Purnima Menon IFPRI Enabling policy environments for infant and young child feeding and nutrition: The roles of actors, networks, narratives, and data

Funding and contributors  Funding:  Bill & Melinda Gates Foundation, through Alive & Thrive, managed by FHI 360 (  A4NH  Contributors  IFPRI  Noora-Lisa Aberman  Eva Schiffer  Jody Harris  Andrew Kennedy  Neha Kohli  Kuntal Saha  Phuong Nguyen  Disha Ali  Collaborators  Nazneen Akhtar  GMMB  Edward Frongillo

The first 1000 days of life (pre-pregnancy to 24 months) are a crucial period for nutrition LAC Europe & Central Asia North Africa & Near East Sub Saharan Africa South Asia INFANT AND YOUNG CHILD FEEDING

mo: Complementary feeding & Continued BF Windows of Opportunity Preconception through pregnancy 0-6 mo: Exclusive breastfeeding K Dewey Guiding principles for complementary feeding (2003; 2005) INFANT AND YOUNG CHILD FEEDING

Optimal IYCF practices at the household level also require an enabling policy environment  Exclusive breastfeeding (EBF)  Agreements about critical need to provide policy support to EBF  Maternity leave and work place legislation  Monitoring of compliance with the International Code of Marketing of Breastmilk Substitutes (“the Code”)  Investments in communications and awareness raising campaigns  Complementary feeding  Monitoring of compliance with the International Code of Marketing of Breastmilk Substitutes (“the Code”)  Investments in communications and awareness raising campaigns  Codex Alimentarius standards for production of complementary foods

Using data to drive program focus and results Alive & Thrive Program Framework

Elements of Alive & Thrive advocacy and policy engagement strategy Policy Advocacy Messages and materials Data and evidence Stakeholders and partnershiips Media engagement

Key objectives for policy advocacy evaluation led by IFPRI  Understand and document shifts in the overall policy environment for IYCF and nutrition in Bangladesh, Vietnam and Ethiopia  Elucidate contribution of Alive & Thrive policy advocacy engagement and interventions to the shifts in the policy environment (focus on issue ascendance)  Separate ‘deep-dive’ studies in each country  Media engagement in Bangladesh  Support to provincial planning for nutrition in Vietnam  Bringing attention to stunting and prevention of stunting in Ethiopia Illustrative example for today: overall policy environment in Bangladesh

Issue ascendance is one of the more “upstream” stages in the policy process Menon et al., Food and Nutrition Bulletin, 2011

Framework for issue ascendance Shiffman and Smith (2007): framework for issue ascendance in global health Ideas Issue Characteristics Policy Dialogue Political Contexts Actor Power Framework used because major policy and advocacy interventions in Alive & Thrive were initially focused primarily on getting and keeping the issue of IYCF on the agenda (rather than, say, getting a policy formulated)

2014 endline assessment of policy environment, integrating analysis of event database and program documentation baseline assessment of policy environment Document A&T activities through event database Key components of policy process research

Data collection for policy environment assessment at 2010 and in 2014 (planned) Framework domain Actor Power (actors, networks, leading institutions) Net-Map (IFPRI, individual interviews) Net-Map (planned by another research group; use of group interviews) IdeasOpinion leader research by advocacy firm (2009) Stakeholder interviews by IFPRI Policy contextReview of policy documents by IFPRI Review of policy documents and A&T documentation by IFPRI Issue characteristicsNational level data from DHS (2007) National level data from DHS (2011)

Event database developed to track and analyze advocacy strategies  Data based was coded based on advocacy best practices  to identify strategies initially used, and shifts in strategies over time Monthly project updates

Ideas Issue Characteristics Issue ascendance on the policy agenda Political Contexts Actor Power Very complex, with many local and civil society players.. Strong central influence of some key government players and some individuals. The were was high level of central influence and lack of dynamic exchange across the network Stunting levels remain high and stagnant in recent years Exclusive breastfeeding was low, and stagnant over the years; complementary feeding is very suboptimal Nutrition was seen as one of many issues that should be tackled by raising the economic status of the population and reducing poverty Knowledge about stunting, the importance of IYCF, or solutions to the problems were variable across key actors Global actions and strategies have entered into national policy discourses and actions but concerns remain about translating of guidelines into action on the ground. Public health messages on IYCF are in danger of being eroded by persistent Code violations on the marketing of formula Overall Bangladesh policy environment (2010)

What baseline findings meant for IYCF policy advocacy in Bangladesh  Ideas: Diverse views at the beginning; advocacy aims to shape a more coherent narrative  Policies: Having national strategy for infant feeding helped; A&T was able to take it to the next actionable level.  Issue characteristics: The situation was poor to start with; the data enabled good ‘story telling’. A&T focus on deepening understanding through data People matter. In Bangladesh, the actor network for nutrition was complex and large. A&T’s advocacy and policy engagement has been strategic and systematic – slowly reaching all influential actors and ‘bringing them in’ over 4 years

Key insights from event analysis on strategic mix of advocacy activities - Activities included: generating and framing evidence on IYCF, investing in capacity-building initiatives for communities and government quarters, and building communication materials at an early stage, training media and initiating media study circles to enhance media coverage and shape discourse via media - A&T staff, in partnership with staff from other organizations, acted as policy entrepreneurs and champions using strategies such as alliance building, dialogues, and discussions as well as media and dissemination strategies. - A&T and partners used or created policy windows that included award ceremonies, launch events, and special days or weeks. - Extensive efforts to popularize the discourse via news coverage and dissemination, thereby providing external framing and advocacy of policy issues.

Methodological reflections  Shiffman & Smith framework works well for assessing factors related to issue ascendance; other aspects of policy process demand other frameworks and theories  Net-Map was useful to map actors and networks, but not perfect; major network characteristics well captured, but nature of participatory Net-Map interviews, time/availability or lack of knowledge of some stakeholders about others limits utility/accuracy  Event database requires continuous and diligent ‘data entry’ and continuity of research staff for coding and analysis; monthly updates possibly limited  Program itself has moved rapidly and advocacy and policy support interventions have gone beyond advocacy for “issue ascendance”!  Data challenges between 2010 and 2014 assessments: several other policy process issues and researchers, but similar methods, same stakeholders/interviewees

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