Integrating MIYCN with Family Planning_Galloway_5.7.14


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Integrating MIYCN with Family Planning_Galloway_5.7.14

  1. 1. Integrating MIYCN-FP in Yemen: Results from Research Using Trials of Improved Practices Rae Galloway, Technical Lead for Nutrition, MCHIP CORE Group Meeting Presentation, May 7, 2014
  2. 2. Yemen: Population, Family Planning and Nutrition  24 million people  Low contraceptive prevalence  Highest rates of stunting in the world  Limited access to health and FP services by women who often stay in the home 2
  3. 3. Objectives for the Study  Determine current maternal, infant and young child nutrition (MIYCN) and family planning (FP) practices  Explore if mothers/couples are willing to try MIYCN-FP practices they are not using  Identify barriers to trying or continuing to use ideal practices  Develop messages to integrate into a MIYCN-FP counseling package for health facility and community workers 3
  4. 4. Some Reasons for Integrating MIYCN and FP  MIYCN status and birth spacing are linked— short birth spacing is associated with anemia and underweight in women and underweight and stunting in children  Addressing barriers to EBF ensures women meet LAM criteria  Linking transition to complementary foods and family methods at 6 mos promotes timely introduction of CF and continued BF and prevents another pregnancy 4
  5. 5. Some reasons for integrating MIYCN and FP  Increases number of services women (and husbands) obtain at each contact with health services  e.g., men going to FP services with their wives receive MIYCN information so they can support these practices at home  Increases use of optimal MIYCN or FP practices by linking MIYCN status with birth spacing & preventing a pregnancy with meeting the LAM criteria 5
  6. 6. What is Trials of Improved Practices?  TIPs was developed by the Manoff Group, based on market research methods, for use in IYCF, iron supplementation, bed nets and family planning programs  TIPs is qualitative research that allows exploration of using new behaviors & gives program managers feedback about the behaviors  TIPs uses small sample sizes to get in-depth information about the “why” of behaviors 6
  7. 7. TIPs Methodology  Basic Methodology: Three TIPs Visits  TIPs Visit#1-in-depth interviews about past and current practices; 24 hour recalls, food frequency and observations in the home  TIPs Visit#2-discuss the results of TIPs Visit#1, counsel on optimal practices, identification by the mother (or husband) of a new practice to try  TIPs Visit#3- visit 6 days later to see if the practice was tried, barriers/motivators to use in the future 7
  8. 8. TIPs Methodology in Yemen Location:  Dhamar Governorate (south of Sana’a)  Two districts ( Magreb and Wesab)  Two geographical zones (highland & lowland) 8 Driving to the highland village of Thelah, Magreb
  9. 9. TIPs Methodology in Yemen TIPs Participants: MIYCN interviews:  16 mothers with children<2 years (NS status of child) FP interviews:  16 mothers with children<2 years  16 husbands of FP mothers 9 Mother respondent and her children in Magreb
  10. 10. TIPs Methodology in Yemen  MIYCN and FP TIPs mothers were different mothers but MIYCN mothers were asked some FP questions  FP TIPs husbands were asked questions about MIYCN 10 Husband being interviewed by field staff
  11. 11. TIPs Methodology in Yemen  The study was approved by the JHU IRB and the Ministry of Health  Training took place over 5 days and included technical and human protection training and practice sessions in the field  Full consent was obtained from all participants  Full consent was obtained for the pictures taken of respondents used in this presentation 11
  12. 12. Selected Results: Review of Main Results MIYCN TIPs Visit#1  No infant<6 months was EBF; food was introduced after a few days or weeks  The reason food was introduced was mothers perceived their breast milk was “insufficient”  11/16 mothers felt they didn’t have sufficient breast milk  10 mothers said they thought this because the child cried after BF 12 Mother and child in Wesab
  13. 13. Selected Results: Review of Main Results MIYCN TIPs Visit#1  9/16 mothers reported early breastfeeding problems (cracked or sore nipples; engorgement) but self-treated (hot presses, ointment) or in one case sought treatment  From interviews and observations breastfeeding practices were not ideal— mothers didn’t know how to increase breast milk production, were feeding for short periods of time or from only one breast 13
  14. 14. Three WHO Indicators for a Minimum Adequate Diet 6-23 months  Breastfed; if not breastfed, child should receive 1-2 c. of milk/dairy per day  Consume at least 4 out of 7 designated food groups (grains/potatoes; legumes & nuts; dairy; meat/flesh/fish; eggs; F/V with vitamin A; other F/V)—if not BF, the child should consume 4 FG + 1-2 c. milk  Consume 2-3 meals/day (6-8 mos); 3-4 meals/day (9-23 mos); if not BF, 1-2 extra meals 14
  15. 15. Selected Results: MIYCN TIPs Visit#1—Three Practices 6-23 mos 15 Age groups (n=12) Breastfed or milk products Minimum number (4) of food groups/day Minimum number of meals/day Meeting all three practices 6-8 mos (4) 4 0 3 0 9-11 mos (4) 4 0 2 0 12-23 mos (4) 3 1 1 1 Total 11 1 6 1
  16. 16. Selected Results: MIYCN TIPs Visit#1—Three Practices 6-23 mos  All but one child continued to be breastfed; the frequency varied from 1-4 times per day  The non-BF child received milk but only 100 ml per day  Meeting the minimum number of meals (6) was easier than meeting the minimum food groups (only 1) but as the child got older meeting the mimimum number of meals declined 16
  17. 17. Selected Results: MIYCN TIPs Visit#1—Three Practices 6-23 mos  Only one child (22 mos) out of 12 was fed by all three practices  Many children were fed sugar cookies/biscuits starting as early as one month  One child (15 mos) was given only sugary biscuits (no other foods) and breast milk  Biscuits are perceived as an easy food to give to children of any age 17
  18. 18. Selected Results: Review of Main Results MIYCN TIPs Visit#1  More nutritious foods and snacks were not given to children for a variety of reasons— they were not appropriate for younger children. Milk/dairy & grains/potatoes were most appropriate as most children (10/12) received dairy products and grains/potatoes (8/12)  Only 2/12 children received foods from the meat/fish group 18
  19. 19. Selected Results: MIYCN TIPs Visit#1— Reasons for Practices 6-23 mos  3/12 received Fruits or vegetables; 3/12 received legumes (older children); no child received eggs  In some cases the availability of these foods limited what mothers could feed their children  Half of children (6/12) received cake or biscuits the day before with 5 living in Wesab  About half of mothers were consuming a more diverse diet than their children. 19
  20. 20. Selected Results: MIYCN TIPs Visit#1— Observations in the Home  Most mothers washed their hands before food prep and feeding their child but not with soap; about half washed their baby’s hand before feeding (but not with soap)  While mothers recognized the child not eating as a sign of poor health/growth, half of mothers were not using responsive feeding practices and most mothers reported that their child did not eat all the food served 20
  21. 21. Selected Results: Review of Main Results FP TIPs Visit#1  Family planning use varied by zone with one zone limited by the availability of methods in the public sector  Family planning methods were available in the private sector but at a cost which many families couldn’t afford  Most couples in Yemen decide on FP together; there were a few cases where men continue to decide if FP should be used. 21
  22. 22. Selected Results: Review of Main Results FP TIPs Visit#1  MIYCN-FP mothers didn’t know (7/30) or thought BF was the best way to or could prevent another pregnancy (15/30) and were motivated to continue BF to prevent another pregnancy  5 mothers alluded to BF criteria to prevent pregnancy (continuous, exclusive, before return of menses)  About half of all mothers knew someone who had become pregnant while BF 22
  23. 23. Selected Results: Review of Main Results MIYCN TIPs Visit#1  The majority said it was healthy to wait 2+ years before becoming pregnant  Half (8/16) of mothers were using a family planning method—most in one district  OC and injections were the most common methods used; one woman had a permanent method.  The reasons for not using FP were side effect;, cost; didn’t need it, couldn’t become pregnant 23
  24. 24. Selected Results: Review of Main Results MIYCN TIPs Visit#1  5/8 women who were not using FP said they would start using a method after their menses returns and one women said after two years  All but one mothers felt comfortable about talking with their husbands about using FP and said their husbands were supportive and also wanted to prevent another pregnancy 24
  25. 25. Selected MIYCN-TIPs Results Practice Offered & Accepted Tried Succeeded using daily Infants 0-5 mos: breastfeed only 3 3 3 Infants 6-23 mos: breastfeed from both breasts until empty 4 4 4 IYC 6-23: vary the child’s diet 10 10 9 Give more meals/food 3 3 3 Mothers: Vary mother’s diet 10 10 10 25
  26. 26. Family Planning TIPs Results Practice Sex Offered & Accepted Tried Succeeded Discuss FP intentions with spouse M 8 8 8 F 6 8 8 Go to health facility for info on FP M 13 13 9 F 11 11 7 Start using modern method M 8 7 1 F 8 8 1 Satisfied users discuss benefits with others in community M 0 1 1 F 4 4 4 26
  27. 27. Feedback from mothers  MIYCN: most mothers succeeded in trying one or several practices and reported being happy with the new practices because they felt their babies were getting better nutrition, sleeping better, healthier  MIYCN: some limitation in the types of food. Animal foods (meat) was not available all the time; one mother said she had too many children to eat more food herself. 27
  28. 28. Feedback from FP couples  Talking with each other about family planning was not a problem for most couples  Couples were willing to go for family planning advice; in some cases men wanted more information about side effects from modern methods.  There was high unmet need but services and methods were not always available 28
  29. 29. Strengths of the study  In-depth information about beliefs about health, nutrition and family planning  Information about past and current practices  Willingness of mothers and couples to consider and try new practices  Demonstrated couples willingness to talk with each about FP  Positive feedback from respondents about trying new practices 29
  30. 30. Limitations of the study  More information is needed about how to resolve barriers to optimal practices  Lack of commodities and food limit success for TIPs  For FP method uptake, a longer period of time might be needed between TIPs 2 and 3 30
  31. 31. Next steps:  Finish the key informant analysis  Develop MIYCN-FP messages and counseling package  Prepare the draft report  Present findings in Yemen (June) 31 Mother and her children in Wesab
  32. 32. Thank you to the fantastic study team! 32