Modalities
Infant and young child feeding counselling must be provided to all carers of infants and young children as part of routine care and across all services that deal with mothers and children (including treatment of wasting, ANC and PNC, ongoing MCHN support etc), especially in contexts where wasting and nutritional oedema occur.
- Develop/adopt/deliver SBC approaches using multiple channels and platforms (traditional, local, digital and others) to address barriers to good practice for health and nutrition.
- Identify all the groups from the community that might influence IYCF practices: mothers, fathers, grandmothers, mothers–in–law, traditional healers, religious leaders, male groups, elders, siblings etc. These are known as the key influencers or the gatekeepers to change;
- Prioritise individual level behaviour change (for caregivers as well as key influencers) over mass campaigns.
- Identify barriers to optimal IYCF practices and then use those barriers to design relevant activities.
Conditions and considerations
- Nutrition counselling needs to go beyond providing information; work with individuals, families and community leaders to understand their needs and motivations, identify their strengths and lower barriers to positive change.
- Mass campaigns are useful to communicate messages but show limited influence on individual behaviours.
- In order for this counselling to have the most benefit for the prevention of undernutrition and for other child health and nutrition outcomes, personnel carrying out the counselling should have comprehensive training and be supervised regularly, with dedicated resources and time within health system strategic planning for this intervention. This includes training in IYCF basic messages as well as identification of IYCF issues in order to refer for appropriate care and support.
- Regular supervision is required to support community and health workers in the delivery of quality nutrition education and counselling.
- Wherever SBC interventions are implemented, contextually–appropriate gender equality promotion should form a core element of the approach.
- If health services are mobile, consider including an IYCF Counsellor in mobile teams to identify feeding issues that may relate to the health status.
- Pregnant women, mothers, families and health care workers need to be protected from exploitative marketing from manufacturers and distributors of breastmilk substitutes.
- In camp settings MCHN staff should set up a structure to welcome and provide IYCF assessment and counselling to mothers, caretakers, infants and children and refer for skilled support once feeding difficulties are identified (eg, at registration).
- Designing behaviour change interventions requires engagement with the target population, understanding their barriers and motivation to change, and adapting interventions to the contexts that facilitate change, including the environment and social networks. This can include:
- Formative research on gaps in knowledge, skills, practices, acceptability, desirability and affordability linked to complementary feeding may be required.
- Understanding the enabling environment and supportive services required to enable women to continue breastfeeding, eg, access to breastfeeding counselling, actions/services that support women to breastfeed outside the home/when they are working.
- Consideration of caregivers’ WASH and nutrition– related practices and beliefs, their overall workload and social position when designing behaviour change interventions.
- Empowering women, through knowledge, resources and child care support, to adopt best practice.
- Consideration of resources/time available, eg, responsive feeding requires caregivers to have time to be present while the young child eats or self–feeds and have resources so that food loss during self–feeding does not present a problem.
- Counselling and SBC to support recommended best hygiene practices for child nutrition, eg, For nomadic groups, awareness–raising about the safe burial of feces (eg, safe distances from water points and homes, “cat pit/hole” methodology).