A SOCIAL NORMS PERSPECTIVE FOR IMPROVING INFANT FEEDING IN WEST AND CENTRAL AFRICA

***** FROM PROMOTING SCIENTIFIC EVIDENCE TO ADDRESSING FACTUAL

BELIEFS AND NORMATIVE EXPECTATIONS

Felicite TCHIBINDAT – UNICEF WCAROAdvances in social norms and social change

University of Pennsylvania, 07/12/2012

Outline of the presentation

• Introduction• Main behaviour

problem and analysis• What has been done

and analysis• How to address the

behaviour problem through a social norms’ perspective

LLik

oual

a

Lek

oum

ou

Brazzaville Pool

Cuvette

Sangha

Cu

vett

eO

ues

t

Plateaux

Niari

KouilouBouenza

Global recommendations on IYCF

• early initiation of breastfeeding with one hour of birth;

• exclusive breastfeeding 0-5 mos (reduction of mortality 13%);

• Nutritionally adequate and safe complementary foods 6-23 mos (reduction of stunting 19.8%).

Click icon to add picture

SSA – 34%; ESAR – 49%WCAR – 24%Congo – National (19%); Brazzaville (41%), Plateau (15%)

Chad

Côte d'Iv

oire

Gabon

Sierra

Leone

Nigeria

B.Faso

Congo

Camero

onCAR

Eq.G

uineaW

CARNige

r

Seneg

al

Liberi

a

Gambia

DRC

G.Bissau Mali

Maurit

ania

Benin

Guinea STP

Cape V

erde

Ghana

Togo

-

10

20

30

40

50

60

70

3 4 6

11 13

16 19

21 23 24 24

27

34 34 36 37 38 38

41 43

48 51

60 63 63

Rates of exclusive breastfeeding in West and Central Africa Region - 2011

Main behaviour problem

• The main problem for infant feeding in Plateau region is the fact that most mothers do not exclusively breastfeed because they give water with breast-milk and they introduce semi-solid food much earlier than the recommended six months.

0-1 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-23

0

10

20

30

40

50

60

70

80

90

100

age (months)

%

Giving water is a social norm in Plateau region influenced by factual beliefs and social expectations

Most mothers do not exclusively breastfeed their under 6 months because of mothers in law and other

mothers in the village

CONDITIONAL PREFERENCE

They believe that other mothers are giving

water before 6 months EMPIRICAL EXPECTATIONS

They believe also that their mothers in law; other elder women and their peer believe that they ought to give

water to the infant; if they do differently; they will be consider as

bad mothers

NORMATIVE EXPECTATIONS Mothers give the reason that breast-milk is hot and

it heats the heart of the child and water is given to cool the heart otherwise

the child will die

FACTUAL BELIEF

Young mothers has supposed to obey to their

mothers in law

SOCIAL EXPECTATIONS

Analysis of the behaviour

7

Strategies promoted globally

Community-based

counselling and support

Skilled support by the health

system (Maternity and

PHC)

Legislation (Code and maternity

protection)

Additional complementary

feeding components (optimized use of local

foods, agriculture, supplements and social

protection)

Communication (multiple channels)

IYCF in difficult circumstances

(HIV and emergency)

Strategies implemented in Congo

• Draft national code for marketing breast-milk substitutes (legal framework)

• Baby-friendly hospital initiative (HW capacity development)

• Capacity building of Community Resource Persons• Interpersonal communication (mothers with young

children) on benefits of BF/EBF• Group communication on how to improve

complementary feeding (use of germinated maize, peanut butter)

• Evaluation (knowledge change but not behaviour)

Analysis of the intervention

• Training limited to scientific facts and did not address the factual beliefs.

• Communication materials not based on the results of the formative

• Communication activities targeted young mothers and not mothers in law.

• The group communication focused on technology improvement but not on addressing factual beliefs and scripts.

Using social norms perspective to improve infant feeding

CHANGING FACTUAL BELIEFS

Water in breast-milk Hot/cold

RE-CATEGORISATION

A good mother is one who exclusively breastfeed her baby

LEVERAGING THE COHERENCE

Involving mothers in law and other central nodes (network analysis)

Core group (network analysis) Organised diffusion (bridges)

FOSTERING COMMITMENT

Interactive popular theatre, use of stilt walkers or puppets

Common hut (“Mbongui”) Sisterhood societies Public declarations

RECOMMANDATIONS

1. Formative research (behaviour, factual beliefs, scripts, social expectations, network groups)

2. Creative ways of changing factual beliefs or changing social norms;

3. Creative ways of organising the diffusion4. Documentation and lessons learnt5. Monitoring and evaluation (developing tools..)6. Capacity development on social norms for

nutrition specialists

THANK YOU

MERCI

OBRIGADO

ASANTE