1 FORMATIVE RESEARCH ON MATERNAL , INFANT AND YOUNG CHILD IN EAST JAVA

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FORMATIVE RESEARCH ON MATERNAL, INFANT

AND YOUNG CHILD IN EAST JAVA

Jakarta, 20 January 2015

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Background & Objective

Background

• GAIN, the London School of Hygiene and Tropical Medicine (LSHTM) and

the local partner (Savica & Kadence), developed and executed formative

research to support the development and testing of a comprehensive and

multi-channel Behaviour Change Communication (BCC) campaign

Objective

• These formative research (FR) aims to identify the factors constraining or

facilitating healthier maternal and infant, young children feeding (IYCF)

practices and to support the development of feasible and scalable

behaviour change interventions for the promotion of target behaviours.

• The hypothesis is that this will result in more aspirational and impactful

behaviour change interventions

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Methodology

• Evo-Eco Theoretical Framework:

• developed by LSHTM.

• It is based on the inference that behaviour is produced by

brains evolved to provide adaptive responses to rapidly

changing or complex environmental conditions.

• Formative Research Methodology:

• full-day video ethnographies, changing practices analysis,

food attribute ranking, food „life history‟,

• physical infrastructure survey, and a motives exercise

aimed at identifying which human motives drive feeding

behaviours (e.g. nurture, status, affiliate).

• Creative Design Process:

• The FR insights were translated into a brief for a creative

agency to develop the campaign considering aspects of

scalability, sustainability and being provoking.

• Each iteration of the creative campaign materials was

discussed with the research team to ensure the Evo-Eco

behaviour change principles were appropriately applied.

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Process & Progress

Formative Research

Creative Design

3 months BCI Pilot

Process Evaluation

BCIImplementation

Completed & Disseminated on May 2013

Completed, 3 TVCs- EBF- Healthy Snacking- Complimentary food

Completed, 3 TVCsaired at JTV & community activation in 12 villages

Writing report of pre-post and case-control evaluation by SEAMEO

Formative Research

Creative Design

BCI Phase 1 Implementation

Process Evaluation

BCI Phase 2 Implementation

Implementation partner selection

Completed & Disseminated on Dec 2014

On-going for 2 TVCs

Implementation partner selection

TBD TBD

Infant Young Children Nutrition

Maternal Nutrition

Baduta Program

1. Health Services Strengthening

2. Behavioural change

3. Nutritious product

4. Safe drinking water

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FR Highlighted Findings - 1

• IYCF Practices

• Breastfeeding:

• Breast-milk is understood to be best, but women lack confidence in

the quality and quantity of their own breast milk, which they cannot

see or measure.

• Well-meant advice also undermines confidence (“if I cannot afford the

food the midwife advices, my breast milk cannot be good either”).

• Mothers are unaware that formula does not supplement, but

displaces breast milk.

• Complimentary feeding:

• Mothers‟ ultimate goal is getting her child into a routine and eating

from the family plate as soon as possible – for social, economic and

practical reasons. This results in a too brief complementary feeding

phase.

• Home-made porridge copies the family diet in adult proportions,

which is rice-heavy, filling up the stomach of the child with insufficient

nutrients.

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• IYCF Practices

• Snacking and processed foods:

• Feeding is about keeping the child happy, and is led by the child,

resulting in uncontrolled snacking habits.

• Snacks (biscuits, deep-fried snacks) are being given – often just

before the next meal.

• Maternal & Adolescent Nutrition • The life history from key informants can be summarized into following

diagram

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• marriage is the major event after which the lives of women change

dramatically,

• clear distinction with respect to our target audience namely;

• Adolescence (unmarried female):

live at home,

working/studying (high school/university).

No assignments as worker.

Mother does the cooking.

Rebellion, eat kid food/snacks.

Marriage is still aspiration (don't rebel against that).

• Reproductive (married female):

live either with own parents or husband‟s parents (negotiated).

Many role changes: now needs to cook for husband, self and kids (to be a

„complete woman‟);

becomes obedient wife, eats „mature‟ food, more meals.

Some degree of independence of the new couple within the larger

household.

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Main insights from the formative

research IYCF

• Three key behaviours were identified

• Reducing use of formula and increase exclusive breastfeeding

• Increase the diversity of complementary foods, reduce rice-heavy meals

• Reducing unhealthy snacking just before meals

• The umbrella campaign idea “Healthy Gossip” is built around the insight that

the mother is being judged by her social environment, including “nosy”

neighbours, whom she likes to please, to be seen as a good mother.

• Key characters in the campaign are:

• Lady Gossip – who gossips and gets corrected;

• An authority figure: the midwife, the grandmother;

• The „Perfect Mom‟ who„s got it all right.

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research Maternal Nutrition-1

A. Fear of having a large baby

• Pregnant women are worried about the pain of childbirth, and their

perception is that a bigger baby will produce more pain even lead to C-

section.

• The fear of C-section is caused by its hugely expensive costs (5 – 25 million

Rupiah, which will be very hard for them to afford), and a wide-spread belief

that a C-section more likely happens if the baby is large.

• There is also a belief, which is perceived by all of them that small babies

can catch up later in life.

• In addition, as they also face so many food taboos, they become more

careful of what they eat while pregnant.

• The combination of these factors makes the pregnant women uncertain and

fearful of having a baby that is too big, and thus restrict their food intake

(particularly fruit) while pregnant, with the potential consequence of having

an underweight baby at birth.

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B. Food and Financial Issues

• Food is not seen as a financial priority, so no one spends a lot on it. Food is

considered ephemeral: you eat it, and then it is gone. It is not an investment

like making your house nicer. If someone has extra money, they will spend it

on something that lasts, like house, clothes, or a child‟s education.

• Thrift or ngirit, is a part of the life philosophy and cultural training of all

Indonesians. It is one of the reasons why having high quality food is seen as

a wasteful luxury. There is also the concept of a “food wallet” (food

allowance), which means that people only spend a certain proportion of

their income on foodand disregarding its variations. This amount of money

spent tends to be the same regardless of social class. People spend

roughly IDR 10.000,00/day irrespective of how many people are in the

family.

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• People deprive themselves of food in daily life in order to be able to save

some to give it to the neighbors at special occasions:

Life-events (for social display)

Getting married (ceremony)

Getting pregnant (ceremony at 7 months to feed the neighborhood)

Giving birth (potential C-section)

Money for Ramadan

Helping family and relatives who needed (to reduce income variability)

• While there is special considerations provided: to pregnant women (this

related more with workload and any cravings she may have) – not for a

pregnant women, let alone a women not yet pregnant, to consume any form

of special foods which are different from the diet of the remainder of the

family.

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Conclusions from the formative


• There is lack of awareness amongst women of reproductive age

about the benefits of regularly consuming animal protein

• There is a belief that eating too much during pregnancy will result in

a larger baby, which is painful to deliver and might require having an

expensive C-section where as it is commonly believed that a child

born small will “catch up” later in life

• Food which they consume is more about satisfying basic hunger

needs than nutrition needs.

• The daily meal prepared at home is the same for the whole day,

which results in minimum appetite.

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Conclusions from the formative


• Snacking becomes part of their daily habit to avoid boredom.

• There is a culture of buying good (expensive) food only on special

occasions.

• It is not common for pregnant women to be fed differently and

women avoid asking for special food during pregnancy out of fear of

being seen as spoiled.

• The use of high quality foods are considered luxury foods eaten on

special occasions and served during social and cultural ceremonies,

e.g. the naming celebration.

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THANK YOU

Documents

1 FORMATIVE RESEARCH ON MATERNAL , INFANT AND YOUNG CHILD IN EAST JAVA