Review of stakeholder’s institutional responsibilities.
  • Vietnam: additionally, carried out a review of the legislative process and a mapping exercise to determine levels of influence and involvement of the key actors in the policy and decision-making process.

4. Goals and strategies:

  • Identify critical interfaces for change.
  • Gather and triangulate all information and data to develop policy and advocacy goals tailored to each country’s context.
  • Prioritized two to three goals that were immediately relevant and had potential for success within the project timeframe.
  • Identify activities and tactics with the potential to bring about change.
  • Identify core set of advocacy partners that could contribute human, financial, and technical resources to execute the strategies.
  • Lessons learned:
    • Strategies must be grounded in the existing country context - and what has previously been done - and tailored to the local stakeholders (government, NGOs, civil society, professional bodies, thought leaders, business leaders, and media gatekeepers); and
    • One person or dedicated group is likely to be less effective than collaborative efforts and alliances, which should be built on existing in-country partnerships and leveraged into current global initiatives. Integrating IYCF advocacy with other advocacy efforts enables harmonization of activities and resources for a higher return on investment.

5. Measurement, learning, and evaluation:  

A&T designed an evaluation strategy based on the framework by Shiffman and Smith (Reference #2). Data collection included a stakeholder-influence mapping method called Net Map (see General Resources) analysis, along with document review and stakeholder interviews.  This data was collected again three years later.  The country teams planned to use event tracking to analyze and understand the causes of any shifts in the overall policy environment during the project timeframe.

Additional evaluations were carried out on specific innovations in the advocacy strategies, for example, the provincial nutrition planning support activities in Vietnam (stakeholder interviews and content analysis of provincial nutrition plans) and the media engagement strategy in Bangladesh (media content analysis and stakeholder interviews).

Results:
In Viet Nam, the above processes identified the key challenges for bringing about optimal IYCF practices and the critical individuals and groups necessary to engender change. One of these challenges was the existing maternity leave legislation. Research found that only 20% of babies were breastfed exclusively for the first 6 months and 22% up to 24 months and that mothers named going back to work as a primary reason for ceasing breastfeeding. As women made up 48% of the workforce, the need for two more months paid maternity leave was clear.  A&T had four prongs to their advocacy strategy, which utilized the extensive research base they amassed:

  1. Develop and sustain partnerships: A&T learned that the labor code was to be reviewed and their stakeholder analysis identified the Legislation Department of Ministry of Labor, Invalids and Social Affairs as a key partner, as this was the group responsible for actually drafting the revised code. Additionally, they identified and fostered partnerships with other important civil society and governmental groups and a set of champions for changing the labor code emerged.  Each of these champions brought their own expertise into play, for example:
    • The Social Security Department undertook a financial analysis and confirmed that the government could afford to extend maternity leave;
    • The Vietnam General Confederation for Labour surveyed their female workers and found that 78% of female workers were aware of the importance of breastfeeding and 90% of them supported extending maternity leave rather than any other type of parental entitlement option; and
    • The Institute of Legislative Studies (ILS), through their mandated role to provide capacity development for members of parliament, helped with access to and information provision to the National Assembly.

  2. Building a continuous evidence base: necessary to anticipate and address questions/concerns of partners and engender cooperation.  This evidence base included the global conventions and recommendations, and scientific, local and empirical evidence for the benefits of breastfeeding.  For example, experience with extending maternity leave in other countries and the results of employee surveys.

  3. Strategic Communication: information gleaned from the research enabled bespoke messages to be developed and disseminated through a variety of print and electronic materials.

  4. Interpersonal and Group Communication: including meetings, consultations and briefings to bring all parties on board.  A&T and their partner champions used their influence to build consensus and target key decision-makers.

In 2012, Viet Nam’s National Assembly extended paid maternity leave from 4 to 6 months – and it passed with more than 90% of votes.
In Bangladesh, the research found there was a lack of knowledge about IYCF practices and their impact on malnutrition within the country amongst policy makers and the more educated populace. The landscape analysis identified the media as having the greatest potential impact on increasing knowledge and influencing policy decisions. In order to utilize this resource more effectively, A&T embarked on a media engagement program. It had three main goals:

  1. “Enhance capacity of health reporters to conduct in-depth reporting on IYCF and child nutrition through training and ongoing journalist engagement.
  2. Increase the availability and use of new data and information to create a steady drumbeat of information to drive coverage and deeper content.
  3. Increase news editor and news director commitment to covering IYCF and child nutrition.”

Among the many events, A&T organized as part of this program, they ran an IYCF journalist training workshop. This took place over 2 days and included reporters from national print and on-line media. The journalists heard from experts and academics, they received hands-on experience through mock interview sessions and story development, and they got feedback from seasoned journalists. They also ran a more local level training workshop for reporters in two of Bangladesh’s areas with the highest levels of malnutrition. A&T developed a journalist fellowship program which included site visits to community programs and study circles. This resulted in more in-depth and frequent IYCF news coverage. References #5 and #6 go into more detail about their media engagement program, including case studies. See also Other Resources under AG1.

References:

  1. Hajeebhoy, N., Rigsby, A., McColl, A., Sanghvi, T., Abrha, T. H., Godana, A., . . . Uddin, B. (2013). Developing evidence-based advocacy and policy change strategies to protect, promote, and support infant and young child feeding. Food Nutr Bull, 34(3 Suppl), S181-194.
  2. Nguyen, P. H., Menon, P., Ruel, M., & Hajeebhoy, N. (2011).A situational review of infant and young child feeding practices and interventions in Viet Nam. Asia Pac J Clin Nutr, 20(3), 359-374.
  3. Shiffman J, Smith S. Generation of political priority for global health initiatives: A framework and case study of maternal mortality. Lancet 2007;370:1370–9.
  4. Pelletier, D., Haider, R., Hajeebhoy, N., Mangasaryan, N., Mwadime, R., & Sarkar, S. (2013). The principles and practices of nutrition advocacy: evidence, experience and the way forward for stunting reduction.  Maternal & Child Nutrition, 9, 83-100. doi:10.1111/mcn.12081
  5. Alive and Thrive. (2014). Media engagement and Capacity-Building to increase Commitment to child nutrition policies and programs: Lessons Learned From Alive & Thrive.   
  6. Alive and Thrive. (2013). Engaging the Media: A practical guide to meeting child nutrition advocacy goals through working with journalists.   
  7. Labbok, M. H., Taylor E. (2008).Achieving Exclusive Breastfeeding in the United States: Findings and Recommendations. Washington, D.C: United States Breastfeeding Committee.

The United States Breastfeeding Committee (USBC) is the national breastfeeding coalition - an independent nonprofit organization formed in 1998 in response to the Innocenti Declaration of 1990. The USBC is now a coalition of more than 50 organizations that support its mission to drive collaborative efforts for policy and practices that support breastfeeding across the United States. The USBC was built as an “organization of organizations: a forum to coordinate opportunities for collaboration and change”. The USBC supports breastfeeding advocacy by providing many online tools and resources available on their website.

In 2014, the USBC launched a new Strategic Framework designed to facilitate deeper, more effective, and more inclusive collaboration across the breastfeeding field. The intention is to provide the infrastructure supports for stakeholders to lead collaborative work where there is a particular niche, interest, and funded capacity. These collaborations involve individuals with breastfeeding experience, community-based organizations providing direct services, state-level coalitions advocating for change, and national entities leading and supporting trends and strategic opportunities.

Reference:

  1. United States Breastfeeding Committee.

The Norwegian Breastfeeding Association, “Ammehjelpen” is a collation of mother-to-mother support groups.  It is run by a country-wide network of dedicated volunteers, including health professionals, who are on call 24-7 to help mothers who encounter problems with breastfeeding.  The group grew out of a grassroots advocacy movement in the 1970s which successfully pressured the government to improve the breastfeeding agenda. 

Ammehjelpen act as watchdogs for the implementation and violations of the Code, which in Norway is done through a voluntary agreement between industry and the government. They were also the catalyst in bringing about important changes on maternity wards, specifically widening the availability of “rooming-in” and encouragement of skin-to-skin contact immediately post birth.  In addition, Ammehjelpen provide training to health professionals.

Reference:

  1. Ammehjelpen. The Norwegian Breastfeeding Association.  

The Save the Children study, Breastfeeding: Policy Matters, found that collaborative advocacy efforts with a few harmonized and consistent messages will have the best effect on breastfeeding scale up. (Reference #15) These efforts will be most successful when the government is involved in the partnership, specifically across all relevant sectors of the government, and there is an agreed plan of action. In addition, there should be effective communication strategies, based on formative research, to help achieve community support for breastfeeding interventions.

Alive & Thrive (A&T)

A&T have published a number of advocacy resources that are available for countries to use and adapt for their own context (Reference #1).  They include:

  • An interview guide, with set questions for key stakeholders, used during the research phase of Viet Nam’s program (Reference #2);
  • Methodology and key findings of research conducted in 2010 in Viet Nam to understand leaders’ perspectives and the policy environment to enable the building political will for supportive nutrition policies (Reference #3);
  • A Step-by-Step guide to Concept Testing handout that defines concept testing and gives specific details on how Alive & Thrive used it in Bangladesh to design their TV media campaign. (Reference #4) Concept testing allows researchers to try out a variety of emotional appeals on the people they are trying to reach, while still being entertaining.  In Bangladesh, they tested concepts after the priority behaviors to promote had been selected but before they wrote the scripts.  Also available is a copy of the TV scripts before and after concept testing (Reference # 5), the guide Alive & Thrive used when concept testing the TV spots - it gives the objectives, scripts and questions to ask about each spot (Reference #6) and the "stilomatic" used in concept testing - it has the feel of a real TV spot without the expense of full production (Reference #7).
  • A guide based on the experience of a media engagement and capacity building program in Bangladesh, specifically around child nutrition - provides a step-by-step roadmap of activities, recommendations, and best practices for conducting media outreach. (Reference #8)
  • Power of Nutrition advocacy tools: video -illustrates the importance of IYCF, for use in a meeting or presentation, poster – an example of printed advocacy material; and Resource Guide – background information, key messages, actions for policy makers and useful resources (Reference # 9)
  • Example of evidence based pamphlet used in Viet Nam to promote longer maternity leave legislation. (Reference #10)
  • A case study kit on A&T’s experiences with challenging traditional gender roles and engaging fathers in child feeding. (Reference # 11) The brief offers a way to determine if a focus on fathers is right for your program, provides examples from interventions that engage fathers in child feeding, has links to tested program activities and materials that may be tailored for your own setting and it sets out 6 strategies to ensure fathers’ program is more likely to change behaviors:
    • Grab them with emotion: Testing concepts to find compelling and emotion-based approaches;
    • Ease the way by busting stereotypes: Making it “a man’s job” to lead the family to support 6 months of exclusive breastfeeding;
    • Find fathers where they already are: Investing in channels that already reach fathers;
    • Provide crystal-clear direction for actions fathers can take: Naming clear and simple actions;
    • Give fathers practice: Designing materials that make fathers interact and that “model” the new actions; and
    • Show fathers a benefit that they care about: Finding the “sweet spot,” the benefit that makes the change seem irresistible.
  • Literature review as part of the case study kit, “Dads can do that! How to involve fathers in child feeding.” (Reference # 12). The main summary points are as follows:
    • Fathers have generally been overlooked in IYCF interventions. Including fathers in IYCF promotion efforts may reposition IYCF from being a concern limited to mothers and make it the concern of entire communities;
    • IYCF efforts to include fathers must take into account culture-specific norms related to gender roles; and
    • Fathers can be encouraged to take specific actions that support improved feeding practices, such as exclusive breastfeeding and providing nutrient-dense complementary foods for young children.
  • Handout that defines the trials of improved practices, or TIPs, method for testing which behaviors a person really can do and can be used for Advocacy and BCC program strategies (Reference #13). 

With the TIPS method, all potential practices should be tested, ideally in people’s homes, before they are recommended. For A&T, their objectives were to: 1. To test mothers’ responses to recommendations for improving infant and child feeding and determine which are most feasible and acceptable and 2. To investigate the constraints on mothers’ willingness to change feeding patterns and their motivations for trying and sustaining new practices.

Through using TIPs, researchers can discover:

  • The relative ease or difficulty of communicating various recommended practices;

  • Modifications that make the recommendations more acceptable;

  • Unanticipated resistance points that limit behavior change;

  • Ways in which recommendations are undermined by practices such as dilution, replacement, or children’s resistance to new foods; and

  • The approximate proportion of families who are and are not able to modify feeding practices and improve nutrition without additional resources.

A&T adapted their TIPs program from the manual Designing By Dialogue: A Program Planners Guide to Consultative Research for Improving Young Child Feeding. (Reference #14) The purpose of this manual is to provide the tools to design, carry out, and analyze the results of formative, consultative research and to use them to design effective programs to improve infant and young child feeding. This approach is based on evidence that community nutrition programs are more effective in changing child feeding practices and improving nutrition when program planners pay close attention to the voices of the families who will participate in the program.

This is a step-by-step guide on how to:

  • Define the key problems in child feeding practices.
  • Identify simple and effective actions within the household that will improve child feeding.
  • Test these recommended practices in homes to determine which are the most practical and culturally acceptable ones.
  • Develop an effective strategy to promote these improved child feeding practices among the population. 

The methods used are open-ended questioning, discussions, trials, and observation to gather in-depth, descriptive information on what people say, believe, do, and want to do. The results are usually descriptions, not numbers. People are asked to tell their stories and describe their feelings rather than give short answers to structured questions. Mixed with the qualitative information are a few quantitative methods such as dietary assessment, structured observation, and some aspects of trials of practices and recipes. These quantitative methods help the researcher and participants assess the significance of the qualitative information.

The methods used by A&T, TIPs, is described in detail. TIPs can be used to test every new feeding practice with mothers and children, to make sure they are willing and able to try it, and like it enough to continue. People are given the chance to explore how they can take action themselves to improve their children's health and nutrition. 

The manual covers the research process from design to analysis and interpretation. For each phase of the research the manual provides:

  • Task boxes listing all the important steps
  • Step-by-step guidelines
  • Worksheets for planning
  • Program examples
  • Samples of research tools:
    • Question guides
    • Research plans
    • Assessment and counseling guides
    • Focus Group Reports
    • Final recommendations
    • Household In-depth Interview Guides
    • Observation Form
    • Recruitment Form
    • Summary Sheets for Scoring Behaviors
    • Sample Diet History
    • Recipe Trials Recording and Assessment Forms
    • Trial of Improved Practices (TIPs) Guide for a Three-Visit Interview
    • TIPs Tabulation Guide
    • Focus Group Discussion Guides.

References:

  1. Alive and Thrive. (2014). Advocacy: Infant and Young Child Feeding at Scale. Retrieved from http://aliveandthrive.org/wp-content/uploads/2014/10/Advocacy-Brief-2014.pdf
  2. Alive and Thrive. (2015). Formative Research for IYCF Advocacy with Decision Makers in Viet Nam: Survey Instruments for Key Informants.   
  3. Alive and Thrive. (2012). Policy Support for IYCF in Viet Nam: Leader Perspectives.   
  4. Alive and Thrive. (2015). Step-by-step guide to Concept Testing. 
  5. http://aliveandthrive.org/wp-content/uploads/2014/11/Toolkit-R2A-Before-and-after-scripts.pdf
  6. http://aliveandthrive.org/wp-content/uploads/2014/11/Toolkit-R2A-Pretest-instrument_0.pdf
  7. http://aliveandthrive.org/resources/watch-full-stilomatic-0111/
  8. Alive and Thrive. (2013). Engaging the Media: A practical guide to meeting child nutrition advocacy goals through working with journalists. 
  9. http://aliveandthrive.org/resources/power-of-nutrition-advocacy-tools/
  10. Alive and Thrive. (2012). A Strong Maternity Leave Policy: A Strong Investment In Viet Nam’s Future.
  11. Alive and Thrive. (2012). Spotlight on Innovation: Dads can do that! Strategies to involve fathers in child feeding. 
  12. Alive and Thrive. (2012). Spotlight on Innovation: Literature Review - Fathers Support Infant and Young Child Feeding. 
  13. Alive and Thrive. (2015). Introduction to TIPs, Trials of Improved Practices. 
  14. Kate Dickin, Marcia Griffiths, Ellen Piwoz. (1997). Designing By Dialogue: A Program Planners Guide to Consultative Research for Improving Young Child Feeding. 
  15. Alison McFadden, N. K.-M., Heather Whitford and Mary J Renfrew. (2015). Breastfeeding: Policy Matters. Identifying strategies to effectively influence political committment to breastfeeding: a review of six country case studies. 
Breastfeeding help

An accredited social health activist (ASHA) counsels a new mother using the mSakhi video on breastfeeding in Badagaon block, Jhansi district, Uttar Pradesh, India. © 2014 Girdhari Bora for IntraHealth International, Courtesy of Photoshare