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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!