IMPLEMENTATION RESEARCH

Government public ANC services at health facilities and in the community, based on updated WHO guidelines (2016), focus on maternal nutrition counseling and iron-folic acid (IFA) counselling and distribution; IFA stock monitoring; maternal weight measurement; and breastfeeding counseling. To address capacity gaps to provide quality counseling, monitor and track weight gain, conduct community outreach activities, and provide effective training and supportive supervision with use of data A&T is strengthening implementation research in the Boucle du Mouhoun and Hauts-Bassins regions.

The national government maternal nutrition guidelines include maternal nutrition and IFA counseling; IFA distribution and stock monitoring; weight gain monitoring; and breastfeeding counseling. Yet coverage and quality of these interventions remains low. A&T’s implementation research being carried out in Southern Nations Nationalities and People’s Region (SNNPR) and Somali regions tests the integration of an intensive package of interventions into existing ANC services to address these gaps.

Despite national policy guidance based on global ANC guidelines, a streamlined package of proven maternal nutrition services—IFA and calcium supplementation, counseling on maternal diet, weight measurement, and counseling on breastfeeding—does not reach most women during pregnancy. A&T’s implementation research tested strengthening the approach to current ANC services under the Reproductive, Maternal, Neonatal, Child and Adolescent Health (RMNCHA) program to improve coverage as well as maternal and child outcomes in Uttar Pradesh.

Significant gaps exist in access to quality nutrition services in urban areas, particularly for the poor. MIYCN counseling during ANC and nutrition counseling during sick child visits is inconsistent, coverage is low, and quality of interventions is neglected and weak. A&T’s implementation research carried out in eight urban NGO-operated facilities in Dhaka addresses these gaps.

Limited evidence is available on how to effectively address urban and rural malnutrition at scale. A&T’s project in Nigeria adapts the proven A&T IYCF implementation framework and tests its applicability in a large urban setting and a diverse rural area. Carried out in urban Lagos and rural/urban Kaduna states, A&T’s large-scale impact evaluation assesses the impact on breastfeeding and complementary feeding of national and state-level advocacy; mass communications; interpersonal communication and community mobilization; and the strategic use of data.

Most Lagos health facilities are private, constituting the most common points-of-care for ANC and well-child care. Yet private facility-based providers often have gaps in knowledge of optimal breastfeeding practices, and many do not counsel women on infant and young child feeding (IYCF). They also lack materials to support counseling during regular ANC and maternal and child health (MCH) visits. A&T’s implementation research in 20 private health facilities in Lagos assesses how these gaps can be addressed

To fill gaps, including reinforcing the importance of exclusive and continued breastfeeding, adequate age-appropriate complementary feeding, and early childhood development from 3 to 15 months, the government developed a program of five additional structured home visits, Home Based Care for Young Children (HBYC). A&T’s implementation research carried out in two districts of Bihar (Gaya and Sitamarhi) assessed the system's readiness and the status of baseline outcome indicators to facilitate effective rollout of the enhanced program

A&T’s implementation research in Kaduna State tests an innovation that draws on religious and traditional leaders to promote involvement of fathers in complementary feeding practices, reinforced by enrolling fathers in a program to receive text messages on complementary feeding via mobile, and introducing similarly-focused counseling cards for government community health extension workers (CHEWs) to utilize during home visits

In November 2019, Alive & Thrive, UNICEF, and the WHO launched a multi-year advocacy and social and behavior change initiative to improve exclusive breastfeeding in West and Central Africa. A&T is undertaking a qualitative study—desk review, semi-structured interviews, other methods—to assess the implementation of various activities and their effectiveness in inspiring policy and programmatic changes related to breastfeeding.

The Philippines was among the first countries to pass national legislation on the International Code of Marketing of Breastmilk Substitutes (Code) in 1986. In 2006, the Implementing Rules and Regulations of the Code were revised to align with international standards and were approved. In 2018, maternity entitlements increased substantially and covered public, private, and informal sector workers. This study aims to increase understanding the effectiveness of policy interventions in the Philippines to address the structural determinants of breastfeeding.

The National Assembly extended paid maternity leave from four to six months, effective from 2013. Working mothers in Vietnam are also entitled to paid nursing breaks (up to 60 minutes) by law, for up to 12 months. In 2012, the National Assembly voted in favor of implementing a total ban on the promotion of BMS for children up to two years of age. This study aims to examine the potential impact of the new and updated policies and bottlenecks for successful implementation based on available documentation and perspectives of stakeholders

This study was a follow up to an on-going quasi-experimental trial, which was on-going in urban Dhaka in eight NGO health facilities to assess the impact of strengthening delivery of urban nutrition interventions. Using existing contacts of health providers, pregnant women, and mothers from the February 2020 baseline survey provided the opportunity to assess the impact of COVID-19 on services and food security.

This study was a follow up to a cluster-randomized trial (2017-2019), which assessed the impact of strengthening delivery of maternal nutrition interventions in Uttar Pradesh, India. The endline survey was completed in December 2019, just before the onset of COVID-19. The pre-existing contacts and the data from before the pandemic provided the opportunity for this follow-up study to assess the impacts of the COVID-19 on health and nutrition service delivery and utilization, as well as on food security.