IMPLEMENTATION NOTES

× The Foundation for Mother & Child Health (FMCH) promotes effective complementary feeding practices through its First Thousand Days program, which aims to provide clear messaging through one-on-one counseling, courses, and home visits with pregnant and lactating mothers on complementary feeding practices. The objective of this program is to support proper growth and good health during the first 1,000 days of a child’s life, avoiding the common plague of undernutrition and malnutrition. This program was launched in 2006 by the foundation’s trustees and volunteers, and now has 25 full-time staff working at four clinics in Mumbai’s slums.

× In 2014, a baseline survey sampled 2,582 children under the age of three from a population of 150,000 within the informal settlement of Dharavi, Mumbai, one of the largest slums in Asia. The survey found alarming levels of malnutrition among children—18 percent of the children under three were wasted, 25 percent were stunted, and 28 percent were underweight (Aahar 2014).

× Based on global standards for nutrition, the National Rural Health Mission of India recommends complementary feeding to infants at six months to ensure optimum growth and development (NRHM 2012). However, in much of India, that target is not being reached. In an assessment of complementary feeding practices in Bihar, researchers found that only 58 percent children received any complementary foods at six months (Khan et al 2013).

× In October 2012, a baseline survey conducted in 20 blocks in the districts of Muzaffarpur, Samastipur, and Sitamarh in Bihar found significant gaps in infant and young child feeding (IYCF) practices, such as a low rate of breastfeeding immediately following delivery and the absence of any feeding schedule for children (Aga Khan Foundation 2012).

× Evidence shows that consistent and systematic interpersonal communication (IPC) is critical to changing infant and young child feeding (IYCF) practices (UNICEF 2013). Using this evidence, UNICEF designed videos to enhance the capacity of frontline workers to provide correct information and appropriate counseling on IYCF. The assumption is that building the capacity of frontline workers will lead to increased counseling, improved knowledge, and changes in practices among mothers and caregivers.

× Bihar is greatly challenged by a low rate of recommended infant and young child feeding (IYCF) practices. For example, only 30 percent of newborns are breastfed within one hour, and only 29 percent of children are exclusively breastfed for the first six months in Bihar (Government of India 2014). Poor breastfeeding practices alone lead to 800,000 child deaths each year in Bihar— almost 12 percent of all child deaths in the state (Aga Khan 2015). Optimal IYCF practices are urgently needed in the health facilities and at the community level.

× A baseline survey conducted during 2012 among selected districts with extremely marginalized populations in Bihar, Chhattisgarh, Jharkhand, and Odisha revealed high rates of malnutrition and poor infant and young child feeding (IYCF) practices. Among 3,489 children surveyed, 60.2 percent were stunted, 55.1 percent were underweight, and 24.4 percent were wasted. Only 23.9 percent of the children age 6–36 months received appropriate feeding from diverse food groups (AAM Unpublished).

× Participatory learning and action (PLA) is a promising approach to promote infant and young children feeding (IYCF) and other health, nutrition, water sanitation, and hygiene (HNWASH) practices. Since February 2014, PLA has been implemented in 14 blocks in eight districts of Madhya Pradesh through the Sanjhi Sehat program, which is led by the Government of Madhya Pradesh’s State Rural Livelihood Mission (SLRM). The mission implements Sanjhi Sehat in five districts, and district- level nongovernmental organizations (NGOs) implement it in three additional districts. Technical assistance is provided by the Madhya Pradesh Technical Assistance and Support Team (MPTAST) under the Department for International Development (DIFD)-supported Madhya Pradesh Health Systems Reforms program. Other partners include the Department of Health and Family Welfare and the Department of Women & Child Development, whose staff ensure that all services of the program are accessible and accountable to the community. The Public Health Engineering Department is responsible for the safe water and sanitation (toilet construction) infrastructure and services, which forms an important component of the HNWASH interventions.

× In Madhya Pradesh, significant improvements have been made in reducing undernutrition in the last several years. Between 2010 and 2014, the percentage of zero- to five-year-old children who were underweight decreased from 52 percent to 36 percent. However, 41 percent of children in the state were stunted. Poor child-feeding practices are associated with growth faltering. The most recent data show that 74 percent of zero- to five-montholds are exclusively breastfed, but only 48 percent of six- to eight-month-olds receive complementary foods (NIN 2011; MWDC 2014).

× The Integrated Child Development Services (ICDS) program provides supplementary food to millions of women and young children in India for approximately 300 days a year at ICDS-run anganwadi centers (AWCs). In the mid-1970s, ICDS began supplying centrally procured raw commodities or processed foods to AWCs.