What if an egg-a-day could address the big issues we face in complementary feeding? Research led by Professor Lora Iannotti in rural Ecuador has shown that introducing eggs as a daily complementary food to six- to nine-month-old children significantly improved their growth. In a space that has been dominated by micronutrient supplements and fortified foods, the egg is an exciting potential solution. The egg addresses many of the issues facing moms. An egg-a-day is simple, the egg is widely accessible, and most importantly, the egg provides key nutrients to combat stunting and underweight. But introducing eggs into children’s diets is not straightforward nor a simple fix. A follow-up study showed that the gains in growth from eating eggs were gone when the children were older, in part because they stopped eating eggs once the research ended. The “egg solution” raises plenty of questions about their use in any context: Do eggs address the most pressing needs facing mothers? Is eating eggs common here? Are eggs accessible to families? Could introducing eggs have unintended consequences on the feeding of the child or siblings, or anyone else? Human-centered design (HCD) can help answer these questions. HCD is an interdisciplinary problem-solving approach that prioritizes empathy for users – or customers – in every aspect of the work. HCD is driven as much by creative mindsets and teams with diverse life experience as it is by process and tools.
Human-centered design and complementary feeding
The design community has tackled a wide range of global health challenges; childhood pneumonia screening, health care access in rural communities, and domestic violence prevention, to name a few. But none of us has meaningfully applied HCD to the challenges of complementary feeding. The global nutrition community needs to change this. Drawing on a diverse set of tools from a variety of disciplines, including qualitative methods that have been used by the nutrition community, HCD translates a deep understanding of the realities of feeding children into opportunities for innovation, generating tens or hundreds of ideas. Prototyping and testing those ideas in rapid, inexpensive ways to influence behaviors is part of the process of engaging customers, the people who we design for – and those customers are often partners throughout the design process. Food is social. Many people influence complementary feeding, including the children, their mothers and fathers, mothers-in-law, siblings, and shopkeepers. In HCD, we involve them as we explore the best solutions to improve child feeding.
Using HCD to scale an egg-a-day in complementary feeding
How can HCD help us as we try to scale , globally and within countries, an egg-a-day in complementary feeding? Here are four ways:
Start with empathy. In design we emphasize understanding the perspective of the customer. Building on what is already known about nutrition where you are, you might decide to hang out with different mothers who have young children as they go about their daily lives. You might explore what foods people are buying for young ones in different markets. You might interview religious leaders who officiate first feeding ceremonies.
The hope is that you will use empathy to uncover a new insight, a behavior or need that previously went unnoticed, or that you will completely reframe the key challenges mothers are facing feeding their children and where the egg might fit in.
Learn from small experiments. With the evidence that has been generated, it is tempting to scale up poultry operations in places with low egg production. That is what the Uttar Pradesh government did in 2018: the Department of Animal Husbandry distributed 7.5 million chicks to 150,000 women from scheduled castes, along with a cage and a one-time incentive of 425 Indian rupees (about US$6).
Before arriving at a program or a policy initiative like this, rapid, small-scale experimentation is critical. Unlike pilot projects that take months or years, design experimentation is measured in hours and days because the intention is different: small experiments are tools for learning, not for validation or as a path to implementation. Because the experiments are fast, there is an opportunity to learn and feed that learning back into the design of a concept, and to repeat the cycle again. You can even test out multiple competing concepts in parallel. In the Uttar Pradesh program, the per-beneficiary budget was INR4000, meaning that – not including management costs – this was a US$8 million investment. But many of the chicks did not live past infancy. An HCD approach would first use small experiments to test the viability of such a scheme – and not just whether it could be viable, but how to make it more viable. The use of small experiments to learn increases the likelihood of success by mitigating risk.
Proceed with humility. Despite their promise, eggs are not likely to be a solution in every place. Nutrition practitioners need to balance honoring the food traditions of different peoples with following the evidence that shows us what is good for young children.
One recent example comes from Madhya Pradesh, where an opposition politician strongly criticized the inclusion of eggs in anganwadi menus, saying that eating eggs and meat could turn children into cannibals later in life. This perspective may be an outlier, but it’s a reminder that there are influences beyond access.
It’s critical to remember that the ultimate goal is to improve young child nutrition – not to push eggs on people where it doesn’t fit with their food culture. Listening to the evidence from small experiments can help us avoid that mistake. The evidence may show us that eggs are the way, and if it does, it can also show us how to maximize the chances of success. But it may also show us that another path is more sensible in a given context: another food, an existing feeding innovation, something developed by a mother, or an entirely new idea. Proceeding with humility means being open to both evidence and alternatives, which allows us to be appropriately focused on outcomes.
Look to systems for scale. As much as culture matters to drive adoption of any solution, access is just as critical. Combining design with systems thinking yields an approach that accounts for price, production, and availability, as well as trends that will shape food and health culture. In Thailand, Morris and colleagues have modeled different approaches to increasing availability and thus uptake of egg consumption in rural areas. Their systems-level modeling of “egg hubs,” aggregating multiple medium-scale egg producers, may be the most effective way to quickly and effectively scale production in rural areas. The challenges for implementing such a model will vary by region. According to the FAO, Africa represented only 4% of global hen egg production in 2018, and 46% of that was concentrated in North Africa. In sub-Saharan Africa, Nigeria and South Africa account for more than half of the region's egg production. An integration of design and systems thinking can determine the feasibility of different models, like egg hubs, in different contexts and help guide successful rollout.
How can design add to what we already know and are doing?
The question is not, “How can design disrupt complementary feeding?” but rather “How can design add to what we are already doing?” Design practitioners often express confidence that their “fresh eyes” and new perspectives will transform public health. Many of us now recognize the value in integrating design with other approaches in global health. We should avoid reinventing what has already been created over decades by nutrition practitioners and we should make sure we are building on nutrition scientific research. The humble egg is not the solution to global nutrition challenges – nutrition is too complicated to have just one solution. But by using an HCD approach, we can support mothers, respecting the way that their families and communities have traditionally done things, while innovating. If we can do that, we can use eggs as part of the solution in different contexts to improve the nutrition of millions of children.
How have you used design in nutrition, or how could it add to what you are already doing? We'd love to know! Respond in the comments below or send us your ideas on Twitter or Facebook with the hashtag #Inspire4SBC