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

1. Alive & Thrive
BREASTFEEDINGMaternal Nutrition Practices(Diet
Diversity) in Bihar & UP
Formative Research Top Line FindingsAlive & Thrive

2. Alive & Thrive
Objectives of Formative Research
To identify:
• Current MIYCN & S/H practices
• Determinants including barriers and facilitators
• Willingness to change
• Who are the influential ?
• High reach platforms: programs, media
• How mothers can be supported in focused way
thru existing platforms for
 Larger and faster impact
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3. Alive & Thrive
PHASE 1: Determinants
• Quantitative
• Qualitative
Aim: To design
interventions
PHASE 2: Household trials
• Qualitative
Aim: To test interventions
Methods:
In-depth interviews
Small Group discussions Observations
Rapid Household trials

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Six districts
Rural: Gaya, Bhojpur, Saharsa,
Purnea & Gopalganj
Urban: Patna
Bihar - Geographical Scope

5. Alive & Thrive
UP- Geographic scope
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Lucknow
Three High Priority Districts
Rural: Allahabad,
Shahjahanpur, Siddharthnagar
Urban: All districts

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Priority Behaviour Studied for
Maternal Nutrition
• IFA & Ca
supplement
• Dietary diversity
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7. Findings: Maternal
Diet Diversity

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Current dietary diversity :Practices
& perceptions
• 9% Pregnant women & 14% lactating women who consumed at
least 5 specified food groups
• Diet Predominantly starchy staples followed by vegetables, pulses
and dark green leafy vegetables(GLV)
Knowledge/Perception sof Family members
• PW should eat GLVs, milk, fruit, dal, roti ,meat fish, egg and nuts
• PW should avoid cold food, stale food, fried spicy food, unripe
papaya, fish, meat & egg
• Perceived Benefits- mother-child healthy, active, avoid
complications during pregnancy and at the time of delivery
• Perceived Risks- stomach upset & adverse effect on child, fear of
miscarriage
• FLWs claimed to know about diet diversity: Starch, GLV, pulses -
important component of daily meal, very few mentioned flesh foods
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Results of
rapid household trials
Most complied to increasing quantity and frequency of food & adding GLV– awareness leading to practice
Possible for majority to increase frequency and quantity & add nutritious foods such as GLV & fruits in their diet
 Most could not comply to the recommendation of adequate rest due to busy schedule
41
56
34
54
30 31
2
73 79
70 69
49
58
6
0
20
40
60
80
100
Increase
quantity
Increase
frequency
Add GLV Add Fruit Add Dairy Add Flesh
foods
Take rest
RESPONSIVENESS TO DIETARY RECOMMENDATIONS
PRE POST
Numberof
Households
Formative research conducted by CMS, 2015-2016

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Barriers/ Challenges
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–Loss of appetite
–Unaware of unique benefits and specific
nutrients in each food category
–Absence of male members hindered procuring
special items (eggs/fruits/ GLVs)/Distance of
Market
– Some food items unaffordable , culturally not
acceptable
–Food cooked only twice

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Barriers /Challenges
• Vegetarian family diet
• Lack of awareness among Mothers-in-laws primary
decision makers on frequency of meals & choice of
food
• No proper counselling to pregnant women
• Low coverage of timely contacts by ASHA, AWWs
• Specific knowledge and skills not provided by FLW
during Home Visit
• Rigorous supervision and monitoring not in place
• No continuous refresher training/mentoring &
monthly meetings where feedback given and FLW
difficulties addressed
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12. Alive & Thrive
Maternal Nutrition:
Facilitators
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–Counseling led to practice
–Awareness of how mother’s health can
impact her child’s health
–Availability of food items in household
–Family members supported by:
–reminding to eat the recommended food
items
–procuring fruits and eggs from the
market

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Influentials:
Key to social &
behavior change
• Husbands
• Mothers in law
• Front Line
Workers
Can best be reached through
mobile phone, TV and home visits

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Opportunities
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• Mothers’ willingness to improve behaviors
• Confidence they can include GLV, lentils and milk/milk
products in diet; (increase animal protein content in Bihar)
• Community able to arrange for green leafy vegetables in
the daily diet of pregnant women
• Husband’s ability to support, procure food & IFA
• VHNDs potentially effective
• Availability of water for hand-washing
• Mobile phone available at HH level
• Influentials and decision makers reachable through TV and
print media
• Optimizing existing contacts by FLWs

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Formative research identifies which practices, what
limitations and opportunities to address, what can
family/community members do, how to reach them
Outcome of FR: Prioritized SBC Strategy

16. Alive & Thrive
With social & systems support and
timely counseling, pregnant women in
UP & Bihar demonstrate motivation and
confidence to adopt recommended
nutrition practices during pregnancy
Thank you