The Best Start In Life For Every Child
By
Eric-Alain ATEGBO
UNICEF Niger
University of Pennsylvania
July 2012
THE CONTEXT
• High prevalence of all forms of malnutrition among children.
– One in every five children below 2 years is affected by acute malnutrition
(high correlation with mortality)
– Among children under 5, every other child is stunted (chronic
malnutrition)
• High prevalence of malnutrition has negative consequences for:
– Child survival, growth and development
– The development of the community and the country
THE CONTEXT (2)
A simple and effective technology - Exclusive breastfeeding
Exclusive breastfeeding implies:
– initiation of breastfeeding within one hour after delivery
– breast milk being the sole food and fluid the newborn is raised on, from
birth up to six months of age. Except medical advise
Exclusive Breastfeeding is the single cost effective intervention with
the highest impact on child survival (prevent 13% of under 5
mortality)
Despite what we know, unfortunately only 2 in 5 babies
worldwide, and 1 in 4 babies in Niger enjoys Exclusive
Breastfeeding
WHAT DO WE KNOW?
Current Beliefs
Barriers to
exclusive
breastfeeding
Only weak women required more than one
medical checkup during pregnancy.
It is a pride to deliver at home in the presence
of the mother in law .
Colostrum is bad for the newborn, and is
thrown away.
The baby needs water to survive.
Solid foods are required to satisfy the needs of
the child.
Breast milk of the pregnant mother is a
poison.
WHAT HAS BEEN DONE SO FAR?
• Baby Friendly Hospital Initiative (BFHI)
• Celebration of the World BreastFeeding Week
• Massive communication campaigns
– Mass media
– Community based approaches
– Interpersonnal technics
• Nutrition education, IEC, BCC and now C4D
RESULT: In Niger 3 out of 4 children are still
denied their right to best start in life
WHAT WENT WRONG?
•
•
•
•
Usually one way communication (prescriptive)
Failure to identify and use trusted sources
Communication abstract and lacking creativity
No or weak link between local beliefs and promotion of
exclusive breastfeeding
• Targeting individual behaviour change
• Failure to include all stakeholders in the strategy
THE DIAGNOSTIC
DECISION
Preference
unconditional
Factual beliefs
Normative
beliefs
Empirical
expectations
Normative
expectations
YES
YES
OBSERVATIONS
Guided by the preference of
the mother in Law
Six known to date
Negative attitude about EBF
NO
Mainly what the mother in law
did
NO
Mainly what the mother in law
thinks the mother should did
CONCLUSIONS
1. There is no Social Norm governing adoption of exclusive
breastfeeding.
2. There are wrong factual beliefs about exclusive
breastfeeding, underlined by obligation to obey the mother
in law
ALTERNATIVE APPROACH TO PROMOTE
EXCLUSIVE BREASTFEEDING
A FORMATIVE RESEARCH TO BETTER UNDERSTAND THE SITUATION
(AN ETHNOGRAPHIC APPROACH)
•
•
•
•
Understand barriers to exclusive breastfeeding (Factual beliefs)
What is the rationale behind these factual beliefs?
Who is involved in the young child feeding?
Who is involved in making the decision to adopt / reject exclusive
breastfeeding?
• Is there any underlying norms guiding the decision of the mother?
(beyond obey the mother in law)
• Network analysis to identify all relevant reference group
INTERVENTION APPROACH
• A well seasoned communication strategy carefully
designed using tools and concepts from the social norm
domain, to ensure a collective change of the factual
beliefs
–
–
–
–
–
–
–
–
–
Creativity (Water content of breastmilk)
Address rationale of existing wrong factual beliefs
Include all reference group members (Networking)
Message delivered from trusted sources
Offer alternative to wrong factual believe
Value views of the target group (public deliberation)
Visibility (Public declaration)
Include incentives (moral and image)
Respect the relationship between mother in law and mother
DESIRED FACTUAL BELIEFS
1. At least 4 ANC visits are required over the course of the
pregnancy
2. All delivery should be done in the presence of trained health
worker
3. Colostrum is good for my baby
4. Breast milk contains enough water to meet the needs of my
baby
5. Solid food is not required before 6 months of age
6. My breast milk is still good even if pregnant
After the AHAAAAA moment……