Food Based Approaches to Improve Infant and Young Child Feeding Practices

Lessons from Afghanistan

South Asia Regional Knowledge Forum: Improving IYCN

Dr. M Akbar Shahristani, Food Security and Nutrition Coordinator, MDGF, FAO-AF

Dr. SM Moazzem Hossain, Chief of H&N, UNICEF Afghanistan

Kathmandu, Nepal, June 12-13, 2012

Malnutrition and Food Insecurity in Afghanistan

U5 mortality rate 97 per 1000 live births

U5 Chronic

malnutrition (stunting)

55 %

U5 Underweight 31 %

U5 Acute malnutrition 10 – 30 %

High prevalence of micronutrient deficiencies

Low dietary diversity 61 %

Low food intake 30 %

Below poverty line 42 %

Improving Complementary Feeding through Household Food Security

Geographical Coverage:

1. 4 Provinces, 8 districts, 16

Villages/ 64 HH

2. diversity of practices: ecology,

culture, food access and

seasonal variation

Proj. duration: 2006 – 2008 2nd

phase up to 2011

Implment: FAO-AF in collaboration

with line Ministries

Tech inputs: UNICEF Afghanistan

Challenges for improving complementary feeding for young children

• Poverty affecting ability to obtain and prepare nutritious

Complementary Feeding (CF), but also living conditions that can

impact the health of young children

• Availability and accessibility of diverse nutritious food

• Limited family financial resources to buy foods for CF

• Seasonal food availability problems

• High number of children in a Household

• Misconceptions or beliefs about certain food

• Time constraint to cook and feed

• Lack of motivation mothers/caregivers

Testing feeding recommendations through Trials of Improved Practices

• Past experiences in nut education:

Focus on giving ideal messages

Little participation by caregivers

• Justification of TIPs:

Pre-test in real home situation find out what is practical and why

Identify motivating factors for behaviour change before wider dissemination of recommendations

Set interim targets towards ideal & modify recommendations

Steps towards Ideal Behaviour

Improving CF Practices

Linking food production & nutrition linkage:

• Raise awareness of foods available & gaps for

balancing diets

• Develop seasonal food availability calendar

• Facilitate effective participatory planning Using participatory approach

Improve/Develop CF recipes

•Wheat flour + Oil •Bread +Tea

• Assess the most acceptable and

feasible feeding practices

• Identify the constraints to change

• Identify motivation for mothers to

continue good practices

• Dialogue between mothers and

service provider

• Mother has a choice

• Mother selects a practice

• Recommendations are tested at home

• Mother takes small practical steps at a

time

• Information is gathered

Consultative Process for Improving CF

Start! Demonstration

Counseling

Follow up ! Help in

demonstration Counseling

Follow up ! Help with

demonstration Counseling

Economical

Problems

Un-aware

Un-informed

Mother

Time

Busy Mother

Support to

mother

Food habit

Food behavior

Food availability

Local & Seasonal

Demonstration & Counseling

• Mothers improved the content and frequency

• Children have better appetite of improved complementary food than

plain porridge

• Mothers changed their cooking and purchasing patterns

• Mothers of sick and malnourished children tried a wider variety of

recipes

• Locally produced food empower families to feed their children

• Visible improvement in children’s nutritional status encouraged mothers

Results

• Ensuring availability of diverse foods at the household-level all year round (food production, diversification, preservation and processing)

• Methods of food preparation to reduce the time needed to prepare CF

– Introducing fuel efficient stoves

• More counseling on complementary feeding practices to encourage and support positive behaviors

• Income-generation activities to empower family also to buy food needed to improve CF

• Hygiene education and improved sanitation

• Strengthened monitoring and evaluation

Lessons Learned

Linking Complementary Feeding with Food Security

Small Scale Food Processing

(for year-round availability and

accessibility)

-Drying, pickling

-Jam and chutney making

Reducing Mothers time for CF:

- Processing techniques such as

pounding (nuts, dried vegetables)

-Cooking methods of different foods

(soaking beans before cooking to

reduce preparation time)

Diet Diversification • Selecting crops based on

nutritional value • Setting up home gardens • Promoting fruit tree nurseries • Improving water availability

(irrigation, water harvesting) • Raising small scale animal

husbandry • Bee keeping Food Safety and Hygiene Proper preparation and handling

while cooking Improving storage of foods Hygiene (home environment,

cooking utensils)

Nutrition Education

Food Production

Food Preparation

Food Processing

Livelihood Income

Rural Development

Families, Women and Children

Community

Mobilisers

Health

Health Workers

Community

Volunteers

Agriculture and

Women

Extension

Education

Literacy

Teachers

School

Teachers

Schools

Students

Literacy

Classes

Women Producer

Groups

Health Action

Groups Community Development

Committees

Project Planning, Coordination, Implementation (Government of Afghanistan and FAO)

Community Platform

Household, Individual Level

Sectors

Women Affairs

Agriculture

Women

Shuras

Health and

Economic unit

Food production, marketing Post harvest management

Community Institutions

CDCs (Gardens, GH, NE)

WC (gardens, FP, NE, CD)

Schools (Garden, NE)

CHW (Gardens, Nutrition messages)

Clinics (gardens, NE, CD)

Agriculture Extensions: NE, FP, CD

School Shura

Rep DoW: moblz, NE, FP

PNO, health officer: NE

SM: Organize CDCs

Mullah Imams: give massages

in religious events

Multi-Sectoral Approach in IYCF

Project to Program to Policy:

Multi-Sectoral Approach at National Level

Nutrition Action Framework (NAF)

Nutrition Action Framework 2012-16

A Multi-Sectoral Framework with:

Ministry of Agriculture, Irrigation and Livestock

Ministry of Commerce and Industry

Ministry of Education

Ministry of Public Health

Ministry of Rehabilitation and Rural Development

Overall Objective

To reduce stunting in children aged 0-24 months by 10 percentage points (from an estimated 59% to 49% by the end of 2016).

Primary focus:

• “first 1000 days,” i.e. the period from conception to two years of age (minus 9 months to plus 24 months)

Actions to be implemented

• Increase food availability for food insecure families

• Improve food access for food insecure families

• Improve the quality of diets

• Improve care and feeding practices for infants and young child children and self-care for pregnant women and adolescent girls

• Assure the healthy absorption of nutrients by preventing infection

Food security and nutrition security

Nutrition

status

Caring

capacity Environmental

conditions

Health

services

Food

intake Health

status

Food

availability

Production

Purchase

Donation

Food security

Nutrition Security

Proposed Governance of NAF

• Agreement for a high-level coordination mechanism

• High Level Food and Nutrition Security Steering Committee being proposed under the chairmanship of the Second Vice President and comprised of the Ministers from each of the five core Ministries

• Steering Committee to be supported by a modest secretariat with the following core functions:

– Coordination and oversight function,

– Develop a M&E Framework, data collection and analysis to track the operationalization of the NAF by core ministries

– Advocacy/communications

Thank you!