Buniyaad: Reducing infant mortality through optimal infant feeding practices

Abhishek Singh, Programme Manager, BuniyaadProgramme

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

Project Geography

Districts 3

Blocks 20

Panchayats 387

Villages 1436

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

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.

Insights from Formative ResearchEarly 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.

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

Interpersonal communication

(IPC)

Mid-media

Mass- media

Healthy Baby shows

4500

Breastfeeding & Nutrition

Week

Radio Spots

Home Visits

592,866Group

Meetings 167,256

Level 1: Household level

Wall writings

2800

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

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

Achievements

Key Indicators

Indicators

Project baseline

(Sept-Oct2012)

Achievements

Year 1March 2013

Year 2Jan-Mar

2014

Year 3 Jan-Mar

2015Early 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 appropriatecomplementary feeding for their child)

19.8 22.1 29.9 44.08

17.4

23.1

44.6

65.2

15.2

20.0

33.9

49.6

05

10152025303540455055606570

BASELINE (OCT' 2012)

(MARCH 2013) (MARCH 2014) (MARCH 2015)

EIBF Achieved EBF Achieved

Breastfeeding

Initiation of Breastfeeding before 1 hour of Birth

Exclusive Breastfeeding till six month

Complementary Feeding

73.4 74.979.8

87.19

19.822.1

29.9

44.08

0

10

20

30

40

50

60

70

80

90

100

BASELINE (OCT' 2012) (MARCH 2013) (MARCH 2014) (MARCH 2015)

Introduction of Complementary feeding Age Appropriate Complementary feeding

Introduction of Complementary feeding at the age of 6 Month

Age Appropriate Complementary Feeding to child aged 12-13 olds

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 behaviourchange.

• Continued use of water to feed babies.

• Need to adapt BCC tools and messaging as you implement so that progressively can address challenges.

Thank you!