A summary of Alive & Thrive's published research in 2021

Feb 03 2022


In 2021, Alive & Thrive supported MIYCN research in Bangladesh, Ethiopia, India, Burkina Faso, West Africa and Southeast Asia, which led to articles in major peer-reviewed journals.

Our annual research summary organizes the articles according to the following topics: COVID-19; the International Code of Marketing of Breastmilk Substitutes; human milk banking; maternity protections; maternal resources for care; breastfeeding and IYCF; and maternal nutrition.

Research Resources Launched in 2021

  • Explore over a decade of Alive & Thrive research in our interactive evidence map! Over a decade of peer-reviewed research is organized by topic and theme.
  • Alive & Thrive's Implementation Research seeks to answer "how" to implement the most effective policies and interventions.

Alive & Thrive is committed to the principles of Open Data.

Maternal Nutrition

Strengthening nutrition interventions in antenatal care services had modest impacts on dietary intake, micronutrient intake, gestational weight gain, and breastfeeding in Uttar Pradesh, India: Results of a cluster-randomized program evaluation

Intensifying interpersonal counseling and community mobilization through government ANC services improved maternal nutrition practices. Women who received nutrition-intensified ANC compared to standard ANC received more home visits and counseling and saw improvements in consumption of IFA and calcium as well as exclusive breastfeeding; however, dietary diversity, supplement consumption, and breastfeeding practices remained suboptimal. 

Understanding implementation and improving nutrition interventions: Barriers and facilitators of using data strategically to inform the implementation of maternal nutrition in Uttar Pradesh, India

Despite intensive data-collection efforts, half of supervisors interviewed for this study reported using data to identify areas for improvement while only 23% reported using data to inform decision-making, which is critical to plan interventions and provide targeted support to frontline workers. 

Maternal diets in India: Gaps, barriers, and opportunities

Pregnant women’s diets suffer from low energy, macronutrient imbalance, and poor micronutrient intake, while market and cultural factors - including food unavailability, gender norms, and lack of income - constrain healthy diets. The authors explore potential interventions and their bottlenecks and efficacy, and recommend investing in health, nutrition, and agricultural systems to promote healthier diets for mothers. 

Beliefs and norms associated with the use of ultra-processed commercial milk formulas for pregnant women in Vietnam

This analysis examines the associations between the use of commercial milk formula for pregnant women (CMF-PW) and the belief that CMF-PW will make children smarter and healthier, as well as the perceived social norm that CMF-PW use is common among pregnant women. 

Gaps in the implementation and uptake of maternal nutrition interventions in antenatal care services in Bangladesh, Burkina Faso, Ethiopia and India

Maternal nutrition intervention coverage was consistently lower than ANC coverage in Bangladesh, Burkina Faso, Ethiopia, and India, despite ANC being the largest global platform to deliver maternal nutrition interventions, this study showed. 

The International Code of Marketing of Breastmilk Substitutes

Advice to use infant formula and free samples are common in both urban and rural areas in China: A cross-sectional survey

Breastmilk substitute (BMS) companies are targeting mothers using aggressive and unethical marketing strategies that violate the Code in both urban and rural areas in China, this study revealed. 

Old tricks, new opportunities: How companies violate the International Code of Marketing of Breastmilk Substitutes and undermine maternal and child health during the COVID-19 pandemic

An analysis reveals that BMS companies are using health claims, misinformation about breastfeeding, digital marketing, and promotional tactics, such as donations and services, to capitalize on families’ COVID-19 fears to sell their products - and consequently undermining breastfeeding. 

Mothers' and health workers' exposure to breastmilk substitutes promotions in Abidjan, Côte d'Ivoire

This study applied the WHO NetCode protocol to reveal that BMS companies in Cote d’Ivoire routinely promote their products directly to health workers, 92% of whom are unfamiliar with the Code. 

Implementation of the Code of Marketing of Breast-Milk Substitutes in Vietnam: Marketing practices by the industry and perceptions of caregivers and health workers

Although Viet Nam has a strong regulatory environment for the protection, promotion, and support of breastfeeding, this study reveals the existence of gaps in implementation, monitoring, and enforcement. 

Breastfeeding, first-food systems and corporate power: A case study on the market and political practices of the transnational baby food industry and public health resistance in the Philippines

The efforts of breastfeeding coalitions, advocates, and mothers has led to a resurgence in breastfeeding in the Philippines, but the BMS industry’s marketing and political strategies require continued vigilance to strengthen breastfeeding protections, this case study shows. 

Evidence of violations of the International Code of Marketing of Breastmilk Substitutes since the adoption by the World Health Assembly in 1981: A systematic scoping review protocol

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. 

To mark the 40th anniversary of the Code in 2021, Alive & Thrive launched a special page on our website. Visit the page.


Impact of COVID-19 on household food insecurity and interlinkages with child feeding practices and coping strategies in Uttar Pradesh, India: A longitudinal community-based study

Rates of household food insecurity (HFI) sharply increased during the COVID-19 pandemic, affecting children’s dietary diversity and feeding practices as well as families’ coping strategies. The findings demonstrate a need to invest in social protection strategies relating to HFI during and after the pandemic. 

India's 2.42 million frontline health workers enable restoration of health and nutrition service delivery after early COVID-19 lockdowns

Given policy guidance and allowed to adapt practices, frontline health workers in India likely were able to quickly restore services disrupted by the pandemic, this study suggests. 

COVID-19 disrupted provision and utilization of health and nutrition services in Uttar Pradesh, India: Insights from service providers, household phone surveys, and administrative data

COVID-19 significantly reduced health services in Uttar Pradesh, India, this study suggests. Strengthening logistical support, capacity enhancement, performance management, and demand creation are needed to improve service provision and utilization during and post-COVID-19.

Provision and utilisation of health and nutrition services during COVID-19 pandemic in urban Bangladesh

Despite adaptations to service provision during the COVID-19 pandemic, this paper revealed that continued availability of routine maternal and child health services in Bangladesh did not translate into service utilization. Further investments are needed to provide timely and accurate information on COVID-19 to the public, improve COVID-19 training, provide incentives for health care providers, and ensure availability of personal protective equipment for providers and beneficiaries. 

Human Milk Banking

Human milk banks in the response to COVID-19: A statement of the regional human milk bank network for Southeast Asia and beyond

This statement from the Regional Human Milk Bank Network for Southeast Asia and Beyond examines the insufficient guidance on the use of donor human milk and the role of human milk banks in in clinical management guidelines for COVID-19 response. 

Trends and dynamics in the first four years of operation of the first human milk bank in Vietnam

This examination of Viet Nam’s first human milk banks analyzes characteristics of the donors, donation, pasteurization, and recipients, demonstrating efficiency and operational improvements in donor recruitment, milk quality, and patients served. 

Factors associated with the use of pasteurized donor milk for healthy newborns: Experience from the first Human Milk Bank in Vietnam

This examination of Viet Nam’s first human milk bank examines factors associated with the prescription and prolonged use (>48 h) of privately purchased pasteurized donor milk (PDM) to healthy newborns. The prescription and prolonged use of privately purchased PDM was associated with non-medical factors unrelated to the ability to breastfeed effectively. The findings suggest the need for improved breastfeeding communication, counseling and support skills for health staff, development, and application of strict criteria on PDM use for healthy newborns and better routine monitoring of PDM use over time.

Maternity Protection

The yearly financing need of providing paid maternity leave in the informal sector in Indonesia

This study examined the yearly financing need to provide maternity cash transfers for women of reproductive age in the informal sector in Indonesia. Results show the financing need would not exceed 0.5% of Indonesian GDP and simultaneously provide significant public health savings by promoting breastfeeding.

The financing need of equitable provision of paid maternal leave in the informal sector in Indonesia: a comparison of estimation methods

A comparison of financing needs for two methods of maternity leave provision in Indonesia revealed a need for greater investigation into the strengths and weaknesses of both methods. 

Implementation of two policies to extend maternity leave and further restrict marketing of breast milk substitutes in Vietnam: A qualitative study

This study demonstrated that implementing two breastfeeding promotion policies in Viet Nam – an extended maternity leave policy and a policy further restricting BMS marketing – resulted in positive outcomes, facilitated by several factors including policy precedence, a broad set of policies to promote the rights of women and children, and involvement from national- and international-level stakeholders. 

Breastfeeding & IYCF


Community support model on breastfeeding and complementary feeding practices in remote areas in Vietnam: Implementation, cost, and effectiveness

After Alive & Thrive initiated IYCF community support groups in remote villages across nine provinces in Viet Nam, an evaluation showed that the group model was effective in reaching remote populations and likely contributed to improved IYCF practices, including higher odds of early initiation of breastfeeding, exclusive breastfeeding, no bottle feeding, and minimum acceptable diet. 

The association between a novel Baby-Friendly Hospital program and equitable support for breastfeeding in Vietnam

This study examined the efficacy of Alive & Thrive’s novel Center of Excellence for Breastfeeding approach, and finds that health facilities’ enrollment in the model was associated with increases in levels of both exclusive breastfeeding and early initiation of breastfeeding. 

What is the impact of removing performance-based financial incentives on community health worker motivation? A qualitative study from an infant and young child feeding program in Bangladesh

This study revealed that removing performance-based financial incentives from community health worker programs can negatively affect workers’ motivation, suggesting that program decision makers should consider the sustainability of such incentives. 



Maternal Resources for Care

resources for care

Factor structure and equivalence of maternal resources for care in Bangladesh, Vietnam, and Ethiopia

Maternal resources for care in Bangladesh, Viet Nam, and Ethiopia are structurally similar and measurement equivalent, this study showed. 

Maternal resources for care are associated with child growth and early childhood development in Bangladesh and Vietnam

Resources for care, represented by maternal height, well-nourishment, mental well-being, decision-making, support in chores, and perceived social support, were analyzed against Alive & Thrive baseline data from household surveys in Bangladesh and Viet Nam and found to be associated with child outcomes. This study’s implications suggest that interventions to improve maternal resources could foster child growth and development.  

Thank you for being a part of Alive & Thrive's mission to improve maternal, child, and infant nutrition in 2021! Here's to more adaptation and innovation in 2022.

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