This document summarizes a presentation given by Alive & Thrive about their work improving infant and young child feeding practices in Ethiopia. It describes their multi-pronged approach, which included community education, health system strengthening, and engaging religious leaders. Evaluation results showed small increases in minimum diet diversity. Further analysis found Orthodox Christian children faced higher malnutrition rates and lower diet diversity. Priests were engaged and developed sermon guides to clarify that fasting exempts young children. An increase in minimum diet diversity followed in areas where this approach was implemented.

1. Insert image here
CORE Group meeting, Baltimore, MD| September 28, 2017
Using data to engage religious
leaders

2. Alive & Thrive
Agenda
• Intro to Alive & Thrive
• Phase 1 evaluation results (2010-2014)
• Determinants of stunting and IYCF practices
• Engaging priests
• Phase 2 evaluation results (2015-2017)
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3. Alive & Thrive
Alive & Thrive
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4. Alive & Thrive
Alive & Thrive
• Initiative to save lives, prevent illness and ensure health growth
through improved breastfeeding and complementary feeding
• 2009-2014: Deliver IYCF at scale with impact: Bangladesh, Ethiopia,
Viet Nam
• Support others to scale up nutrition
• Develop and test innovative approaches for maternal, infant and
young child nutrition
• Expanded to include Burkina Faso, India, Nigeria, ASEAN, ECOWAS
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5. Alive & Thrive
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6. Alive & Thrive
Implementation framework for scaling up
behavior change
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7. Alive & Thrive
Ethiopia
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8. Alive & Thrive
Ethiopia Overview
• Total Population: 105 million
• Total Fertility Rate: 5.0 (down
from 6 in 2005)
• Maternal Mortality Ratio: 412
(down from 673 in 2005)
• Infant Mortality Rate: 50 (down
from 82 in 2005)
58%
51%
44%
38%
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2000 2005 2011 2015

9. Alive & Thrive
Ethiopia Overview
47%
55%
66%
28%
52%
27%
52%
5%
49%
4%
0%
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Early Initiation Prelacteal feeding Exclusive Breastfeeding Minimum Diet Diversity Minimum Meal Frequency Minimum Acceptable Diet
IYCF PRACTICES, 2000-2011
2000 2005 2011

10. Alive & Thrive
Ethiopia Program (Phase 1: 2010-2014)
• Community-based interventions to improve IYCF through
interpersonal counseling, group education, and community
outreach
• Health system-based interventions via Health Extension Program
to strengthen IYCF delivery by HEWs, CHVs, HEW supervisors
through capacity building, consistent/harmonized IYCF messages
• Creating an Enabling Environment for IYCF through national and
regional initiatives (women’s associations, churches, journalists)
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11. Alive & Thrive
Results
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12. Alive & Thrive
Small, but significant increase in minimum diet
diversity
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6%
12%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2010 2014
Minimum diet diversity in A&T areas of Tigray & SNNPR, 2010-2014

13. Alive & Thrive
Following our
hunches
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14. Alive & Thrive
Is religion associated with IYCF practices in
Ethiopia?
• Secondary analysis of 2011 DHS
• Qualitative research during lent
in Amhara, Ethiopia
• Trials of improved practices

15. Alive & Thrive
Yes it is!
Study Summary of Findings
Secondary analysis of DHS Prevalence of stunting was 10 pp higher among Orthodox Christian Children (32% among
Orthodox Children vs. 23% among other religious groups)
Orthodox children about 40% less likely to consume minimum diet diversity (OR=0.6,
compared with other religions)
Consumption of animal source foods was significantly lower among Orthodox Christian
Children (35% vs. 52%)
Qualitative research None of the 40 mothers observed fed their child animal source foods on the interview day
-Household utensils will be contaminated
-Neighbors would object
-Smell would interfere with mothers’ fast
Trials of Improved Practices Almost all mothers were willing to try feeding animal source foods, especially eggs and milk
for two weeks
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16. Alive & Thrive
Summary presented to priests
• Orthodox children are more likely to be
chronically malnourished
• Despite exemption, young children are
not consuming animal source foods on
fasting days
• Mothers believe their fast can be
contaminated or that they will be
shamed by neighbors, etc.
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17. Alive & Thrive
Evoked emotions
• Fears among women about the
consequences of touching or
preparing animal foods for their
children
• Shame among priests that
misconceptions about fasting
contributing to child
undernutrition
• Anxiety among mothers about
how they were perceived by
others
• A sense of responsibility for the
well-being of their church
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18. Alive & Thrive 18
Their response. . .
• Bible says children should not fast
• Foods not consumed when fasting
should be shared
• Smelling does not interfere with
fasting
• Utensils can be washed between
use

19. Alive & Thrive
Sermon guides key messages
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20. Alive & Thrive
Weaving into the four component framework
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• At high levels, advocated with
EOC to change how church
teachings are communicated
• Developed sermon guides for
priests to use during services
• Paired priests with HEWs to
reassure moms
• Included priests as recurring
characters on radio drama

21. Alive & Thrive
Increase in minimum diet diversity
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5%
25%
5% 18%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2015 2017
Minimum Diet Diversity
A&T Comparison