{"id":33496,"date":"2015-03-03T14:49:24","date_gmt":"2015-03-03T13:49:24","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=33496"},"modified":"2015-03-03T14:49:24","modified_gmt":"2015-03-03T13:49:24","slug":"insights-into-infant-feeding-practices-in-indonesia","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2015\/03\/03\/insights-into-infant-feeding-practices-in-indonesia\/","title":{"rendered":"Janneke Hartvig Blomberg: Insights into infant feeding practices in Indonesia"},"content":{"rendered":"

\"unnamed\"<\/a>Experts in nutrition, researchers, academics, and business leaders gathered in London last\u00a0week for the Global Alliance for Improved Nutrition<\/a> (GAIN)\u2019s Symposium<\/a> to progress thinking\u00a0around infant and young child nutrition. When seeking to develop effective communications\u00a0to bring about lasting change, understanding the motivations and cultural and societal\u00a0beliefs that\u00a0inform behaviours is essential.<\/p>\n

Indonesia faces major nutritional challenges. Rates of childhood malnutrition are high and,\u00a0according\u00a0to the national nutrition survey Riskesdas<\/a> (2013), 37.2% of children in the country are affected by\u00a0stunting.<\/p>\n

In May 2013, GAIN teamed up with researchers from the London School of Hygiene and Tropical\u00a0Medicine<\/a> and Savica<\/a>, a public health consultancy, to conduct research into infant feeding practices in\u00a0East Java, Indonesia. The objective was to improve our understanding of what influenced women\u00a0when feeding their children, in order to develop a behaviour change campaign that would improve\u00a0infant and young child feeding practices. In particular, we wanted to find out more about the practice\u00a0of giving infants formula milk as a supplement in the first six months of the child\u2019s life\u2014a behaviour\u00a0we wanted to change.<\/p>\n

The formative research gave us some valuable insights into what influenced the behaviour of\u00a0mothers. With breastfeeding, we found that women were often concerned about their ability to\u00a0produce sufficient breast milk or whether it was of good enough quality. It wasn\u2019t that women didn\u2019t\u00a0want to breastfeed exclusively\u2014they all want what\u2019s best for their children so if they consider that\u00a0their own breast milk is insufficient, they may resort to using formula in the first six months.<\/p>\n

As a universal insight, it is common for women anywhere in the world to feel insecure about their\u00a0own breast milk. In our community activation component, one approach we chose was to use “emo-demos”\u2014short for “emotional demonstrations,” where we aimed to address the varying underlying\u00a0motivators of behaviour, which are generally non-rational and based on emotional responses. We\u00a0were trying to steer away from the education\/information route, which is often used for these types\u00a0of nutrition interventions. Our aim was for the women themselves to have an emotional revelation\u00a0moment, because we believed that would be far more influential on how they practised a particular\u00a0behaviour in the future. Most knew what the ideal behaviour was, but didn\u2019t do it because they\u00a0didn\u2019t believe their<\/em> breast milk was enough for their child.<\/p>\n

We also tapped into behavioural motives such as nurture, love, curiosity, and disgust. One such emo-demo we dubbed “refilling the glass.”<\/p>\n

Women\u2019s concern that they do not produce enough breast milk stems from the fact that they cannot\u00a0see how much their child consumes. As infants develop, they become more interested in other\u00a0things going on around them, they get more unsettled and distracted while they are being breastfed,\u00a0or begin putting things into their mouths, and lots of women misinterpret these behaviours as their\u00a0child being hungry, or ready to eat other foods.<\/p>\n

Refilling the glass was aimed at trying to get mothers to understand the relationship between their\u00a0child suckling and the production of the breast milk, namely the physiological response of milk\u00a0production stimulated by a child\u2019s suckling. Our objective was to have them realise that they can\u00a0produce enough during the first six months since their bodies will adjust to the needs and demands\u00a0of their child. If they use formula, the child will suckle less, which in turn means that the mother will\u00a0produce less milk. We were trying to give them a moment of revelation about the fact that they can\u00a0produce what their child needs.<\/p>\n

To visualise this, we utilised the very simple physics of oil versus milk, to demonstrate that if you\u00a0breastfeed then your body produces as much milk as your child consumes. We poured one glass full\u00a0of milk to represent the amount that the child demanded, and in the second we poured half milk\u00a0and half oil (representing formula). We then spoke about the fact that the child was consuming the\u00a0same amount in either case and that formula would not be given in addition, but would merely\u00a0replace the breast milk. We then also discussed that the milk produced afterwards would be less in\u00a0the woman who supplemented with formula, since milk\u00a0production\u00a0would only match what was\u00a0consumed previously.<\/p>\n

“Refilling the glass” was just one of a number of emo-demos we developed, and promoting exclusive\u00a0breast feeding was just one of several key behaviours we are trying to change. Yet it demonstrates\u00a0how important formative research can be in shaping behaviour change interventions, which can alter\u00a0deeply held beliefs about infant and child feeding.<\/p>\n

For further information, visit www.gainhealth.org<\/a><\/p>\n

Janneke Hartvig Blomberg<\/a><\/strong> is a senior associate with GAIN in the Maternal, Infant, and Young Child Nutrition team, where she is leading the design of complex projects including the MYICN project in Indonesia. She has worked on nutrition issues across sectors including health, agriculture, social protection, and early childhood development for more than 10 years, including as nutrition specialist for the World Bank, in academia (including the WHO collaborating centre Metropol University College, DK), and for various NGOs\u2014mainly in East Africa. She has a MSc in public health nutrition from the London School of Hygiene and Tropical Medicine, and a Honours BSc in nutritional and nutraceutical sciences from University of Guelph, Canada.<\/em><\/p>\n

Competing interests: None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"

Experts in nutrition, researchers, academics, and business leaders gathered in London last\u00a0week for the Global Alliance for Improved Nutrition (GAIN)\u2019s Symposium to progress thinking\u00a0around infant and young child nutrition. When […]<\/p>\n

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