An unexpected bit of data: Choosing which complementary foods to promote

By Ann Jimerson, Behavior Change Specialist, Alive & Thrive

As our blog’s name, “Less Guess,” implies, we’re big on using data to make program choices. And we’re particularly glad when we can find the data we need without conducting a big new research effort. We found an excellent source in the form of a free and readily-available resource: local Demographic and Health Surveys. This “data tip,” based on Alive & Thrive’s work in Bangladesh, may help your choices too.

Here’s how it worked. Global evidence points to animal source foods, like meat, fish, poultry, and eggs, as crucial for children’s optimal growth and cognitive development. And since very few Bangladeshi children were fed these foods as recommended—starting at 6 months of age—there was plenty of room for improvement. It seemed like an obvious “small behavior” to promote.

But was it “doable”? That is, was the behavior feasible for poor Bangladeshi families?

When we suggested a focus on animal source foods, some of our partners argued that it was not ethical to suggest to families that they should offer their babies meat, fish, poultry, or eggs every day. Poor families could not afford those foods for their children. If our program promoted these foods, our partners said, we could leave families feeling poorer and more dejected.

But buried deep in the 2007 Bangladesh Demographic and Health Survey (BDHS) report, on page 157, Tina Sanghvi, our country director, found a table that made a different case.

BDHS table v2-01

This table in the 2007 Bangladesh Demographic and Health Survey (BDHS), “Foods and liquids consumed by children in the day or night preceding the interview,” offered an unanticipated bit of data for A&T’s choice of behaviors to promote. This helpful bit was on page 157.

The BDHS survey had asked mothers what foods and liquids they had given their children in the day or night preceding the interview. Not surprisingly, only 10% of children 6 to 7 months old had eaten meat, fish, poultry, or eggs. Perhaps families really were too poor to offer these foods to their children.

Instead of leaving the discussion at that, though, Tina ran her finger further down the column of figures. In the same sample of mothers, 75% said they had fed these foods the day before the survey to their children who were 2 to 3 years old. The majority of families did have the resources to feed their older children these highly valued foods on a daily basis. They apparently just weren’t convinced that it was appropriate to give these foods as early as 6 months of age.

BD diet diversity v2-01This fresh look at the BDHS won over the stakeholders. That one bit of data allowed our program partners to feel confident they could encourage mothers to feed these to their babies every day, starting as young as 6 months.

Instead of dropping that important behavior, the program planners shifted their attention to figuring out the best ways to convince mothers, families, and decision makers of every type that it was important—and safe—to feed these nutrient-rich foods to babies starting at 6 months.

That decision to promote animal source foods actively, as one part of a comprehensive program, paid off. Our aim had been to improve dietary diversity among children 6 to 24 months of age. In just four years, in the areas where the program operated most intensively, dietary diversity doubled, from 32% to 64%. Some of the greatest increases were in the animal source foods we promoted: following the program intervention, almost three times as many children in that age group ate eggs compared with before the program; six times as many ate liver or other organ meats; and twice as many ate fish.


The BDHS data helped planners feel comfortable with broadcasting this TV spot to promote animal foods for all babies over 6 months of age.

No need to guess—or base decisions on incorrect assumptions. Instead, search for data to shape your strategy. And remember that sometimes the data are there all along, waiting. You just need to track them down.

Tackling gender equity, one nutrition TV spot at a time

By Ann Jimerson, Behavior Change Specialist, Alive & Thrive

As the clock ticks to mark the first hour of the baby’s life, a young mother raises her hand to contradict her mother-in-law, who wants to give the baby honey instead of breastmilk. It’s one of my favorite TV spots from Alive & Thrive’s (A&T) program in Bangladesh. Every time I view this TV spot, I feel a surge of emotion when the young mother firmly says, “No, give her to me. I have to breastfeed.”

bangladesh 1

This young mother surprised viewers by taking control of her baby’s first hour of life.

So it caught me off guard when a participant in the recent SUN Movement Global Gathering questioned the program planners’ decision to portray this young mother standing up to the authority of elders. “Why did you show the mother that way? It’s completely unrealistic. That would never happen,” the participant said.

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Breastfeeding: Working to make it work

Ellen Piwoz, Senior Program Officer, the Bill & Melinda Gates Foundation
Originally posted on Devex

The theme of World Breastfeeding Week 2015 is “Let’s make it work!”—focusing on supporting working women that breastfeed. The reality is that all women work, whether in the home or in an office, factory, or field. The question then is: What do we need to do to make breastfeeding work for women and their children, no matter where they live or what they do?

An important first step is ensuring that women have the accurate information needed to make feeding choices for their children. Just last week, a National Institutes of Health study found that 20 percent of new moms in the United States did not receive any breastfeeding guidance from their doctors. The World Health Organization recommends initiating breastfeeding within one hour of birth and breastfeeding exclusively — no water, nor anything else — for the first six months.

To read the full text, please visit: Breast-feeding: Working to make it work

Remembering Luann Martin: Promoting breastfeeding for 25 years


In memory of our friend, colleague, and long-time advocate for infant and young child feeding, Luann Martin, we are sharing a personal story that she wrote last year at this time. Luann recently passed away on July 14, 2015.

luann for webLuann and I met in 1994 in Washington, DC. We had both recently returned from living overseas and soon discovered we had much in common. From that time on, we worked together for the next 20 years. Most recently, I had the pleasure of working with her on Alive & Thrive, from the beginning in 2009 until December 2014 when she retired.

Luann cared deeply about improving the lives of women and children and her work touched the lives of millions of children and their families around the world.

In celebration of Luann’s legacy and in honor of World Breastfeeding Week, here is her story. We welcome you to share memories of Luann in the comments of this blog post.

Originally published during World Breastfeeding Week 2014.

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In Ethiopia, rapid improvements in child feeding behaviors are possible

Dr. Manisha tharaney, senior technical advisor, nutrition, ALIVE & THRIVE



Alive & Thrive recently released results from its first five years in Ethiopia, where infant and young child feeding programs reached an estimated two million mothers of children under two. As in Bangladesh and Viet Nam, we found that a comprehensive approach led to rapid improvements in feeding practices.

The prevalence of exclusive breastfeeding—already at high levels—increased to more than 80 percent in program areas. We also saw promising gains in complementary feeding practices. More children started receiving appropriate complementary foods at around six months of age and the percentage of children eating a diverse diet, while still extremely low, doubled in just four years.

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Scaling up nutrition works: Three strategies for success

JEAN BAKER, project director, ALIVE & THRIVEFHI 360

Can interventions be delivered at scale to improve nutrition during a child’s critical first two years? That is the question we set out to answer more than six years ago. And now the evidence is in—rapid, large scale increases in infant and young child feeding practices are feasible.

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How to reach “masses” when mass media are not available? Follow the money!

Ann JimersonTina Sanghvi, and Silvia AlayónALIVE & THRIVE

Quick. I say “mass media campaign” and you name the “media” that come to mind: _____.

Not so long ago, you would likely have answered “TV and radio.” With “new media” abounding, broadcast TV and radio are now relegated to “traditional media.” But what about when technology—even electricity—lags. What does “mass media” mean then?

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