The 2010’s are over – but data-driven innovations from the last decade will continue to drive improvements in MIYCN for healthier families, communities, and nations. In 2019, A&T continued support research in a variety of areas.
“The rigorous research that A&T supports fills data gaps and documents improvements in maternal, child, and infant nutrition (MIYCN) at scale, in both policies and programs,” explains Joy Del Rosso, Director of Knowledge, Leadership and Learning for Alive & Thrive. “The A&T initiative continues to expand global knowledge on maternal nutrition, breastfeeding, and complementary feeding in its effort to improve nutrition outcomes around the world.”
A billion dollars and two thousand lives, every day. This impactful study, which is the foundation for Alive and Thrive’s online tool
, examines the human and economic costs of not breastfeeding. Each year, $340 billion in unnecessary healthcare costs and cognitive losses, as well as 700,000 lives of mothers and infants are lost due to inadequate breastfeeding. This data calls for scaling up financing and implementation of policies, programs and interventions worldwide to create enabling environments that support breastfeeding mothers.
Indonesia would reap significant economic benefits from expanding maternity protection programs, according to this study that explored the potential financial cost to optimizing paid maternity protection programs. The costs of implementing maternity benefits are far less than the significant economic profits and health benefits Indonesia would gain as a result of expanding maternity protection, such as increasing maternity leave from three to six months and incorporating lactation rooms in medium and large firms.
This supplement, comprising three papers, addresses gaps in policy advocacy to create supportive environments for optimal breastfeeding and infant and young child feeding (IYCF). While policy advocacy is nearly universal, few studies in this field directly evaluate advocacy strategies and document their effects. The supplement serves as a guide for future IYCF policy enhancement, identifying the drivers and triggers of policy change and providing evidence that Alive & Thrive, UNICEF, and partners enhanced policies in Southeast Asia.
The International Code of Marketing of Breast-Milk Substitutes (the Code) is intended to prevent inappropriate marketing of breastmilk substitutes, but these practices persist around the world. Creating a strategic group and implementing 15 critical tasks are the key drivers of advocacy efforts necessary to translate the Code into national legislation, according to this real-time analysis of A&T advocacy efforts undertaken with UNICEF in seven Southeast Asian countries.
The advocacy efforts of Alive & Thrive, UNICEF and partners have made progress in improving IYCF policies, according to a study that used contribution analysis (CA), a recent advance in the field of evaluation. CA is a six‐step approach that can help explore attribution in complex environments. Complemented with developmental evaluation, CA showed that advocacy efforts did in fact improve IYCF policies in the seven countries where Alive & Thrive and UNICEF implemented a four-part process for policy change.
Large initiatives should adopt an explicit advocacy approach, create a strategic group of actors, and realize 15 critical tasks to enhance their effectiveness in advocacy for policy change, specifically related to implementation of the Code, according to this real-time analysis of advocacy efforts.
In this case study of the collective impact (CI) approach, researchers conclude that an Alive & Thrive-UNICEF advocacy effort was effective because it met conditions for an effective CI initiative: 1) an independently funded staff dedicated to the initiative provided ongoing support; 2) participants shared a vision for change that included a common understanding of the problem and a joint approach to solving the problem through agreed‐upon actions; 3) a diverse set of stakeholders, across sectors, coordinated a set of differentiated activities through a mutually reinforcing plan; 4) all players engaged in frequent and structured open communication to build trust, assure mutual objectives, and create common motivation; and 5) all participating organizations agreed on the ways success would be measured and reported.
The 2019 Nobel Prize in Economics recognized the importance of using experimental research – namely randomized control trials – to identify solutions to development problems. Alive & Thrive has used cluster-randomized evaluations, with other methods, to generate lessons about infant and young child nutrition behavior change at scale in Bangladesh, Vietnam, and Ethiopia. After testing adaptations in other countries, this body of evidence now informs the shaping of nutrition behavior-change strategies around the world, benefitting millions of women, children, and their communities.
Nutrition Systems Strengthening
Alive & Thrive-supported training, supervision and mass media activities improved front-line health workers’ (FLW) delivery of nutrition services, according to a study in Bangladesh and Viet Nam. Interventions were significantly associated with at-scale service delivery improvements, indicating these strategies should be considered when designing future interventions.
A study of caregivers in Bangladesh concluded that health workers who comply with evidence-based practices positively influence their clients’ IYCF behaviors. The study documented the relationship between providers’ compliance with evidence-based practices during counseling and clients’ IYCF behavior change, such as reported increases in exclusive breastfeeding. While behavior change is multifactorial, improvements to technical quality of care may contribute to desired health outcomes.
A multi-dimensional intervention using interpersonal communication and community mobilization activities, delivered at scale in Burkina Faso, increased mothers’ optimal breastfeeding knowledge, breastfeeding beliefs and breastfeeding practices. Women in the intervention areas were more likely to exclusively breastfeed, initiate breastfeeding within an hour of birth and avoid giving their infants pre-lacteal feeds.
Multilevel support for breastfeeding could increase early initiation of breastfeeding by 25%, reduce prelacteal feeding by 25%, and increase exclusive breastfeeding by 25%, according to this study in Uttar Pradesh. Breastfeeding is not a one-woman job – fathers, grandmothers, health workers, and communities play a part in child feeding. A cross-sectional survey conducted among new mothers, husbands, and mothers-in-law in Uttar Pradesh, examined determinants of breastfeeding practices and potential strategies for improvement. A multifactorial approach, including strategies such as health services and family and community level interventions, has the potential to improve practices, the study found.
The Becoming Breastfeeding Friendly (BBF) initiative provides a guide for countries to assess the enabling environment for breastfeeding policies, programs and scale-up. This study documents the BBF process and outcomes in Myanmar, revealing the initiative was successfully conducted and the environment for scale-up was moderate. Nine recommendations are discussed to strengthen the enabling environment, prioritizing a National Infant and Young Child Feeding Alliance. Lessons are noted to inform considerations for other countries committing to the BBF initiative.
Maternal behavioral characteristics (such as knowledge, beliefs and self‐efficacy), followed by support from family members, community factors and adequate health services access, were significantly associated with key maternal nutrition practice, according to this study conducted in Uttar Pradesh, India. The study found that while strengthening existing program operations could result in large improvements, maternal nutrition determinants are multifactorial, and strengthening operations may not be sufficient to meet WHO-recommended levels without creating an enabling environment.
Participation in nutrition-focused antenatal care can reduce food insecurity during pregnancy and the postpartum period, according to this study conducted in Bangladesh. Integrating social and behavior change interventions to improve nutrition knowledge of pregnant and lactating women in populations where resources can be directed towards accessing adequate and appropriate foods can provide a potentially effective means to reduce food insecurity, without incurring high costs of providing supplemental food, the study found.
The provision of intensive counseling and micronutrient supplements led to lower overall complications among recently delivered women in Bangladesh, according to this study. The study suggests that maternal nutrition interventions may reduce pregnancy complications or impact women’s ability to accurately recognize complications.
Delivery of social and behavior change interventions using multiple platforms was feasible and effective, resulting in improvements in complementary feeding practices and child stunting within a two-year period, this study in Ethiopia concluded. The study evaluated the impact of the A&T intensive complementary feeding interventions compared to standard interventions on knowledges, practices and child growth.
Breastfeeding, dietary diversity, complementary feeding and malnourishment as a health hazard are not understood, and women experience a lack of health-related autonomy, this study involving mothers of malnourished children found. Given that malnutrition has roots in infancy, the study’s results underscore an urgent need to create community awareness about infant feeding practices, using innovative behavior change strategies.
Mothers in the rural Boucle de Mouhoun Region of Burkina Faso had low levels of knowledge of IYCF and practices, according to this study: 60% of children had the minimum meal frequency, while only 18% benefited from the minimum dietary diversity and 13% received minimum acceptable diet. Mothers’ perceived self-efficacy to provide children with these food groups was low. The results highlight the need to improve mothers’ IYCF knowledge and practices in the region.
Interaction within mothers’ social networks, reinforced by promoting positive social norms for appropriate behaviors, can affect IYCF practices, according to this study in Bangladesh. The study used household surveys to trace the paths of exposure to interventions like interpersonal counseling, community mobilization and mass media. Findings conclude that through networks, diffusion and norms, exposure to large-scale social and behavior change interventions will contribute to sustained positive changes in IYCF.