How might we improve infant nutrition in rural India?

2019 | Duration: 4 months | Client: UK-based funder & Rajasthan state government | Location: Rajasthan, India

Role: Behavioral Researcher responsible for designing research plan and framing scenario questions, assisted in moderator training, analyzed over 80 transcripts of different stakeholders, and assisted in conducting a co-creation workshop with a creative agency. Worked with two Graphic Designers, a Strategic Lead and an Engagement Manager

Problem

Improve infant nutrition in a state where only 3.4% of babies receive adequate diet and less than 60% of babies are exclusively breastfed, through a behavior change campaign

Process

Identifying the problem

After conducting a Literature Review and speaking to Field Experts we understood the key factors affecting infant nutrition in the state of Rajasthan. We focused on improving the three initial phases of nutrition, since these have the maximum impact on nutrition for this geography.

  1. Timely initiation of breastfeeding (at the time of birth)

  2. Exclusive breastfeeding (infant age 0-6 months)

  3. Complementary feeding (infant age 6-12 months)

Research Plan

We wanted to cover the primary audience (mothers) as well as strong influencers (mothers-in-law) since decisions about infant nutrition are taken by the household. We spoke to the supporting network (nurses, healthcare workers) to better understand institutional interactions and identify touch-points for intervention

Sample: n = 120

 Conducting Research

Why these methods? The tools were designed to minimize say-do gaps that occur due to easy recall of narratives and fear of judgment.

Picture-cards & Story-telling: Recall the day of childbirth to understand colostrum feeding practices, as well as ritual and key milestones that significantly affect nutrition

Food concept mapping: Grocery style game to understand the willingness to pay by ingredients and build an ingredient portfolio


Vignettes: To understand power dynamics and roles in the household as well as interaction with healthcare workers

 Key Insights

  • In periods of heightened risk the family feels that their feeding practices and caregiving are inadequate, resulting in overcompensation using unhealthy practices

  • High attention is given to the infant’s nutrition during the first vulnerable 6 months. After the initiation of complementary feeding, risk perception starts to reduce and plummets as the child integrates with the family unit

  • The goal of parents is to quickly help the child transition towards independently handling food, families rush through milestones with the use of adult mental models

From Insights to Interventions

A communication campaign strategy was devised that consisted of posters, jingles as well as guidelines for how front-line workers interact. The RajPusht Program now not only tackles pregnant and lactating women but also reaches out to community members, husbands, and family members to improve dietary patterns, health-seeking behaviors, and nutritional practices.

Workshop with a creative agency to design the campaign

Principle: create milestones for feeding

Principle: create a sense of progress

Principle: reduce choice overload

Result: Campaign implemented state-wise. Metrics being tracked over a 5-year period

Metrics: Initiation of breastfeeding within one hour of birth and colostrum feeding, exclusive breastfeeding during the first six months of life including when child is ill, and age-appropriate complementary feeding adequate in terms of diversity, quality, quantity and frequency for children 6-36 month