Annex C: Indicators of women’s empowerment as it relates to infant and young
child feeding and related maternal nutrition in rural Bangladesh
All Indicators:
Knowledge and Education
1.
2.
3.
4.
5.
6.
Did you finish primary school?
Did you finish secondary school?
Did you advance beyond secondary school?
Can you read?
Can you write?
Please explain what you know about the following (Interviewer
should circle “yes” if knowledge is sufficient, and “no” if knowledge is
not sufficient):
a. Early initiation of breastfeeding
b. Exclusive breastfeeding 0-6 months
c. Complementary feeding starting at 7 months
d. Safe Delivery
e. Nutrition during pregnancy and lactation
f. Rest during pregnancy and lactation
g. Hygiene and hand washing
7. Do other members of your family have knowledge about:
a. Early initiation of breastfeeding
b. Exclusive breastfeeding 0-6 months
c. Complementary feeding starting at 7 months
d. Safe Delivery
e. Nutrition during pregnancy and lactation
f. Rest during pregnancy and lactation
g. Hygiene and hand washing
Financial Autonomy
8. Do you have cash available in your possession to purchase a variety of
nutritious foods for you and your children?
9. Do you have cash available in your possession to purchase soap for
your household?
10. If you ask your husband or another family member to purchase a
variety of nutritious foods will they do it every time?
11. If you ask your husband to purchase soap for the household will he do
it every time?
12. Do you have a means of earning money on your own?
Decision Making
13. Does your mother-in-law forbid you from having safe deliveries (in
presence of trained birth attendant or doctor)?
14. Does your mother-in-law permit you to eat enough food during
pregnancy?
15. Does your mother-in-law always allow you to take your child to the
hospital if it is sick?
16. If your mother-in-law forbids you from having a safe delivery can you
still make the decision to have a safe delivery?
17. If your mother-in-law forbids you from taking a sick child to the
hospital can you still make the decision to take the child to the
hospital?
18. If your mother-in-law does not allow you to eat enough food during
your pregnancy period can you still make the decision to eat enough
food during pregnancy?
19. Does the size of your family obstruct your IYCF/rMN decision-making
abilities?
20. Does your husband allow you to rest during your pregnancy period?
21. If your husband forbids you from taking rest during pregnancy can
you make the decision to do so anyway?
22. Does your husband always allow you to take a sick child to the
hospital?
23. If your husband forbids you from taking a sick child to the hospital
can you make the decision to take the sick child to the hospital
anyway?
24. Do you make your own decisions without having to get permission
from anyone else regarding:
a. Initiation of breastfeeding within 1 hour after birth
b. Exclusive breastfeeding 0-6 months
c. Complementary feeding starting at 7 months
d. Safe Delivery
e. Nutrition during pregnancy and lactation
f. Taking rest during pregnancy and lactation
g. Washing your hands and your children’s hands with soap
h. Taking a sick child to the doctor
25. Do you have the power to influence others in your family to allow you
to practice:
a. Initiation of breastfeeding within 1 hour after birth
b. Exclusive breastfeeding 0-6 months
c. Complementary feeding starting at 7 months
d. Safe Delivery
e. Nutrition during pregnancy and lactation
f. Taking rest during pregnancy and lactation
g. Washing your hands and your children’s hands with soap
h. Taking a sick child to the doctor
Mobility Autonomy
26. Do you need permission to go to the health center for any reason?
27. Do you need permission to visit other people’s homes?
28. Do you need permission to go to the market?
29. Do you need permission to go to a place where you can safely deliver a
child?
Attitudes Towards Domestic Violence
30. Is it ok if a husband doesn’t allow his wife to eat enough food?
31. Is it ok for a woman to fear her husband?
32. Is a mother-in-law justified in picking a quarrel with her daughter-inlaw if her daughter-in-law makes her own decisions about IYCF/rMN?
33. Is a mother-in-law justified in picking a quarrel with her daughter-inlaw if her daughter-in-law takes extra rest during pregnancy?
34. Is it ok for a mother-in-law not to allow her daughter-in-law to eat at
night?
Social Relations and Support
35. Do you have access to a mobile telephone?
36. Do you have access to a television?
37. Do you get suggestions from neighbors and friends outside your
family about IYCF/rMN?
38. Do you share information about IYCF/rMN with people outside your
family?
39. Do you trust the advice you receive from your neighbors and friends
outside your family?
40. Does your husband or other senior members of your family bring
home a variety of nutritious foods from the market for your children?
41. Does your husband or other senior members of your family ever take
your child to the doctor if it is sick?
42. Do you work together well with your husband?
43. Do your family members offer you advice about breast-feeding, child
feeding, and mother’s nutrition?
44. Do you trust the advice you receive from your family members?
45. Do your family members help you with your family work?
46. Do you get advice from health workers?
47. Do health workers come to visit you in your home?
48. Do you get advice from the hospital or health center?
Self-Efficacy
49. Do you wish to make changes in your behavior regarding IYCF and
rMN?
50. Do you ever feel too lazy to use soap?
51. Do you ever feel too lazy to prepare a variety of nutritious foods for
your children?
52. In the family, there is a decision maker who makes all the decisions
for the family. If you get an opportunity to be this decision maker,
would you want to take the opportunity?
53. If someone is teasing you about using soap will you continue to use it?
If yes, what do you say to the person?
54. Are you comfortable breastfeeding in public or in the presence of nonfamily members?
55. Are you comfortable seeing a male doctor for a routine visit such as an
antenatal care visit?
56. Are you comfortable seeing a male doctor for an emergency?
57. Do you ever feel shame when you breastfeed?
58. Are you confident that you can start breastfeeding within 1 hour after
birth?
59. Are you confident that you will produce enough milk for your baby
from 0-6 months, so that you don’t have to give it anything besides
breast-milk?
60. If your baby 0-6 months is crying is it likely that it’s because your
breast-milk is not sufficient?
61. Can you feed your child complementary feeding even if the child does
not want to eat?
62. Are you confident that you will produce enough milk for your baby
even if you are sick?
63. Are you confident that if you are ill your children will get
complementary feeding?
64. Do you feel comfortable stopping other family members from giving
your child additional food when it is between 0-6 months?
65. If an elder family member tells you that your baby does not need
breastfeeding in the first hour, do you feel confident breastfeeding
within the first hour anyway?
66. If a birth attendant wants to give your baby honey or sugar water do
you feel confident forbidding them from giving it?
67. If your husband or another elder family member wants to give your
baby honey or sugar water do you feel confident forbidding them from
giving it?
68. If an elder family member tells you that if you eat too much
nutritional food during pregnancy your baby will become too big, can
you eat nutritional food anyway?
69. If your husband or other elder family members want to give your baby
junk food can you forbid them from giving it?
70. If an elder family member tells you that if you feed your child rice its
belly will get too big can you feed it rice anyway?
Negotiation Habits
71. Do you ask people to help you with your work?
72. Do you have any say in the amount of work you do?
73. If you ask people to help you with your work do they do it?
74. If someone asks you to do work and you feel you need to rest do you do
the work anyway?
Psycho-Social Well-Being
75. Do you feed your child when you are feeling annoyed by it?
76. When you feel tension does it stop you from properly breastfeeding
your child?
77. When you feel tension does it stop you from giving your children
complementary feeding?
78. Do you often feel stress or tension?
79. Have you ever sought advice about tension or worries you feel?
Evidence to support indicators:
Financial Autonomy/Control over Assets:
1. Cash Availability
Indicators:
1. Do you have cash available in your possession to purchase a variety of
nutritious foods for you and your children?
2. Do you have cash available in your possession to purchase soap for
your household?
3. If you ask your husband or another family member to purchase a
variety of nutritious foods will they do it every time?
4. If you ask your husband to purchase soap for the household will he do
it every time?
Qualitative Research Evidence:
a. “I have not enough money, so I depends on my mother in law or
father in law. If they bring anything [food] they give me.” –IDI
b. “Mother can not go to hospital with baby if baby become ill. Lack
of money is the reason for it.” –IDI
c. “Those who cannot make their own decisions have no money.” –
IDI
d. “Husband is most powerful person to feed child. Mother can not
bring all the necessary things. Husband brings all the things from
market.” –IDI
e. “I think I am not powerful person because my financial situation is
not good.” –IDI
f. “Mother tells the baby’s father to bring soap and then father brings
soap from the market.” –Problem Tree
g. “If mother has some money for herself, then she can bring some
food from the market for complementary feeding.” –Pile Sorting
h. “Most mother cannot eat enough during pregnancy because they
have no money.” –Problem Tree
2. Maternal Financial Self Support
Indicators:
1. Do you have a means of earning money on your own?
Qualitative Research Evidence:
a. “One solution to lack of nutrition during pregnancy is that the
mother should rear hens and ducks.” – Problem Tree
b. “CARE gave me 5 thousand taka. Then I bought a cow. Now I can
take decision because I find financial help.” –IDI
c. “I know a woman who works in house and also work in a
restaurant. She makes different types of food and maintain her
family. She and her baby are sound and healthy. Her husband do
business. Their children are healthy and they go to school. The
woman take all the decisions.”-IDI
d. “[To change my power relationships], I want to cultivate vegetable
and grow up my profit.” –IDI
e. “If mother rears hens, she can eat egg and meat and she can give
breastfeeding.” –Pile Sorting
f. “Mother can take decision if they grow different types of
vegetables.” –Pile Sorting
Decision Making Autonomy:
1. Mother-in-Law Influence
Indicators:
1. Does your mother-in-law forbid you from having safe deliveries (in
presence of trained birth attendant or doctor)?
2. Does your mother-in-law permit you to eat enough food during
pregnancy?
3. Does your mother-in-law always allow you to take your child to the
hospital if it is sick?
4. If your mother-in-law forbids you from having a safe delivery can you still
make the decision to have a safe delivery?
5. If your mother-in-law forbids you from taking a sick child to the hospital
can you still make the decision to take the child to the hospital?
6. If your mother-in-law does not allow you to eat enough food during your
pregnancy period can you still make the decision to eat enough food
during pregnancy?
Qualitative Research Evidence:
a. “When I become a mother-in-law, I do not obstruct the work of my
daughter in law. They do which they want. They can do it freely.” –
IDI
b. “I want to change my power relationships, but after my mother-in-law
dies.” –IDI
c. “most mother-in-law forbid mothers to go to the hospital for safe
delivery.” – Problem Tree
d. “Some grand mother do not give enough food to mothers so that the
baby does not find enough breastfeeding.” –Pile Sorting
e. “In delivery period, mother-in-law take most of the decisions.
Grandfather and grandmothers decisions are accepted more.” -10
Seed
f. “Mother cannot make the decision to take a sick child to the hospital
without the permission of mother-in-law, father-in-law, and husband.”
– 10 Seed
2. Family Size
Indicators:
1. Does the size of your family obstruct your IYCF/rMN decision-making
abilities?
Qualitative Research Evidence:
a. “It is not possible to feed child if ten person forbade to feed it
because we live together. I should obey to family members word.”
–IDI
b. “As it is an extended family, mother can not take decision alone.” –
IDI
c. “There is many people in family. Those who have son they want
daughter and those have daughter they want son. In this way,
family become big. So in this family, mother can not take decision
about nutritional food. They always think about their family, so
they can not take care of baby. This mother are not healthy. Their
child is not healthy.” –IDI
d. “They have many people in their family, so they can not maintain
their family in right way.” –IDI
e. “In extended family, mother can not eat more and mother can not
feed her baby enough food…In extended family mother can not
take her own and baby’s decision. They remain busy with their
family. They suffer from sorrow. Their health is not so good.
Baby are weak.” –IDI
f. “Those who have many children can not easily make changes to
their practices.” –IDI
g. “In extended families, mother can not feed child in right rule. In
nuclear families mother can rear her child in a good way. In
extended family, baby and mother remain ill.” –IDI
h. “in small family, mother have little work to do, and so it is easy for
them to make decisions about baby feeding and mother nutrition.
In big family, mother have many work to do and so it is not easy
for them.” –IDI
i. “Mother can not wash hands with soap because family have a lot of
child.” –Problem Tree
j. “If there are too many children, mother cannot give
complementary feeding to the child.” – Pile Sorting
3. Husband Influence
Indicators:
1. Does your husband allow you to rest during your pregnancy period?
2. If your husband forbids you from taking rest during pregnancy can you
make the decision to do so anyway?
3. Does your husband always allow you to take a sick child to the hospital?
4. If your husband forbids you from taking a sick child to the hospital can
you make the decision to take the sick child to the hospital anyway?
Qualitative Research Evidence:
a. “Mother is most powerful person because her husband went to Dhaka.
So she take most decision.” –IDI
b. “We are village women and so our husbands forbid to go hear many
things. They tell to do family work. We cannot take any decision. Our
health is not good. Our baby’s health is also bad. I pass my day with
sufferings.” –IDI
c. “I think I have enough power. Husband remains out of home and so I
take all of the decisions about the baby. So I think I have the most
power to take decisions about babies feeding and mothers nutrition.”
–IDI
d. “Husband takes most of the decision for if the mother can rest during
pregnancy period.” – Problem Tree
e. “Sometimes husband forbids the mother to take rest during
pregnancy.” – Pile Sorting
4. Mother Influence
Indicators
2. Do you make your own decisions without having to get permission from
anyone else regarding:
a. Initiation of breastfeeding within 1 hour after birth
b. Exclusive breastfeeding 0-6 months
c. Complementary feeding starting at 7 months
d. Safe Delivery
e. Nutrition during pregnancy and lactation
f. Taking rest during pregnancy and lactation
g. Washing your hands and your children’s hands with soap
h. Taking a sick child to the doctor
3. Do you have the power to influence others in your family to allow you to
practice:
a. Initiation of breastfeeding within 1 hour after birth
b. Exclusive breastfeeding 0-6 months
c. Complementary feeding starting at 7 months
d. Safe Delivery
e. Nutrition during pregnancy and lactation
f. Taking rest during pregnancy and lactation
g. Washing your hands and your children’s hands with soap
h. Taking a sick child to the doctor
Qualitative Research Evidence:
a. “I think it is essential for mother to take decision about feeding child
and mothers nutrition. Mother should not listen another peoples
word. If mother take her own decision, she can find good result.” –IDI
b. “Mothers who do not feel comfortable to take decision, they suffer
from many diseases.” –IDI
c. “Mothers who take decisions freely, they rear child in good way. They
take care their children, and keep their children neat and clean.” –IDI
d. “It is essential for mother to take decision about feeding child and
nutrition. If mother can take decision, baby and mother remain well.”
–IDI
e. “My advice for new mothers is for them to make their own decisions.”
–IDI
f. “I think it is very essential for a mother to take her own decisions
about her baby. Mother is most related with baby than father. Mother
take most care to her baby. If mother take all the decision, baby
remains sound and healthy. Mother should not listen what another
people say.” –IDI
g. “If mothers are aware and stay with their decisions, nobody can
obstruct to it. Mother’s decisions are the best decision.” -10 Seed
Mobility Autonomy:
Indicators
1. Do you need permission to go to the health center for any reason?
2. Do you need permission to visit other people’s homes?
3. Do you need permission to go to the market?
4. Do you need permission to go to a place where you can safely deliver a
child?
Qualitative Research Evidence
a. “Mother hear about breast feeding from health complex.” –IDI
b. “If there is a flood, mother may not be able to have a safe delivery
because she will not be able to reach the hospital.” – Pile Sorting
c. “For safe delivery need vehicle to go to the hospital.” –Pile Sorting
d. “If mother can get many things from shops it helps the mother make
[IYCF/rMN] decisions.” – Pile Sorting
e. “When I become a mother in law, I tell my daughter in law to move
freely.” –IDI
f. “Mothers who do not make decisions do not go anywhere so they can
not take decision.” –IDI
g. “I can not go to other home, so I can not know it clearly [information
about IYCF/rMN].” –IDI
h. “Husband is most powerful person to feed child. Mother can not bring
all the necessary things. Husband brings all the things from market.” –
IDI
Attitudes towards Domestic Violence:
1. Fear of Husband
Indicators:
1. Is it ok if a husband doesn’t allow his wife to eat enough food?
2. Is it ok for a woman to fear her husband?
Qualitative Research Evidence
a. “In previous time, we find fear if we see male. We did not speak with
male. We did not work without husband’s permission. Now every
mother becomes aware and they can take decision.” –IDI
b. “In previous time, most mother feared her husband.” –IDI
c. “Sometimes aggressive husband do not want to give the mother
enough food to eat. They avoid it.” –Problem Tree
2. Fear of mother-in-law
Indicators:
1. Is a mother-in-law justified in picking a quarrel with her daughter-in-law
if her daughter-in-law makes her own decisions about IYCF/rMN?
2. Is a mother-in-law justified in picking a quarrel with her daughter-in-law
if her daughter-in-law takes extra rest during pregnancy?
3. Is it ok for a mother-in-law not to allow her daughter-in-law to eat at
night?
Qualitative Research Evidence:
a. “They live with mother-in-law and father-in-law so they cannot take
decision. If they take their own decision, mother-in-law pick up
quarrel with them.” –IDI
b. “Aggressive grandmother do not give mother to take rest. If mother
take rest, grandmother pick quarrel with them.” – Pile Sorting
c. “Sometimes grandmother do not give food in the night to the mother.”
-10 Seed
Social Relations and Support:
1. Access to Television and Mobile Phones
Indicators:
1. Do you have access to a mobile telephone?
2. Do you have access to a television?
Qualitative Research Evidence
a. “They hear about child feeding from tv” – IDI
b. “Now everyone learn from TV. In previous time, mother did not know
anything.” –IDI
c. “To help mothers be able to take their sick children to the hospital,
they need mobile for communication with their family members.” –
Pile Sorting
d. “Sometimes mother can learn many things from doctor by mobile
phone.” –Pile Sorting
e. “Mothers can learn about safe delivery from the TV.” –Pile Sorting
2. Social Network
Indicators:
1. Do you get suggestions from neighbors and friends outside your family
about IYCF/rMN?
2. Do you share information about IYCF/rMN with people outside your
family?
3. Do you trust the advice you receive from your neighbors and friends
outside your family?
Qualitative Research Evidence
a.
b.
c.
d.
e.
f.
g.
h.
“If mother do not know something, she learn it from another.” –IDI
“If mothers go to another people, they can find good suggestion.” –IDI
“If mother finds good suggestions she can change her habit.” –IDI
“I know a neighbor woman. She has a son. She does not listen
anybody’s word. Her child died some days ago.” –IDI
“Sometimes shopkeepers forbids mother from giving another food
before 6 months.” – Pile Sorting
“Neighbors can help the mother to take a sick child to the hospital.” –
Pile Sorting
“Mother can learn many things [about IYCF/rMN] from going to the
CARE meetings.” – Pile Sorting
“Aware people should give the mother suggestions about
complementary feeding.” –Problem Tree
3. Support from family members
a. Material/Monetary Support
Indicators:
1. Does your husband or other senior members of your family bring home a
variety of nutritious foods from the market for your children?
2. Does your husband or other senior members of your family ever take
your child to the doctor if it is sick?
Qualitative Research Evidence
i. “For complementary feeding, father can bring many types of
food from the market for feeding child.” – Pile Sorting
ii. “Grandmother and grandfather help by bringing different types
of food.” –Pile Sorting
iii. “The husband can help with hand washing by bringing soap
home from the market.” –Pile Sorting
iv. “Baby’s father brings necessary things for the baby and brings
it to the hospital if it becomes ill.” –Social Mapping
v. “Mother gets help from husband. Husband gives different
types of foods like fish, milk, eggs, etc. to baby’s mother. He
provides financial support.” – Social Mapping
vi. “Father gives financial support and so mother take suggestion
from baby’s father.” –Problem Tree
b. Suggestions/Advice
Indicators:
1. Do you work together well with your husband?
2. Do your family members offer you advice about breast-feeding, child
feeding, safe delivery, and mother’s nutrition?
Qualitative Research Evidence
i. “If husband and wife do not work together, the family remain
unhappy.”-IDI
ii. “My husband, father-in-law, and mother-in-law gives
permission to feed child.” –IDI
iii. “I think it is essential to take my own decision. But I cannot do
it. I need help from another. Husband helps mother to take
decision. Grandmother and grandfather also helps mother.” –
IDI
iv. “Mother and baby can eat enough food because her husband is
good. She can take decision.” –IDI
v. “If I find enough help, I want to take more care of my baby.” –
IDI
vi. “those who cannot make the decision to practice infant feeding
and mother’s nutrition have little relation with family.” –IDI
vii. “Husband helps mostly and so I can take decision.” –IDI
viii. “Husband do not help the baby’s mother to wash hands with
soap so mother can not wash hand with soap.” –Problem Tree
ix. “Husband and mother-in-law do not help the mother so she
can not eat nutritional food.” – Problem Tree
x. “Grandmother and grandfather tell to give only breastfeeding
for 0-6 months” – Pile Sorting
xi. “Grandmother and grandfather teaches baby’s mother how to
feed child.” – Pile Sorting
xii. “When baby become ill, grand father and grandmother tell to
go to hospital.” – Pile Sorting
xiii. “Mother and father in law can help with complementary
feeding by giving suggestions to the mother.” –Pile Sorting
xiv. “Grandmother can help by giving suggestion to mother to use
soap.” –Pile Sorting
xv. “Grandparents can give suggestion to mother to rest during
pregnancy to help the mother make the decision to rest.” –Pile
Sorting
xvi. “New mother does not know about baby’s care, so sister in law
teaches baby’s mother how to feed a child.” –Social Mapping
xvii. “If mother remains in her home, her mother and father help
her and tell her to take rest during pregnancy.” -10 Seed
c. Help with work
Indicators:
1. Do your family members help you with your family work?
Qualitative Research Evidence
i. “A solution to problems with complementary feeding is that all
the family members should help the baby’s mother by doing
work.” –Problem Tree
ii. “Mother in law can help the mother to take rest during
pregnancy by doing mother’s work.” – Pile Sorting
iii. “Husband, grandparents, and elder siblings can help the
mother to practice good child feeding and mother nutrition by
helping her with her work.” –Social Mapping
4. Support from Health Workers
Indicators:
1. Do you get advice from health workers?
2. Do health workers come to visit you in your home?
3. Do you get advice from the hospital or health center?
Qualitative Research Evidence
a. “One solution to early initiation is for the mother to communicate
with health workers.” –Problem Tree
b. “Doctors help by giving suggestions about exclusive breastfeeding to
mother.” – Pile Sorting
c. “Nurse gives suggestion how to feed child.” – Pile Sorting
d. “Window of opportunity sister can help by giving suggestions how to
make complementary feeding and how to feed it to child.” – Pile
Sorting
e. “mother can find suggestions for complementary feeding from the
hospital.” – Pile Sorting
f. “Window of opportunity sister goes to every house and teaches
mother how to give breastfeeding.” – Pile Sorting
g. “Birth attendant give suggestions about rest, food, and nutrition.” –
Social Mapping
Knowledge and Education:
1. Formal Education
Indicators:
1. Did you finish primary school?
2. Did you finish secondary school?
3. Did you advance beyond secondary school?
4. Can you read?
5. Can you write?
Qualitative Research Evidence
a. “I know little about IYCF/rMN because I have little education.” –IDI
b. “Those who can make the decision to practice infant feeding and
mother’s nutrition are more literate and they have more honor. They
learn most and so people respect them.” -IDI
c. “Literate family can use soap.” – Pile Sorting
d. “Elder boys and girls learn many things about exclusive breast feeding
from school and tell their mothers.” –Pile Sorting
e. “For safe delivery, lack of education is a main obstacle.” -10 Seed
f. “In previous time mother remain illiterate and so they can not go to
hospital. But now every mother that is literate feel comfortable.” –
Problem Tree
g. “Literate mothers can make the decision to practice complementary
feeding.” –Problem Tree
h. “Literate families learned everything about nutrition during
pregnancy so they can eat ideal foods.” – Problem Tree
2. Knowledge
Indicators:
80. Please explain what you know about the following:
a. Early initiation of breastfeeding
b. Exclusive breastfeeding 0-6 months
c. Complementary feeding starting at 7 months
d. Safe Delivery
e. Nutrition during pregnancy and lactation
f. Rest during pregnancy and lactation
g. Hygiene and hand washing
81. Do other members of your family have knowledge about:
a. Early initiation of breastfeeding
b. Exclusive breastfeeding 0-6 months
c. Complementary feeding starting at 7 months
d. Safe Delivery
e. Nutrition during pregnancy and lactation
f. Rest during pregnancy and lactation
g. Hygiene and hand washing
Qualitative Research Evidence
a. “Mothers who do not make their own decisions have no knowledge.” –
IDI
b. “One sister gives suggestions and decisions about feeding child. This
helps me make the decisions about child feeding and mothers
nutrition. They give knowledge. We can learn many things from
them.” –IDI
c. “Mother should eat enough nutritional food and vegetable. If mother
learn it she feel comfortable. I learn everything and so I can do
everything.” –IDI
d. “Mothers who have no knowledge about it [IYCF/rMN], they do not
feel comfortable.” –IDI
e. “I am most aware person in the village. I have one sister in law, she
knew little about babies care. So I try to teach her about babies care.
Now she also knows about babies care. Her health is very good and
her baby is also healthy. The villagers tell them very well and respect
them. Her children are not remain dirty. Her children remain at good
environment.” –IDI
f. “All the family members and the mother do not know about the
importance of exclusive breastfeeding so mother can not give it.” –
Problem Tree
g. “Those who know about the importance of breastfeeding, they can
give breastfeeding.” –Pile Sorting
h. “If mothers have no knowledge about complementary feeding, they
cannot make the decision to do it.” –Pile Sorting
i.
j.
“Mother teaches grandmother and grandfather about the importance
of breast feeding, so mother can take decision.” – 10 Seed
“Health worker should teach husband, father in law, and mother in
law about the importance of rest during pregnancy.” –Problem Tree
Self-Efficacy:
1. Personal Drive/Motivation
Indicators:
1. Do you wish to make changes in your behavior regarding IYCF and rMN?
Qualitative Research Evidence
a. “someone can not change it [behavior change] because they have no
interest”. –IDI
b. “If mother wants to change her practices, she can do it. It depends on
mother’s wish.” –IDI
c. “Who have wish, she can change. Who have no wish to change, she
can not change.” –IDI
d. “Mother should have a wish to do [proper IYCF/rMN practices]
because if mother have no wish it is not easy for mother.” –IDI
2. Laziness
Indicators:
1. Do you ever feel too lazy to use soap?
2. Do you ever feel too lazy to prepare a variety of nutritious foods for your
children?
Qualitative Research Evidence
a. “they can not change their habit for the reason of idleness.” –IDI
b. “mother can not change habits because of idleness.” –IDI
c. “most mothers do not wash their hands with soap because of
idleness.” –Problem Tree
d. “Some mothers do not give breastfeeding because they are idle.” –Pile
Sorting
e. “Idle mothers can not want to feed child complementary feeding.
They feel bored to give child different types of food.” –Problem Tree
3. Social Consequences
Indicators:
1. If you could change your power relations to gain more power in the
household would you do it?
2. If someone is teasing you about using soap will you continue to use it?
3. Are you comfortable breastfeeding in public or in the presence of nonfamily members?
4. Are you comfortable seeing a male doctor for a routine visit such as an
antenatal care visit?
5. Are you comfortable seeing a male doctor for an emergency?
6. Do you ever feel shame when you breastfeed?
Qualitative Research Evidence
a. “I do not want to change my power relations. I want to live according
to the rule of society. If I talk about it, may be problem as I live in an
extended family.” –IDI
b. “Sometimes mother goes to meetings and so she cannot give breast
feeding.” –Pile Sorting
c. “Sometimes mother get shame and so she cannot give breastfeeding.
Many mothers remain out of the home, and so they need to give their
baby additional food instead of exclusive breastfeeding.” -10 Seed
d. “If mother uses soap, her brother in law and sister in law is teasing
her.” -10 Seed
e. “Some mothers cannot go to the hospital for the reason of male
doctor.” –Problem Tree
f. “Employed mother do not stay in home and so she can not give
exclusive breastfeeding from 0-6 months.” –Problem Tree
g. “Sometimes birth attendant forbids the mother from going to the
hospital. She thinks that she can do it properly.” –Problem Tree
4. Confidence
Indicators:
1. Are you confident that you can start breastfeeding within 1 hour after
birth?
2. Are you confident that you will produce enough milk for your baby from
0-6 months, so that you don’t have to give it anything besides breastmilk?
3. If your baby 0-6 months is crying is it likely that it’s because your breastmilk is not sufficient?
4. Can you feed your child complementary feeding even if the child does not
want to eat?
Qualitative Research Evidence
a. “sometime breastfeeding not come and so they give sugar mix water.”
–IDI
b. “I think I am most powerful person to take decision about feeding
child and nutrition. If I take decision, my baby and I will become
c.
d.
e.
f.
g.
h.
i.
j.
k.
healthy. The bad side is that people say to me, ‘why do you take the
decision alone?’ They tell me bad. “-IDI
“I want to change my power relations. I want to develop my situation
and I try for it. But I can not change it because I have no ability.” –IDI
“I know one woman who is my sister in law. They feed breast-feeding
to their children. They take care of baby. Their health is well. I can
not do like them because I have no ability.” –IDI
“I think I am good for my baby. I take my own decisions. I do baby’s
work firstly and then I do another work.” -IDI
“I know all the things and I do not obey another’s obstruction.” –IDI
“Baby do not want to eat rice so mother can not take decision.” –
Problem Tree
“Who have the wish, they can give exclusive breastfeeding from 0-6
months. Some believe that breastfeeding is not enough for the child.”
-10 Seed
“When baby is crying, mother thinks that breastfeeding is not enough
for child and so they give other foods.” -10 Seed
“When a baby becomes ill, some mothers do not feel confident making
the decision to go to the hospital because the grandmother and
grandfather say there is no need to go.” -10 Seed
“Some mothers want to do work first and then feed her child.” –Pile
Sorting
5. Illness
Indicators:
1. Are you confident that you will produce enough milk for your baby even if
you are sick?
2. Are you confident that if you are ill your children will get complementary
feeding?
Qualitative Research Evidence
a. “Mother become ill and so another family member give honey to
baby’s mouth.” –Problem Tree
b. “Because of mother’s illness, mother cannot give breastfeeding.” –Pile
Sorting
c. “If mother become ill, mother cannot give complementary feeding.” –
Pile Sorting
d. “Illness reduces mothers confidence that she will produce enough
breast milk for the baby.” – Problem Tree
6. Common Harmful Practices and Superstitions
Indicators:
1. Do you feel comfortable stopping other family members from giving your
child additional food when it is between 0-6 months?
2. If an elder family member tells you that your baby does not need
breastfeeding in the first 24 hours do you feel confident breastfeeding
within the first hour anyway?
3. If a birth attendant wants to give your baby honey or sugar water do you
feel confident forbidding them from giving it?
4. If your husband or another elder family member wants to give your baby
honey or sugar water do you feel confident forbidding them from giving
it?
5. If an elder family member tells you that if you eat too much nutritional
food during pregnancy your baby will become too big, can you eat
nutritional food anyway?
6. If your husband or other elder family members want to give your baby
junk food can you forbid them from giving it?
7. If an elder family member tells you that if you feed your child rice its belly
will get too big can you feed it rice anyway?
Qualitative Research Evidence
a. “Father and uncle loves the baby and give junk food from shop. Then
baby do not want to eat home made food. [complementary feeding]” –
Problem Tree
b. “People believe that if mother eat nutritional food, baby become big
and delivery will be difficult.” –Problem Tree
c. “Most grandmother tell that baby’s belly become big if baby feed rice.”
– Pile Sorting
d. “Sometimes grandmother wants to give honey to baby’s mouth
because she has no knowledge about exclusive breastfeeding.” – Pile
Sorting
e. “Some birth attendant wasn't to give sugar mix water or honey to the
baby’s mouth because it will make the baby speak sweet words.” –Pile
Sorting
f. “Some people tell that baby should not need breast feeding during the
first 24 hours.” -10 Seed
g. “Mother in law and father in law do not give facility to mother to take
rest. They tell that if mother take rest, water come in body.” –Problem
Tree
h. “Sometimes the grandparents of a baby want to give it additional food
at 0-6 months.” –Problem Tree
Negotiation/Accommodation Habits:
1. Work-load negotiation
Indicators:
1. Do you ask people to help you with your work?
2. Do you have any say in the amount of work you do?
3. If you ask people to help you with your work do they usually do it?
4. If someone asks you to do work and you feel you need to rest will you do
the work anyway?
Qualitative Research Evidence
a. “someone do not feel easy (to make IYCF/rMN decisions) because of
work.” – IDI
b. “sometimes I remain busy with my work, so I can not take my decision
for the reason of work.” –IDI
c. “in small family, mother have little work to do, and so it is easy for
them to make decisions about baby feeding and mother nutrition. In
big family, mother have many work to do and so it is not easy for
them.” –IDI
d. “sometimes mother can not feed child complementary feeding
because she has to work hard.” –Problem Tree
e. “A solution to problems with complementary feeding is that al the
family members should help the baby’s mother by doing work.” –
Problem Tree
f. “Most of the mothers can not take rest during pregnancy because they
have to do many works. Mother in law tells to do work at first and
then take rest. Mothers who cannot avoid this work cannot take rest.”
– Problem Tree
g. “Mothers need to have more time available to properly feed their
children.” –Pile Sorting
h. “Mother become busy to her work and so mother cannot wash hands
with soap.” –Pile Sorting
i. “Mother do not find enough time to feed baby because mother have to
work. So another family member gives another food to child.” –
Problem Tree
Psycho-Social Well-Being:
1. Seeing child as an annoyance
Indicators:
a. Do you feed your child when you are feeling annoyed by it?
Qualitative Research Evidence
a. “In feeding time, baby annoy mother”. –IDI
b. “If baby are crying, mother become annoyed and mother do not want
to feed child.” –Problem Tree
2. Stress/Tension
Indicators:
1. When you feel tension does it stop you from properly breastfeeding your
child?
2. When you feel tension does it stop you from giving your children
complementary feeding?
3. Do you often feel stress or tension?
4. Have you ever sought advice about tension or worries you feel?
Qualitative Research Evidence
a. “If husband do not work, mother tension more, so mother can not take
care her baby.” –IDI
b. “Those who are tension free, their children remain healthy.” –IDI
c. “I have an elder sister in law who can not take any decision about
children health and own health. She tension always and so she and
her children is not healthy.” –IDI
d. “If mother tension more, her baby do not find enough breast feeding.”
–Pile Sorting
e. “If mother remain in tension about any things, mother can not give
complementary feeding to child.” – Pile Sorting