This document summarizes the Buniyaad project in Bihar, India that aimed to reduce infant mortality through optimal infant and young child feeding practices. The 3-year project involved over 426,000 mothers in 3 districts. Through various behavior change communication strategies targeting households, community workers, and policymakers, the project achieved significant increases in early initiation of breastfeeding, exclusive breastfeeding rates, and age-appropriate complementary feeding practices. Key lessons included the need for dedicated nutrition counselors and adapting messaging over time to address ongoing challenges.
Challenges in Breastfeeding and Breastmilk Feeding in NICUs in IndiaLeith Greenslade
Little is known about rates of breastfeeding and breastmilk feeding in NICUs in low and middle income settings. Access Health International has joined forces with three tertiary referral hospitals in the states of Maharashtra, Andhra Pradesh and Karnataka in India to document newborn nutrition in their NICUs. The results are important and make a strong case for more investment in this neglected area of child nutrition.
Insights from formative research from Bihar and Uttar Pradesh on maternal die...POSHAN
This presentation was made by Dr. Sebanti Ghosh (Alive & Thrive) in the session on 'Implementation research on delivery of interventions during pre-pregnancy through lactation' at the POSHAN Conference "Delivering for Nutrition in India Learnings from Implementation Research", November 9–10, 2016.
For more information about the conference visit our website: www.poshan.ifpri.info
Innovations in Breastfeeding and Breastmilk Feeding in the NICULeith Greenslade
Can "Lactation Scorecards" drive up low rates of breastmilk feeding in NICUs? Low rates of breastfeeding and breastmilk feeding among sick and vulnerable newborns contribute to low survival rates and poor development outcomes. Medela has developed a new tool that enables NICUs to set new targets and measure their performance - The NICU Lactation Care Scorecard.
Impact of nutrition interventions on infant feeding and other outcomes in Utt...POSHAN
This presentation was made by Laili Irani (Population Council) in the session on 'Implementation research on delivery of interventions during pre-pregnancy through lactation' at the POSHAN Conference "Delivering for Nutrition in India Learnings from Implementation Research", November 9–10, 2016, New Delhi.
For more information about the conference visit our website: www.poshan.ifpri.info
Improving women's diet quality preconceptionally and during gestation: Effect...POSHAN
This presentation was made by Dr. Sirazul Ameen Sahariah (Centre for the Study of Social Change) in the session on 'Implementation research on delivery of interventions during pre-pregnancy through lactation' at the POSHAN Conference "Delivering for Nutrition in India Learnings from Implementation Research", November 9–10, 2016, New Delhi.
For more information about the conference visit our website: www.poshan.ifpri.info
Improving mid-day meal delivery and encouraging micronutrient fortification t...POSHAN
This presentation was made by Ms. Urmi Bhattacharya (J-PAL) in the session on ‘Food supplementation programs for nutrition in the Indian context: Current status and future directions’ at the POSHAN Conference "Delivering for Nutrition in India Learnings from Implementation Research", November 9–10, 2016, New Delhi.
For more information about the conference visit our website: www.poshan.ifpri.info
Challenges in Breastfeeding and Breastmilk Feeding in NICUs in IndiaLeith Greenslade
Little is known about rates of breastfeeding and breastmilk feeding in NICUs in low and middle income settings. Access Health International has joined forces with three tertiary referral hospitals in the states of Maharashtra, Andhra Pradesh and Karnataka in India to document newborn nutrition in their NICUs. The results are important and make a strong case for more investment in this neglected area of child nutrition.
Insights from formative research from Bihar and Uttar Pradesh on maternal die...POSHAN
This presentation was made by Dr. Sebanti Ghosh (Alive & Thrive) in the session on 'Implementation research on delivery of interventions during pre-pregnancy through lactation' at the POSHAN Conference "Delivering for Nutrition in India Learnings from Implementation Research", November 9–10, 2016.
For more information about the conference visit our website: www.poshan.ifpri.info
Innovations in Breastfeeding and Breastmilk Feeding in the NICULeith Greenslade
Can "Lactation Scorecards" drive up low rates of breastmilk feeding in NICUs? Low rates of breastfeeding and breastmilk feeding among sick and vulnerable newborns contribute to low survival rates and poor development outcomes. Medela has developed a new tool that enables NICUs to set new targets and measure their performance - The NICU Lactation Care Scorecard.
Impact of nutrition interventions on infant feeding and other outcomes in Utt...POSHAN
This presentation was made by Laili Irani (Population Council) in the session on 'Implementation research on delivery of interventions during pre-pregnancy through lactation' at the POSHAN Conference "Delivering for Nutrition in India Learnings from Implementation Research", November 9–10, 2016, New Delhi.
For more information about the conference visit our website: www.poshan.ifpri.info
Improving women's diet quality preconceptionally and during gestation: Effect...POSHAN
This presentation was made by Dr. Sirazul Ameen Sahariah (Centre for the Study of Social Change) in the session on 'Implementation research on delivery of interventions during pre-pregnancy through lactation' at the POSHAN Conference "Delivering for Nutrition in India Learnings from Implementation Research", November 9–10, 2016, New Delhi.
For more information about the conference visit our website: www.poshan.ifpri.info
Improving mid-day meal delivery and encouraging micronutrient fortification t...POSHAN
This presentation was made by Ms. Urmi Bhattacharya (J-PAL) in the session on ‘Food supplementation programs for nutrition in the Indian context: Current status and future directions’ at the POSHAN Conference "Delivering for Nutrition in India Learnings from Implementation Research", November 9–10, 2016, New Delhi.
For more information about the conference visit our website: www.poshan.ifpri.info
Effect of Peer Counselling by Mother Support Groups on Infant and Young Child...POSHAN
This presentation was made by Arun Gupta (Breastfeeding Promotion Network of India) in the session on 'Implementation research on delivery of interventions during pre-pregnancy through lactation' at the POSHAN Conference "Delivering for Nutrition in India Learnings from Implementation Research", November 9–10, 2016.
For more information about the conference visit our website: www.poshan.ifpri.info
Intergenerational benefits of India’s national school feeding programPOSHAN
Suman Chakrabarti, Samuel P. Scott, Harold Alderman, Purnima Menon, Daniel O. Gilligan
Poverty Health and Nutrition Division, International Food Policy Research Institute
A tool to assess gaps in district-level coverage of nutrition interventions i...POSHAN
This presentation was made by Dr. Sumathi Swaminathan and Mr. Jithin Sam Varghese (St. John’s Research Institute) in the session on 'Assessing coverage and performance of nutrition interventions: Research experiences from across India' at POSHAN's "Delivering for Nutrition in India - Learnings from Implementation Research" conference, November 9–10, 2016 , New Delhi.
0. day 1 final presentation 6.8.18 niti aayogPOSHAN
Presentation made at a two-day workshop "Stepping up to India’s Nutrition Challenge: The Critical Role of Policy Makers" for district administrators from India’s Aspirational Districts, on 6-7 Aug 2018, at Mussoorie.
Antenatal care and counseling measures increase iron and folic acid receipt a...POSHAN
This presentation was made by Amanda Wendt (University of Heidelberg) in the session on 'Implementation research on delivery of interventions during pre-pregnancy through lactation' at the POSHAN Conference "Delivering for Nutrition in India Learnings from Implementation Research", November 9–10, 2016.
For more information about the conference visit our website: www.poshan.ifpri.info
Monitoring and Evaluation Framework for MAA: Mothers’ Absolute AffectionNandlal Mishra
Mothers’ Absolute Affection (MAA): A Nationwide programme of the Ministry of Health and Family Welfare, Government of India initiated in August 2016 aims to revitalize efforts towards promotion, protection and support of breastfeeding practices through health systems to achieve higher breastfeeding rate.
Karin Lapping
IFPRI and Alive & Thrive Policy Seminar
Taking It to Scale: Insights from IFPRI’s Research on Improving Nutrition Behaviors in Multiple Contexts
June 28, 2017 - 12:15 PM TO 01:45 PM EDT
System Strengthening for BFHI by the Diet Clinic, UgandaTwahR
Improve Maternal, Newborn and Child Health requires strengthening the health systems in most countries. This is being done in Uganda using BFHI and linking it to EMNoC, PMTCT and IMCI in Kitgum district.
Rupal Dalal - Spoken tutorials on maternal and child nutritionPOSHAN
Presentation by Rupal Dalal on "Spoken tutorials on maternal and child nutrition" at Developing a nutrition training roadmap to support India’s nutrition progress (17-18 Dec 2019)
Effect of Peer Counselling by Mother Support Groups on Infant and Young Child...POSHAN
This presentation was made by Arun Gupta (Breastfeeding Promotion Network of India) in the session on 'Implementation research on delivery of interventions during pre-pregnancy through lactation' at the POSHAN Conference "Delivering for Nutrition in India Learnings from Implementation Research", November 9–10, 2016.
For more information about the conference visit our website: www.poshan.ifpri.info
Intergenerational benefits of India’s national school feeding programPOSHAN
Suman Chakrabarti, Samuel P. Scott, Harold Alderman, Purnima Menon, Daniel O. Gilligan
Poverty Health and Nutrition Division, International Food Policy Research Institute
A tool to assess gaps in district-level coverage of nutrition interventions i...POSHAN
This presentation was made by Dr. Sumathi Swaminathan and Mr. Jithin Sam Varghese (St. John’s Research Institute) in the session on 'Assessing coverage and performance of nutrition interventions: Research experiences from across India' at POSHAN's "Delivering for Nutrition in India - Learnings from Implementation Research" conference, November 9–10, 2016 , New Delhi.
0. day 1 final presentation 6.8.18 niti aayogPOSHAN
Presentation made at a two-day workshop "Stepping up to India’s Nutrition Challenge: The Critical Role of Policy Makers" for district administrators from India’s Aspirational Districts, on 6-7 Aug 2018, at Mussoorie.
Antenatal care and counseling measures increase iron and folic acid receipt a...POSHAN
This presentation was made by Amanda Wendt (University of Heidelberg) in the session on 'Implementation research on delivery of interventions during pre-pregnancy through lactation' at the POSHAN Conference "Delivering for Nutrition in India Learnings from Implementation Research", November 9–10, 2016.
For more information about the conference visit our website: www.poshan.ifpri.info
Monitoring and Evaluation Framework for MAA: Mothers’ Absolute AffectionNandlal Mishra
Mothers’ Absolute Affection (MAA): A Nationwide programme of the Ministry of Health and Family Welfare, Government of India initiated in August 2016 aims to revitalize efforts towards promotion, protection and support of breastfeeding practices through health systems to achieve higher breastfeeding rate.
Karin Lapping
IFPRI and Alive & Thrive Policy Seminar
Taking It to Scale: Insights from IFPRI’s Research on Improving Nutrition Behaviors in Multiple Contexts
June 28, 2017 - 12:15 PM TO 01:45 PM EDT
System Strengthening for BFHI by the Diet Clinic, UgandaTwahR
Improve Maternal, Newborn and Child Health requires strengthening the health systems in most countries. This is being done in Uganda using BFHI and linking it to EMNoC, PMTCT and IMCI in Kitgum district.
Rupal Dalal - Spoken tutorials on maternal and child nutritionPOSHAN
Presentation by Rupal Dalal on "Spoken tutorials on maternal and child nutrition" at Developing a nutrition training roadmap to support India’s nutrition progress (17-18 Dec 2019)
Sick and vulnerable newborns often need special support to access breastmilk. Laerdal Global Health is responding to this need with a portfolio of new initiatives.
Integrating nutrition into health systems: opportunities and challengesTransform Nutrition
This presentation by Shams El Arifeen, iccdr,b was shown at the Transform Nutrition - Evidence for Action regional meeting in Kathmandu, Nepal on 8 July 2017. This one-day event shared Transform Nutrition evidence on key issues related to nutrition policy in Nepal, Bangladesh and India, lessons on strategies for change from other contexts and discuss the relevance and applicability of the research findings to policies/programmes that aim to address nutrition in South Asia.
Infant and young child feeding ppt describe the nutritional needs of infant and child. Exclusive breastfeeding for six months and complementary feeding for the child. avoid formula feeding for the child and continue breastfeeding for 24 months.
Proposal Development on Organizing Health Promotion Education Communication T...Mohammad Aslam Shaiekh
Proposal Development on Organizing Health Promotion Education Communication Training Program on Maternal Infant and Young Child Nutrition Practices in Pumdi, Pokhara Municipality 22.
Buniyaad is a three year project (April 2012 to March 2015). The project aims at reaching out to 400,000 women with BCC messages on the three tenets of IYCF (immediate and exclusive breastfeeding and complementary feeding) in its lifetime. These messages are rolled out dedicated grassroot workers-Peer Educators (PEs) and Cluster Coordinators (CCs). Their main job is to counsel mothers and caregivers about recommended IYCF practices and help them overcome the barriers to the same.The BCC efforts under the project are expected to bring about an improvement in the knowledge levels (output) of the primary beneficiaries (pregnant women and mothers of children under two) as well as the secondary target population (health and nutrition functionaries) before resulting in a change in practice (outcome).
The main purpose of this midterm evaluation was to review the progress attained in the project to-date in relation to expected outcomes, highlight what works well which can be scaled up, and what necessary changes (both in strategy as well as action plans) can be made to achieve the desired project objectives. Specifically, the main objectives of the midterm evaluation are:
• To assess progress to-date in terms of achieving key milestones, outputs and early outcomes
• Identify lessons learned, areas to strengthen, modify and refocus to enhance the project’s implementation and sustainability
The project internally generates lot of data which quantifies the progress achieved under key components of the project. However, it was felt that it is important to capture the qualitative response of project beneficiaries and project staff with respect to the project interventions, as well as strengths and weaknesses of specific processes and activities that are affecting, and may further affect the outcomes under the project. Getting a subjective overview of the project will help in assessing the current strategy and help in identifying the need for any further change or modifications.With this view, this mid-term evaluation study has adopted a mixed method approach consisting of both qualitative and quantitative methods of data collection and analysis, aiming at addressing the research questions.
The Aga Khan Foundation (AKF) has initiated a project in three districts of Bihar, India, which aims to improve the uptake of optimal Infant and Young Child Feeding (IYCF) practices by the mothers and care-givers of children under-two years of age. The project is supported by the Department of International Development (DFID), and AKF is working in collaboration with three other implementing partners. The project will use multiple behaviour change
communication (BCC) tools and techniques which are expected to improve the knowledge of pregnant women and breastfeeding mothers regarding IYCF. This change, along with individualised support to mothers by project functionaries will ultimately result in improved
IYCF practices by the mothers and care-givers.
2. Introduction
• Duration: April 2012- March
2015
• 426,587 mothers of children
under two years of age among
the poorest and most
marginalized populations
• Intervention area and
implementing partners
– Muzaffarpur – AKRSP,I and
AKF,I
– Samastipur – AKRSP,I and
Agragami, India
– Sitamarhi – CHARM
4. Project Rationale
• Bihar has poor child
survival indicators: IMR- 52,
NMR- 34, U5MR- 73 [AHS
2011-12]
• Optimal IYCF practices
directly impacts child
survival
• AKF implemented a 3 year
project - Buniyaad - in 3
districts of Bihar
• The effort was aimed at
demonstrating a workable
model for adoption of
optimal IYCF practices
5. Goal and Outcomes
Goal:
Reduction of neonatal and infant
mortality through optimal IYCF
practices among mothers of
children under two years, through
effective BCC strategies.
Outcomes:
• Improved rate of early initiation
of breastfeeding within an hour
of birth.
• Improved rate of exclusive
breastfeeding of infants for the
first 6 months of age.
• Improved rate of age
appropriate complementary
feeding given to the child
beyond six months of age, with
continuation of breastfeeding.
6. Insights from Formative Research
Early Initiation
• Knowledge is there in community. Practice varies for institutional & home delivery.
• Institutional delivery: Within a few (2-3) hours of birth since advised by doctor;
delay because of cleaning baby and giving mother some time to rest.
• Home delivery: Few hours to even 2 days; delay because wait for religious reasons.
• As BF delayed, pre-lactal feeds given to assuage child’s hunger. Sugar water, honey,
cow’s milk most popular.
Exclusive Breastfeeding
• Do not understand “exclusive” BF, often include water to quench thirst.
• Apart from water, some initiate top foods / fluids before six months because
perceive there is “not enough milk”.
• Believe “not enough milk” when:
- Blouse not wet with milk / no fullness
- Child cries a lot even after feeding
Complementary feeding
• Biscuits serve as test food for readiness to eat.
• No transition from semi-solids to solids, no modification of food for child.
• No pro-active feeding (quantity, frequency) – base feeding on child’s demand and
hunger.
7. The BCC Strategy
Level 1:Household Level
Mothers in 3rd trimester and with
children upto 2 years of age
Level 2: Community-based service
providers
ASHA, AWW
Level 3: Facility-based service
providers
ANMs, Mamtas
Level 4: Policy influencers
GoB, Development Partners, other
Professional bodies
9. Involvement in
home visits &
group meetings
Joint
celebration of
key events
Participation in
monthly review
meetings
Exchanging regularly
updates (18 district
level meetings and
240 Block Level
Meetings)
Orientation/ Trainings
(AWW–2814, ASHA–3527,
ANM– 674 and MAMTA -
243)
Level 2 & 3: Community and Facility level service
providers
10. Level 4: Policy Influencers
• AKF part of key Government initiatives as part
of committees, sub-committees, etc.
• Mass media initiatives (wall writings, radio
spots) in consultation with Government
Govt. of Bihar
• Resources for trainings and updates on IYCF
• Opportunities for exposure to their initiatives
Professional
bodies
• Resources for trainings and updates on IYCF
• Opportunities for exposure to their initiatives
• Joint partnership in influencing Government
on key IYCF issues
Development
Partners
12. Key Indicators
Indicators
Project
baseline
(Sept-Oct
2012)
Achievements
Year 1
March 2013
Year 2
Jan-Mar
2014
Year 3
Jan-Mar
2015
Early Initiation of Breast feeding
(Proportion of mothers with newborns less than 7
days old who report having breastfed their
newborns within one hour of birth)
17.4 23.1 44.6 65.24
Exclusive breast feeding
(Proportion of mothers with a child 6-7 months of
age who have exclusively breastfed their child for at
least six months)
15.2 20 33.9 49.63
Complementary feeding
(Proportion of mothers with a child 6-7 months of
age who have introduced complementary feeding
for their child)
73.4 74.9 79.8 87.19
Age appropriate Complementary feeding
(Proportion of mothers with a child aged 12-13
months who are giving age appropriate
complementary feeding for their child)
19.8 22.1 29.9 44.08
15. Learnings and Challenges
• Need for dedicated nutrition counselor in community
to provide information & training.
• Great utility of communication kits.
• Government frontline workers not able to
adequately explain concepts. Knowledge is not
enough – need to be trained on how to communicate
and explain so can bring about belief and behaviour
change.
• Continued use of water to feed babies.
• Need to adapt BCC tools and messaging as you
implement so that progressively can address
challenges.