Stronger with Breastmilk Only campaign aims to save lives, reduce child malnutrition in West and Central Africa

Seven out of every 10 babies in West and Central Africa receive liquids and foods in addition to breastmilk during their first six months of life, contributing to child malnutrition, illnesses and even death. The Stronger With Breastmilk Only multi-year campaign launched today by UNICEF and the Alive & Thrive initiative calls on Governments, partners, businesses, communities and families to ensure that mothers get the support they need to give their babies the best start in life.

Read Alive & Thrive’s advocacy briefs for countries across the region

Despite positive economic growth in West and Central Africa, the number of stunted children under five years has increased from 23 to 29 million between 2000 and 2018. In addition, the region is home to an estimated 4.9 million children suffering from severe acute malnutrition.

For babies under six months to stay healthy, scientific evidence recommends giving them breastmilk only and on demand (day and night). No water, other liquids or foods should be given from the moment of birth until they reach six months of life, even in hot and dry climates, as breastmilk contains all the water and nutrients a baby needs to grow well. According to studies in low- and middle-income countries, babies who receive liquids and foods in addition to breastmilk before six months of age are at greater risk of diarrhoea and respiratory infections. They are almost three times more at risk of dying than those who are exclusively breastfed.

Breastfeeding also has significant benefits for mothers by hastening recovery after childbirth, delaying the return of the menstrual cycle thus helping with birth spacing, and reducing the risk of cancer.

The costs of not breastfeeding are enormous: in addition to thousands of preventable deaths of children, it costs West and Central Africa hundreds of millions of dollars annually to treat illnesses, to buy infant formula, and in lost productivity due to cognitive losses associated with not breastfeeding.

Cost of Not Breastfeeding brief illustration
Alive & Thrive’s advocacy briefs provide country-by-country snapshots of the cost of not breastfeeding – and actions stakeholders can take to improve the situation.

“Breastmilk is a pure gift. It is a baby’s first vaccine and best source of nutrients. Promoting, protecting and supporting mothers to give breastmilk only, no water, for the first six months of life requires encouragement and support from family members, health care providers, employers, policymakers and all of society. Together, we can make a difference”, said Marie-Pierre Poirier, UNICEF Regional Director for West and Central Africa.

A recent poll conducted by UNICEF in 10 countries in West and Central Africa revealed that 55 per cent of youth incorrectly believe that babies need water in the first six months of life. Additionally, 45 per cent of respondents thought that babies should be given something in addition to breastmilk in order to grow strong and healthy. The Stronger With Breastmilk Only campaign focuses on stopping the practice of giving water to babies younger than six months as an entry point for shifting norms and behaviours towards improved breastfeeding practices.

“Alive & Thrive’s successful experiences in Bangladesh, Ethiopia and Vietnam demonstrate that it is possible to significantly increase exclusive breastfeeding rates in a relatively short period of time. Alive & Thrive brings evidence-based frameworks, methods and tools to support countries in West and Central Africa to scale up evidence-informed programmes that work, including initiatives in Burkina Faso and Nigeria, which are already showing promise,” said Dr. Tina Sanghvi, Senior Technical Advisor of Africa Country Programs at Alive & Thrive.

Having a comprehensive national strategy that protects, promotes and supports breastfeeding is the most effective way to influence the environmental, social, economic and behavioural factors that influence a mother’s decision to feed a child breastmilk only in the first six months of life.

The Stronger With Breastmilk Only campaign aims to catalyse much-needed policy, social, institutional, community and family dialogue and change towards improving breastfeeding rates in 24 countries. It calls on governments, partners and businesses across West and Central Africa to take action and position exclusive breastfeeding as a public health priority to improve the health and prosperity of children and nations.

Alive & Thrive data now available via Dataverse

Data make great impact when they are easily accessible to researchers and practitioners. We’re pleased to announce the launch of the Alive & Thrive Dataverse through which data produced by Alive & Thrive-supported research are immediately accessible and open. It includes household, frontline workers, and health facility survey-data from Bangladesh, Ethiopia, Vietnam, India, Burkina Faso, and Nigeria.

Sharing Success: Chinese journalists learn about IYCF achievements in Viet Nam

Chinese journalists visited Alive & Thrive's Viet Nam office on a learning exchange visit.
Participating journalists from China, Bill & Melinda Gates Foundation’s China Office, and the A&T Southeast Asia team during the media orientation meeting. Photo: Alive & Thrive

Eight Chinese journalists traveled to Viet Nam to learn more about successful efforts there in creating a positive environment for breastfeeding. Alive & Thrive and the China Development Research Foundation co-organized the exchange visit to enable the journalists to advocate for replicable models in China, where the exclusive breastfeeding rate stands at 20.8%, far below the WHO recommended rate of 50%.

The journalists, from seven major news agencies including The Paper and Global Times, along with representatives from KREAB Strategic Communication Consultancy and the Bill & Melinda Gates Foundation, participated in the learning exchange, getting insight into A&T’s work as well as breastfeeding policy objectives and the potential to improve infant feeding practices at scale.

“A central part of Alive & Thrive’s strategy is building the capacity of those with influence, like journalists, to spread best practices in maternal nutrition and breastfeeding,” said Roger Mathisen, Alive & Thrive’s regional program director for Southeast Asia. “Bringing journalists from China to Viet Nam allows them to learn firsthand approaches that have worked here, and draw inspiration for adapting these solutions to China’s challenges with breastfeeding.”

Over the past ten years, through collaboration with numerous stakeholders, the Government of Viet Nam has put into place legislation that monitors breastmilk substitute advertising and supports working mothers with paid maternity leave, breastfeeding breaks, and workplace lactation rooms. Combined with communication and information dissemination, these efforts have resulted in a shift in national breastfeeding behavior to reflect WHO standards and better nourish infants and young children.

Journalists toured the Da Nang Hospital for Women and Children to learn firsthand about the Center of Excellence for Breastfeeding initiative, a model in which the Ministry of Health designates hospitals with breastfeeding-friendly environments. After learning about human milk banks, which provide vulnerable infants access to the benefits of breastmilk,  they next visited a sub-rural commune health center, which employs the successful “Little Sun” social franchise and social behavior change communication model. There, they participated in a counseling session to understand how parents receive nutrition and feeding information.

In addition to service delivery sites, journalists met with several advocacy groups, which highlighted the crucial and multifaceted roles of advocacy in Viet Nam’s successful policy reform. Journalists engaged in a roundtable conversation with representatives from the Da Nang Municipal Department of Health, nutrition counselors, mothers, and families, and also discussed Viet Nam’s processes to enact legislation for maternity protection and control the marketing of breastmilk substitutes with representatives from the National Assembly’s Institute for Legislative Studies, the Ministry of Health, the Ministry of Labor, Invalids and Social Affairs, and the Viet Nam General Confederation of Labor. Also emphasized was the importance of mass media, social media, and peer support in the advocacy agenda. The social media group “Betibuti,” a mother-to-mother group with 250,000 members, facilitated a forum with journalists where breastfeeding mothers shared their experiences and underscored the need to raise public support to fight for policy change.

Alive & Thrive will continue to collaborate with the China Development Research Foundation to promote breastfeeding through policy advocacy and communications, working with media agencies and journalists to convey key messages to Chinese families and help them make informed decisions about infant nutrition.

Highlights from World Breastfeeding Week 2019

Alive & Thrive celebrated World Breastfeeding Week 2019 in collaboration with partners and communities around the globe. From August 1-7, A&T planned and participated in events honoring the theme, “Empower Parents, Enable Breastfeeding,” to raise awareness about breastfeeding’s benefits and the need for supportive, enabling environments for mothers and families.

Check out some of the highlights of #WBW2019 around the world!


In July, A&T launched our Cost of Not Breastfeeding Tool, which quantifies the preventable losses of life, cognition, and health system costs in countries around the world due to inadequate breastfeeding. This video, published during WBW, illustrates the importance of the new tool.


The WBW inauguration ceremony, where A&T was presented with an award for contributions to IYCF practices in the country.

The Bangladesh National Nutrition Service presented A&T with an award during the WBW inauguration ceremony, recognizing our achievements in infant and young child feeding (IYCF) practices in the country. “Alive & Thrive is providing technical assistance and support to the Government of Bangladesh, strengthening nutrition services through the health system,” explains Zeba Mahmud, Country Director of A&T in Bangladesh. The award serves to recognize A&T’s varied work in the country –  since 2010, A&T has helped develop guidelines and strategies to promote breastfeeding and complementary feeding, assisting to raise exclusive breastfeeding rates. Collaborating with INGO and government partners, A&T has reached 126 million people in Bangladesh with mass media and interpersonal communications campaigns, and will continue to provide technical assistance to the Government of Bangladesh in implementing the Breastmilk Substitutes Act and its bylaws.


In Cambodia, A&T along with the Cambodia Center for Independent Media and SUN Cambodia hosted a media workshop to educate journalists on the importance of breastfeeding and breastfeeding policies in the nation. The participants developed practical tools to increase media coverage of breastfeeding, pledging to use their influence to build supportive environments and policies for nutrition. Following the workshop, the journalists joined visits to WBW celebrations in Siem Reap and rural areas. Check out the first article published about the workshop, advocating for enforcement of marketing regulations for breastmilk substitutes.

Hon Kroeun, Deputy Country Director of Helen Keller International Cambodia and Coordinator of the SUN CSA Cambodia, speaks with local journalists at the media orientation workshop, hosted by A&T and Cambodia Center for Independent Media in Phnom Penh.
Parents and children attend the World Breastfeeding Week launch event hosted by the Ministry of Health in Siem Reap, Cambodia. Participants in the media orientation attended the launch, interviewing stakeholders and providing media coverage.


To improve the quality and safety of human milk banks (HMBs) in Myanmar, A&T and UNICEF held trainings for hospital staff at Central Women’s Hospital and Yankin Children’s Hospital. Staff learned about new guidelines for the HMB process as well as strategies for breastfeeding counselling. For infants unable to receive breastmilk from their mothers, HMBs serve a vital role, giving vulnerable infants access to the benefits of breastmilk when they need it most.

Staff are trained on best practices for human milk banks at Central Women’s Hospital and Yankin Children’s Hospital.


Mothers in the Philippines simultaneously latch their babies as they take to social media to advocate for the normalization and support of breastfeeding.

The photographer Giacomo Pirozzi visited the Philippines to document breastfeeding practices and challenges. In alignment with the week’s theme “Empower Parents, Enable Breastfeeding,” his photographs focused on workplace lactation in both the formal and informal sectors, drawing attention to enabling environments for breastfeeding for working mothers. August 18th, he photographed Hakab Na! (Big Latch On), the biggest breastfeeding event in the Philippines, hosted by Breastfeeding Pinays, an online forum of over 270,000 breastfeeding families where thousands of mothers simultaneously latched their babies around the country.


In an important milestone for the Center of Excellence (CoE) for Breastfeeding initiative in Vietnam, two designation ceremonies were conducted, following a decision on August 6 from the Ministry of Health, approving a legal foundation to expand the CoE approach nationwide. The potential for impact is widespread.

“The designation of the first hospital in Ca Mau as a Center of Excellence gives us motivation to replicate the model towards building a brea

A&T Southeast Asia Regional Director Roger Mathisen with staff at Tran Van Thoi CoE designation ceremony.

stfeeding-friendly province,” said  Nguyen Van Dung, the Acting Director of the Department of Health in Ca Mau.

To receive the CoE designation, multiple groups evaluate the hospital, including mothers who have recently given birth in the facility; the MOH or DOH then determines which hospitals qualify. Hospitals recognized as a CoE serve as best practice models for the promotion of breastfeeding and receive media attention to help pregnant women and their families make informed choices about their birth facilities. “The CoE initiative is a practically significant intervention to create and maintain a breastfeeding-friendly environment… and can bring great impact on ensuring nutrition and sustainable development of children,” said Nguyen Viet Tien, Deputy Minister of Health at the CoE ceremony.

Vietnam Television produced two videos, looking at the CoE approach and its impact for WBW.


A&T supported the Federal Government of Nigeria to launch the Start Strong/Zero Water Breastfeeding Campaign and unveiled the National Maternity Entitlement Assessment Report to mark the start of WBW. Start Strong/Zero Water is a major mass communication campaign designed to raise awareness of the importance of exclusive breastfeeding for infants in their first 6 months and early initiation of breastfeeding. With only one in three Nigerian children exclusively breastfed, the National Maternity Entitlement Assessment Report presentation highlighted that mothers were often not granted adequate time to breastfeed during work hours.

Dr. Mairo Al-Makura (2nd from right), a representative for Nigeria’s first lady, unveiled the Start Strong/Zero Water campaign logo at the WBW launch.

Kaduna State, Nigeria

Nutrition is crucial in Kaduna state – after the high level of malnourished children in the area prompted a state of emergency in malnutrition, exclusive breastfeeding has been prioritized. Hajiya Aisha Umma Garba El’Rufai, the First Lady of Kaduna State and chairperson of the Kaduna Emergency Nutrition Action Plan, held a parade in Kaduna as well as a panel dialogue called “Breastfeeding: Family friendly policies are key to enabling exclusive breastfeeding.” The panel focused on the need for community support towards nursing mothers to reduce child mortality through exclusive breastfeeding, while the parade raised awareness about exclusive breastfeeding and celebrated the recent legislation passed in the state guaranteeing six months maternity leave.

Her Excellency Hajiya Aisha Ummi Garba El’Rufai wife of the Governor of Kaduna State addressing onlookers during the fun parade.

Watch Madame El Rufai in this Facebook Live interview with A&T’s technical advisor Chinweuba Ezeigwe. 

Lagos, Nigeria

In Lagos, a baby show was held, in recognition of mothers who practice exclusive breastfeeding. The Alive & Thrive team, along with 112 other stakeholders, including representatives from the Lagos State Ministry of Health, the Primary Health Care Board, Traditional Medicine Board, implementing partners, health workers, and breastfeeding mothers from A&T supported public health facilities in Lagos participated in the event. The babies, presented by their mothers, were assigned points based on their health behaviors, encouraging stakeholders in Lagos to adopt best practices in infant health. Judges evaluated factors such as early initiation of breastfeeding; exclusive breastfeeding for babies under 6 months; weight, as a measure of proper nutrition; and adherence to immunization schedule. While only one baby was named the winner, entire communities benefit from raising awareness about the importance of breastfeeding and engaging stakeholders to prioritize infant health.

Winners of the baby show activity at the Lagos Mainland Local Government Area pose with their gifts.


On August 5th, A&T held a panel in India to raise commitment to the creation of enabling environments for breastfeeding, in public and in private. Under the leadership of the Ministry of Health and Family Welfare (MoHFW) and in collaboration with the Indian Academy of Pediatrics and Centre for Advocacy and Research, the panel also informed the development of a guidance note for health facilities to improve adherence to the Infant Milk Substitutes Act, which bans the promotion of milk substitutes to encourage optimal breastfeeding.

Dr. Khera, from the MoHFW, delivering the keynote address at the panel to promote optimal breastfeeding.


A&T in Ethiopia collaborated with partners to organize events at national and regional levels to raise awareness about gender-equitable parenting and social protections to support breastfeeding. Nationally, together with the Ethiopia Federal Ministry of Health, the Ethiopia National Nutrition Program (NNP), and media agencies, A&T helped orchestrate a week of activities raising awareness for breastfeeding, including a press conference, features on national TV programs, and community engagement in health facilities. The breastfeeding promotion extended to regional levels; in Amhara, Tigray, SNNP, Afar, and Somali, A&T provided technical guidance to TV roundtable discussions, radio programs, and communications materials. In each regional city, panel discussions were organized with representatives from NNP, religious leaders, hospitals, implementing partners and breastfeeding mothers, to advocate for optimal breastfeeding strategies and environments in Ethiopia.

Breastfeeding mothers supporting breastfeeding-friendly policies at a regional panel in Ethiopia.

What are Centers of Excellence for Breastfeeding?

In Vietnam, 94% of births take place in the hospital, but not every facility prioritizes breastfeeding in its early newborn care. This video shows how the Center of Excellence for Breastfeeding approach in Vietnam can help families to employ breastfeeding best practices for improved health and nutrition outcomes.


Two hospitals in Viet Nam designated as “Centers of Excellence for Breastfeeding”

The Ministry of Health in cooperation with Alive & Thrive has designated two hospitals as Centers of Excellence for Breastfeeding: Tran Van Thoi Hospital in Ca Mau on August 26 and Can Tho City Gynecology and Obstetrics Hospital on August 28, 2019.

“The Center of Excellence for Breastfeeding is awarded to hospitals for creating and maintaining breastfeeding-friendly environments, which is critical to the health of both mothers and their newborns,” said Prof. Nguyen Viet Tien, Deputy Minister of Health.

Read the Centers of Excellence brief here. Download the map here.

Multiple groups are involved in the comprehensive evaluations of a hospital to be deemed a Center of Excellence, including independent assessors and women who recently delivered at the facility. “This is the first-time feedback from mothers who have recently delivered at a hospital has been incorporated into the hospital designation. It reflects the direction of the Vietnamese Minister of Health to improve healthcare services towards patients’ satisfaction,” said Mr. Nguyen Duc Vinh, Director of Maternal and Child Health Department, Ministry of Health.

The Center of Excellence model is important because early initiation of breastfeeding – within the first hour of birth – is highly beneficial to both a mother and a newborn baby. In Viet Nam, 94% of births take place in hospitals, but only 27% of newborns are breastfed within the first hour after birth. This is mainly because skin-to-skin contact is interrupted for weighing, providing vaccines and other interventions that can wait, which prevents newborns from beginning to breastfeed.

“The model focuses on doing the right interventions at the right time after birth to limit unnecessary separation of the mother and newborn. This will facilitate the first embrace and breastfeeding that helps babies to thrive outside the womb by fostering a natural bond between the mother and newborn. It helps transfer warmth, protective bacteria and essential nutrients, antibodies and immune cells to protect from infections,” said Roger Mathisen, Regional Director, Alive & Thrive Southeast Asia.

According to phone surveys conducted under the Center of Excellence initiative, 84% of mothers report that they receive skin-to-skin contact but only 39% of them had pro-longed contact up to 90 minutes. As a result, only 62% of mothers could breastfeed exclusively during their hospital stay.

“Initially, the Can Tho City Gynecology and Obstetrics Hospital had difficulties in organizing and unifying the procedures to ensure 90-minute skin-to-skin contact,” said Dr. Nguyen Thuy Thuy Ai, Deputy Director of Can Tho City Obstetrics Hospital. “However, the hospital’s leaders and staff managed to do it. When a baby can crawl to find the mother’s breast and have his or her first initiation on the mother’s chest, both the mother and birth staff feel happy. Our health staff also feel happy and motivated to support mothers to breastfeed exclusively during hospital stay.”

Twenty-eight (28) hospitals have so far applied for the Center of Excellence designation nationwide, including four private hospitals; more than half of them are district hospitals. Eight other hospitals have been designated and will also be awarded in 2019.

Expanding the Center of Excellence designation beyond obstetrics and pediatric hospitals aims to catalyze competition among hospitals, decreasing overload among central and provincial hospitals while increasing equal accessibility to good healthcare for all mothers. The expansion to district level hospitals is also to discourage the use of formula milk. “With the passion of all hospital staff, we commit to the hospital slogan, ‘Center of Excellence for Breastfeeding says no to promotion of formula milk,’” said Dr. Nguyen Van Luan, Deputy Director of Tran Van Thoi General Hospital, which is a district level hospital designated today.

The Ministry’s designation of the hospitals has inspired commitments to gain similar Center of Excellence status at other hospitals. “With the good model set forth by the Can Tho City Obstetrics Hospital, by 2020, the Center of Excellence criteria will be applied to all hospitals with obstetrics departments in Can Tho,” said Mr. Huynh Van Nhanh, Deputy Director of Health Department of Can Tho City. “The designation of the first hospital in Ca Mau as a Center of Excellence gives us motivation to replicate the model towards building a breastfeeding-friendly province,” said Mr. Nguyen Van Dung, Acting Director of Ca Mau Province Department of Health.

The Ministry of Health issued Decision No. 3451/QD-BYT on August 6, 2019 to legalize the Center of Excellence for Breastfeeding designation criteria and mechanism for nationwide application. “The Center of Excellence for Breastfeeding designation is not forever, it is valid for five years,” said Mr. Nguyen Duc Vinh, Director General of Maternal and Child Health Department. “Every five years, Ministry of Health shall conduct re-assessment; every year Department of Health shall conduct hospital quality criteria assessment and every quarter phone survey with mothers shall be implemented.”

The Center of Excellence for Breastfeeding initiative has been developed and implemented with the support from Irish Aid. “Irish Aid is very proud to support the Department of Maternal and Child Health and Alive & Thrive to conduct objective assessments and recognize hospitals as Centers of Excellence as part of improving the quality of maternal and newborn care in the community,” said Ms. Réachbha FitzGerald, Deputy Head of Development of the Embassy of Ireland in Viet Nam.

WBW2019: Empower Parents, Enable Breastfeeding

By Karin Lapping

First celebrated in 1992 by World Alliance for Breastfeeding Action, World Breastfeeding Week is now observed in over 120 countries by UNICEF, WHO and partners too numerous to list including individuals, organizations, and governments. Alive & Thrive is proud to be a part of this important week of action.

As this year’s theme makes plain, we need to empower parents to enable breastfeeding. The Cost of Not Breastfeeding tool makes clear why that is so important. We supported the research underlying the tool and then developed an interactive online version that makes it easy for anyone to see just what’s at stake: 700,000 preventable deaths and $1 billion dollars a day. Those statistics powerfully illustrate why we need to do more to support breastfeeding. This great video brings the data to life:

As World Breastfeeding Week kicks off today, I’m happy to announce that we have added French translations of the online tool for francophone countries in West Africa, further increasing access to the information. In coming weeks, we are also adding advocacy briefs for many countries, providing summaries of the data and concrete advocacy actions to increase the rate of exclusive breastfeeding.

Much needs to be done to ensure mothers and infants – and their families and communities, indeed all of us – gain from the benefits of breastfeeding. Training of health workers remains an important means to achieve the global goal of 50% exclusive breastfeeding by 2025 – and 70% by 2040 .

Alive & Thrive Photo Credit : Shafiqul Alam Kiron

In June we launched an e-learning course, Investing in Child Nutrition, in French and English specifically targeting health workers. Already more than a dozen people have completed the course and more than 500 people worldwide have registered to take it. You can too – it’s free and easy to use on just about any device connected to the Internet!

Across the Alive & Thrive world, we are supporting activities and events to celebrate World Breastfeeding Week:

  • In Nigeria, we are collaborating with many partners – the Government of Nigeria, Save the Children, Nutrition International, USAID, and Civil Society-Scaling Up Nutrition and others – on a major national campaign, “Start Strong/Zero Water,” which will launch Aug. 6. We are also launching a major report on maternity entitlements, an assessment of the implementation of parental leave entitlements and workplace breastfeeding support policies and the variety of maternity entitlements offered by the public and private sectors. We are going to broadcast on Facebook Live from the launch event on Aug. 6 at noon in Abuja (WAT; 7 a.m. EST) – go to our Facebook page at that time to tune in!
  • In Bangladesh, we are supporting a national-level symposium on the economic cost of not breastfeeding and to raise awareness of the country’s Breast-milk Substitute act’s key provisions. With WHO and Plan International, we are also supporting “breastfeeding camps” to raise awareness of the importance of breastfeeding and provide breastfeeding education and support to mothers who attend the camps.
  • In India, A&T is organizing “Breastfeeding in India: Commitment to collective actions under the Infant Milk Substitute Act to protect, promote and support breastfeeding,” in New Delhi on Aug. 5, collaboratively supporting activities with UNICEF and the National Health Mission in Uttar Pradesh, and supporting a plenary session during a national level conference, “Lactacon,” which is being organised by the state chapter of Federation of Obstetric and Gynaecological Societies of India – more than 400 practitioners and experts from the field of obstetrics and gynaecology are expected to attend from across the country.

We are promoting these and many other events with posts on our Twitter, Facebook, Instagram and YouTube accounts. Follow us on these pages to find out more about the activities and gain access to various resources we will be promoting throughout the week.

World Breastfeeding Week allows us to emphasize the importance of breastfeeding. We can – and must – do more to address the costs, 700,000 lives and $1 billion a day. Join the global effort to support breastfeeding and convince policy makers to act to do so as well.

Karin Lapping is the Director of Alive & Thrive.

Understanding the factors that determine maternal nutrition practices in Uttar Pradesh, India

Uttar Pradesh, the most populous state in India, has a high burden of undernutrition. It lags behind national averages in maternal nutrition practices. Despite strong policy and program commitments, many maternal nutrition interventions are not yet reaching majority of women during pregnancy. A recent study by researchers from the International Food Policy Research Institute (IFPRI), Alive & Thrive, and others, published in the Maternal and Child Nutrition journal and also included in a supplement of the Current Developments in Nutrition, examines the role of key influential demand and supply factors associated with maternal nutrition practices in Uttar Pradesh.

A maternal check-up during pregnancy in Uttar Pradesh. Image courtesy: Shivani Kachwaha, IFPRI

The determinants of maternal nutrition practices are complex, and each of the practices may have a differing set of determinants. Few studies have examined the determinants for a diverse set of maternal nutrition practices together, and none have been undertaken in the context of Uttar Pradesh. This study, therefore offers some very useful insights in understanding the role of dominant factors associated with maternal nutrition practices in Uttar Pradesh and deriving some practical lessons for implementing policies around them.

Presently, there is a considerable gap in the utilization of existing maternal nutrition services in Uttar Pradesh. According to National Family Health Survey data (NFHS-4 2016), while 76 percent of pregnant women received the first antenatal care (ANC) check-up, for only 26 percent was it followed up with at least four ANCs. Around 62 percent of women received some iron and folic acid (IFA) tablets, but only 13 percent of women consumed IFA tablets for 100 days or more.

To address the challenges of maternal undernutrition in Uttar Pradesh, A&T aims to test the feasibility of improving the provision and uptake of a package of maternal nutrition interventions through the ANC platform using social behavior change and systems strengthening approaches. These include provision of and counselling on IFA and calcium supplements, adequate weight monitoring during pregnancy and counselling on weight gain, interpersonal counselling on diet during pregnancy and on breastfeeding during postpartum, and community mobilization. IFPRI is collaborating with Alive & Thrive in this study to evaluate the impact of delivery of maternal nutrition interventions in Uttar Pradesh.

This paper used baseline data to provides comprehensive information on the multiple factors related to the adoption of four specific maternal nutrition practices – consumption of diverse diets, IFA and calcium supplementation, and weight monitoring – at multiple levels, including individual, household, community, and health services.

The study found that currently only 18 percent of pregnant women met the recommendation of dietary diversity; they consumed 28 IFA and 8 calcium tablets, and were weighed only 1.3 times during pregnancy. Although the current situation is bleak, many of the key factors associated with maternal dietary diversity, IFA/calcium consumption, and weight gain monitoring are modifiable.

This study shows that each specific maternal nutrition practice is influenced by differing sets of determinants. Among the multiple factors, maternal behavioral characteristics (such as knowledge, beliefs and self-efficacy), followed by support from family members, community factors, and adequate health services access are significantly associated with key maternal nutrition practices. Given that diverse diets, IFA and calcium supplements, and weight monitoring are promoted and delivered through a common package, a nuanced understanding of the drivers for each specific practice can help improve access to the full package. For example, maternal diet diversity is a complex outcome and was found to be associated with maternal knowledge and receipt of counseling. Increased consumption of calcium was found to be associated with maternal knowledge, receiving counselling on calcium supplementation, beliefs and self-efficacy, ANC visits and positive social norms.

Through modelling approaches, the effects of individual and combined factors help identify and highlight improvements that may be achieved by the maternal nutrition programs. In particular, these findings provide new evidence on the determinants of calcium consumption and weight monitoring during pregnancy. Under optimal program implementation that explicitly tackles the specific determinants of each maternal nutrition practice, one could expect half of the women to achieve adequate diet diversity, consume an average of 100 IFA and 90 calcium tablets, and be weighed 4.4 times during their pregnancy.

The study findings, based on modelling, suggest that strengthening program operations to improve the supply of interventions and to create adequate demand through behavior change communication, has the potential to improve maternal nutrition practices. The impact evaluation, which is underway, will shed more light on the extent to which Alive & Thrive’s efforts, working with the government of Uttar Pradesh, achieve these impacts. However, along with these efforts, improvements will also be needed in socio‐economic conditions, such as education, income, and employment generating activities to support and sustain behavior change for attaining the World Health Organization‐recommended levels of maternal nutrition. Improving the maternal nutrition practices in Uttar Pradesh will go a long way in improving the overall nutrition status of India.

Access this article: Nguyen, P., S. Kachwaha, R. Avula, M.F. Young, L. Tran, S. Ghosh, R. Agrawal, J. Escobar-Alegria, S. Patil, and P. Menon. 2019. “Maternal Nutrition Practices in Uttar Pradesh, India: Role of Key Influential Demand and Supply Factors”. Maternal & Child Nutrition.

This blog has been jointly developed and cross-posted by the International Food Policy Research Institute and Alive & Thrive.

New cost of not breastfeeding tool launched

A new research study and online tool illustrates the dramatic costs – in human lives and to the global economy – due to inadequate breastfeeding: almost 700,000 lives annually and a billion dollars a day.

Listen to Dr. Dylan Walters, lead author of the Cost of Not Breastfeeding, in this interview with Voice of America:

The cost of not breastfeeding tool allows users to explore data on breastfeeding in 34 countries. Click on image to go to the tool.

The tool was developed by health economist Dr. Dylan Walters with support from Alive & Thrive, an international maternal and child nutrition initiative funded by the Bill & Melinda Gates Foundation.

“Each year not breastfeeding newborns and young children according to recommendations costs global society nearly 700,000 lives and US$341 billion dollars, or 0.7% Gross National Income, in health system costs and lost productivity due to premature mortality, and cognitive losses,” Dr. Walters said. “The world must act to mobilize financial resources necessary and political commitment to achieve the World Health Assembly Global Nutrition Target of exclusive breastfeeding prevalence of 50% by 2025 because it is a human right, it saves lives, and improves the prosperity of economies.”

The online tool, available on Alive & Thrive’s website, provides background on the impacts of not breastfeeding in 34 countries. The tool is based on Dr. Walters’ research published by Health Policy and Planning Journal on June 24 (, which provides data on estimates for the human and economic costs of not breastfeeding for over 100 countries.

“We need to be sensitive to the constraints and hardships faced by mothers and families in a world that lacks basic support systems for their physical, psycho-social, and economic well-being,” Dr. Walters said. “Even more, mothers and families are up against a constant barrage of corporate marketing of alternatives and misinformation spread that undermines what should be boringly second nature and not stigmatized by society.”

Expanding paid family leave to the minimum 18 weeks as recommended by the International Labor Organization would enhance the ability for mothers to exclusively breastfeed. It would further benefit mothers to align this duration with the recommended 6 months of exclusive breastfeeding.

Launched just three weeks before World Breastfeeding Week (Aug. 1-7), the tool is a valuable resource for advocates, said Roger Mathisen, program director of Alive & Thrive’s office in Southeast Asia and a co-author of the paper.

“The data are sending us a compelling message: we must do more to support breastfeeding,” Mathisen said. “With this tool, we hope advocates around the world will be emboldened further in their efforts to obtain greater support from governments.”

Dr. Linh TH Phan, Regional Program Coordinator in Southeast Asia for Alive & Thrive, said the tool was valuable for efforts to increase support for breastfeeding worldwide.

“Low- and middle-income countries, particularly in sub-Saharan Africa and South Asia, and their people, have the most to gain from adopting universal breastfeeding within the first hour of life, exclusively for the first 6 months, and continued for more than two years,” Dr. Phan said. “But wealthier countries also have room for cognitive gains and probably reductions in the burden of childhood obesity and maternal cancers and Type 2 diabetes.”

People can do many things to improve support for breastfeeding mothers. Demanding government adopt policies that promote breastfeeding, compelling employers to provide breastfeeding support at work sites, and ensuring health workers are adequately trained to support mothers to breastfeed are just a few positive actions that can help the world reach the goal of 50% exclusive breastfeeding prevalence by 2025. Additionally, governments should enforce the International Code of Marketing of Breast-milk Substitutes.

For seven actions implementers and donors from governments, philanthropies, international organizations and civil society can take to create a more enabling environment for breastfeeding, visit the Global Breastfeeding Collective: