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
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oual
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Brazzaville Pool
Cuvette
Sangha
Cu
vett
eO
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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%).
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SSA – 34%; ESAR – 49%WCAR – 24%Congo – National (19%); Brazzaville (41%), Plateau (15%)
Chad
Côte d'Iv
oire
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Sierra
Leone
Nigeria
B.Faso
Congo
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onCAR
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r
Seneg
al
Liberi
a
Gambia
DRC
G.Bissau Mali
Maurit
ania
Benin
Guinea STP
Cape V
erde
Ghana
Togo
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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
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