2020: A Year in Publications

Alive & Thrive supports MIYCN research around the world and is committed to the principles of Open Data. In 2020, Alive & Thrive supported MIYCN research in China, Bangladesh, Ethiopia, India and Southeast Asia. While the COVID-19 pandemic radically affected health and nutrition systems, Alive & Thrive-supported research led to articles in leading peer-reviewed journals related to COVID-19; breastfeeding and early essential newborn care; human milk banking; infant and young child feeding; maternal and child dietary adequacy; MIYCN program lessons; and trends in nutritional status.

COVID-19

During the COVID-19 pandemic, policymakers and practitioners must learn from mistakes made during the HIV pandemic, when breastfeeding was undermined through isolating infants from their mothers, and formula feeding resulted in more infant deaths than the disease, the authors of this article assert. To maximize infant health, COVID-19 policies should prioritize skin-to-skin contact, breastfeeding, and maternal proximity.
Guidance documents from 33 countries on newborn care for infants whose mothers are diagnosed with confirmed or suspected COVID-19 were considerably inconsistent with WHO recommendations, this review revealed. None of the guidance documents fully aligned with WHO guidance, while many undervalued the importance of maternal proximity and breastfeeding to infant health.

Breastfeeding and EENC

Early breastfeeding practices influenced exclusive breastfeeding (EBF), but interventions aimed only at the initiation and early days of breastfeeding will be inadequate to promote EBF, according to an analysis of data from three impact evaluations of large-scale social and behavior change communication interventions in Bangladesh, Viet Nam, and Ethiopia. Analysis showed social and behavior change interventions should simultaneously target early initiation of breastfeeding, non-prelacteal feeding, and EBF to support optimal breastfeeding practices.
Although breastfeeding is the norm, rates of early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) are low in China, according to an examination of the association between breastfeeding practices and associated factors in the country. The prevalence of EIBF and EBF is associated with factors at the individual, family, health facility, and environmental levels, including health systems, families, maternity protection, the built environment, breastfeeding knowledge, support from partners, the prevalence of cesarean deliveries, and the marketing of breastmilk substitutes; however, few previous large-scale studies have been conducted in China to examine the determinants of breastfeeding practices.
This article documents the protocol for a study that will review the content, implementation, and potential impact of policies relating to maternity protection and the Code in Myanmar, the Philippines, Thailand, and Viet Nam. The study results are expected to be published in January
 2021 and will increase understanding of the efficacy of policy interventions to improve breastfeeding in order to advocate for further policy adoption and enforcement in study countries and globally.
In the Philippines, workers in the informal economy are not guaranteed paid maternity leave. A non‐contributory maternity cash transfer to informal sector workers could improve social equity, economic productivity, public health, and nutrition through supporting breastfeeding. Using a costing framework developed in Mexico, this study estimates the program’s annual costs would range from a minimum scenario of USD42 million (14‐week maternity cash transfer) to a more ideal scenario of USD309 million (26‐week maternity cash transfer). The latter is financially feasible, making up less than 0.1% of the country’s GDP and far lower than the cost of not breastfeeding, making up 0.7% of GDP.
Interviews with Vietnamese health workers and hospital staff generated insights into staff experiences with the implementation of early essential newborn care (EENC) guidelines after participating in training and coaching initiatives. The interviews revealed common themes, including improved health staff and mother satisfaction and the importance of facilitators to implementation, as well as clarified barriers to successful implementation such as staff shortages and skepticism. The findings contribute to literature that can inform the development of competencies to form and sustain recommended EENC practices among health staff.

Human Milk Banking

Infant feeding guidelines emphasize that breast milk is the best nutrition for infants. Some infants do not have access to their biological mother’s milk for a range of reasons; when a mother’s own milk is unavailable for preterm or low birthweight infants, WHO and UNICEF recommend pasteurized human milk from a human milk bank as the first alternative to feed low birthweight and preterm infants. This article, created with guidelines, expert advice, and patient stories, explains human milk banks in-depth, exploring the rationale for their use, contraindications, directions for use, and how donor milk can support breastfeeding.
Viet Nam established the country’s first human milk bank (HMB) as part of its comprehensive strategy to ensure all infants receive human milk and to improve newborn care. This article explores the HMB’s development, establishment, and challenges, providing insights that are adaptable and applicable to other settings seeking to implement new HMB systems that will support breastfeeding practices and reduce infant deaths.

Maternal Resources & Gender

Maternal resources for care, including maternal education, knowledge, height, nourishment, mental well-being, decision-making autonomy, employment, support in chores, and perceived instrumental support, are associated with care behaviors, such as IYCF, hygiene, health-seeking, and family care behaviors, according to this study. However, associations differed by type of resource and care behavior, with some negative associations. Results suggest that improving resources for care available to mothers, including education, knowledge, nutritional status, mental well-being, autonomy, and social support, would benefit the provision of care for children.
Supportive social and political environments to empower women would advance human rights and promote health and well-being, this study’s results suggested. Using the Gender Gap Index (GGI) from the World Economic Forum’s Global Gender Gap Report (2006–2017), researchers assessed gender equity trends in China, Nepal and Nicaragua. Nepal and Nicaragua both had dramatic increases in GGI (improvement in equity), strongly influenced by political empowerment – which in turn likely impacted access to education and employment opportunities. But in China, they found a significant decline in GGI, largely resulting from decreased gender equity in educational attainment, economic participation and health/survival sub-indices.

Maternal and Child Dietary Adequacy

Interpersonal counseling, community mobilization and mass media campaigns led to higher household household food expenditures that improve diets, according to this analysis comparing Alive & Thrive Phase 1 intensive intervention areas to non-intensive areas in Bangladesh. Household food expenditures (including expenditures on eggs and flesh foods) and women’s employment and control of income increased more in intensive intervention
areas compared to non-intensive, while changes in nonfood expenditures did not differ. Higher expenditures on food groups were reflected in higher consumption by women and children. Recipients in the intensive intervention mobilized additional resources to improve diets, reflected in increased expenditures and consumption of promoted foods.
Nutritious diets in Uttar Pradesh are unaffordable for 75% of households, according to this study that examined food prices and consumption patterns. The study further indicated that income and dietary preferences, rather than food availability, were the key barriers to households obtaining nutritious diets. Practical, habitual, diet-related behavior change communication to middle- and high-income households and additional social protection for poorer households could better enable individuals to access more nutritious diets, the authors concluded.
Adequacy of energy, and micronutrient intakes among self-declared lacto-vegetarian and non-vegetarian pregnant women in Uttar Pradesh are inadequate, and macronutrient intakes are imbalanced regardless of dietary preferences, according to this study. Poor diets across the board necessitate a range of policies and interventions to address nutrient intake for women in this population.

MIYCN Program Lessons

Multiple activities, such as mass media campaigns, policy and advocacy activities, and social mobilization activities were integral to the Alive & Thrive’s Phase 1 success but also made the program difficult to sustain, this study concludes. The study evaluated the sustainability of activities introduced during A&T implementation (2009–2014) in Bangladesh and Viet Nam. While quantitative data show a persisting modest intervention effect in areas including health worker knowledge, other elements such as training, monitoring, and evaluation were eliminated. The authors conclude that future complex programs must plan institutionalization and complementary roles for stakeholders in advance to improve sustainability.
Large-scale behavior change interventions, delivered through a variety of platforms – government health systems, community-based platforms, and mass media – had substantial impacts in Bangladesh, Ethiopia, and Viet Nam. A body of evidence, based on A&T evaluations in these countries, now informs approaches to shaping nutrition behaviors around the world. The authors concluded that carefully done collaborative program evaluations that use randomized controlled trials together with other methods can support effective learning about solutions, even those that operate at scale.
Exposure to interventions matters for impact, but the combination of behavior change interventions and number of interpersonal counseling contacts required to support behavior change in infant and young child feeding are context-specific, according to this analysis of Alive & Thrive Phase 1 data in Bangladesh, Ethiopia, and Viet Nam.
Opinion Leader Research (OLR) should be used to both inform and generate support for MIYCN policymaking processes, according to this research in five Southeast Asian countries. OLR was used to gather information on barriers and solutions to guide strategic engagement for MIYCN policymaking, helping to identify influential leaders and opportunities in Cambodia, Laos, Indonesia, Timor-Leste, and Thailand.
Although Southeast Asian NNS have similarities in structure and content, some interventions and indicators vary by country and do not consistently align with regional and international recommendations, according to this study of national nutrition strategies and action plans (NNS) focusing on maternal, infant, and young child nutrition in the region. The study examined context, objectives, interventions, indicators, strategies, and coordination mechanisms. The authors recommend establishing a database that regularly updates information on NNS components to facilitate cross-checking, comparison, and knowledge-sharing.

Trends in Nutrition Status

Underweight persists, while overweight and obesity are rising among adult women, especially wealthier and capital city residents, an analysis of Demographic and Health Surveys between 1993 and 2017 from 35 countries in Sub-Saharan Africa revealed. The study concluded that anemia remains high among all women, revealing a necessity for multifaceted responses to ensure equity among the region’s women.
The key drivers of child undernutrition in Myanmar, where the prevalence of child stunting is 28% and wasting is 7%, are multifaceted and start in utero, this study found. To reduce child undernutrition and accelerate the country’s human and economic development, investment in multi-sectoral interventions with a focus on improving maternal nutrition is essential.
Thank you for being a part of Alive & Thrive’s mission to improve maternal, child, and infant nutrition in 2020! Here’s to more adaptation and innovation in 2021.