SBC  in Nutrition- using community platform( Jeevika) Bihar, Evidence and learnings Biraj Laxmi Sarangi Technical Specialist – Nutrition, Project Concern International ( PCI) Jeevika Technical Support Program, Bihar

OUR VISION The most vulnerable people in the world will have the power to lift themselves out of poverty and to create vital, healthy lives for their families and communities now and for the future. www.pciglobal.org

Geographical Coverage and MNCHN Interventions (JTSP) District 11 Blocks 101 SHG 124529 SHG women 1494348 Village 6909 Maternal and Child Health (1000 Days Window Period) Maternal Nutrition and IYCF Access, choice, and quality in Family Planning Enteric Diarrheal Diseases

Key Strategies Community Action Group (PRI, VHSNC) Behaviour Change Communication Capacity building of the community institutions for demand generation and quality of services Develop Community Resource Persons to steer H&NS agenda through the community institutions Convergence with ICDS and Health for service provision, availability and accessibility of adequate supplies, and timely referrals Touch Points to integrate Health, Nutrition & Sanitation HHs SHGs VOs CLFs & Community Action Group (PRI, VHSNC)

Pre pregnancy, During pregnancy, Lactation, Inter pregnancy Core Areas – Nutrition Core areas Maternal Nutrition Pre pregnancy, During pregnancy, Lactation, Inter pregnancy Diet Diversity IFA consumption IYCF Early and Exclusive Breast Feeding Complimentary Feeding (adequacy, frequency and diversity) Hygiene Hand Washing © Bill & Melinda Gates Foundation

Campaign on Exclusive breastfeeding Bihar 11th July – 18th July’2016

Why campaign on Exclusive Breastfeeding Universalization of breastfeeding may help avert deaths of 823,000 children and 20,000 mothers globally each year (Lancet series on Breastfeeding, 2016) Despite 63% institutional deliveries in Bihar, rates of EIBF are low (NFHS-4) Only 35% of children are breastfed within an hour of birth Only 54% of children were exclusively breastfed during the first 6 months of their lives All figures in %

Evidence Formative research ( Alive & Thrive 2015)

Initiation Despite 63% (NFHS4) institutional deliveries in Bihar, rates of EIBF are low, primarily because Belief amongst family members and mothers alike that there is no milk in the first 2-3 days combined with lack of knowledge of how much milk a child needs during this time Lack of knowledge and skills on part of FLWs to enable mothers to initiate BF early, lack of complete understanding of when and how breastmilk is produced Common practice of giving pre lacteals due to cultural reasons Delayed initiation in Muslim communities due to practice of reciting the Aazaan before the child is breastfed

Exclusive Breast Feeding Most of the respondents do not practice EBF in spite being knowledgeable because Consider exclusive breastfeeding to be inclusive of water Feed other forms of milk/ milk products & pre lacteals as believe them to be nutritive, digestive & cleansing aids Initiate feeding biscuits, daal ka paani from 4-5 months because of perceived insufficiency of breast milk to suffice child’s hunger Confused about the ideal span of exclusive breastfeeding – before completion of 180 days or before No variations across districts regarding exclusive breastfeeding was found

Continuation Disparity in the period of breastfeeding for boys and girls was noticed among the Muslim communities across Gopalganj, Gaya and Patna as a form of adherence to traditions Health workers do not emerge as the key advisors on problems related to breastfeeding as respondents prefer home remedies to their counsel AWWs are concerned about contradictory advise given by private practitioners

Campaign Coverage District Patna, Begusarai & Nawada Blocks 20 VOs 477 y P t n J m u i R o h s r K B k A S w p l M d b N W e j x z f g V D C E L Units Number/Details District Patna, Begusarai & Nawada Blocks 20 VOs 477 Villages 240 Schools 252 Time 11- 18 July Goal: To increase knowledge around the usefulness/benefits of exclusive breast feeding and address the myths and misconceptions Target Audience Primary: Pregnant Women & Lactating Mothers Secondary: Mothers- in-law, Husbands, School Teachers & Children, Adolescent girls & Frontline workers

CAMPAIGN CHRONOLOGY DAY 1 (11th July) Target group: ASHA and JEEViKA Community Mobilizers BCC event: Slogan writing competition, Signature campaign and Oath taking ceremony. DAY 2 (12th July) Target group: Pregnant and lactating women BCC event: Video films, interactive game on latching & positioning of baby and Padyatra (rally) DAY 3 (13th July) Target group: School Teachers and students BCC event: Video films, slogan writing on EBF and demonstrations on hand washing. DAY 4 (14th July) Target group: Mothers-in-law BCC event: Video films, quiz and interactive games on latching & positioning of baby DAY 5 (15th July) Target group: Male family members BCC event: Video films, quiz and interactive games on latching & positioning of baby. DAY 6 (16th July) Target group: Adolescent girls BCC event: Bicycle rallies with slogans. DAY 7 (18th July) District workshop led by the District Magistrate and attended by the DDC, Civil Surgeon, officials from Health, ICDS and Education departments.

Campaign Coverage District Blocks Village VO School Planned Covered Pregnant & Lactating Women Mothers-in-law Fathers & Fathers-in-law Adolescent Girls Patna 3 38 37 82  81 Nawada 9 126 115 118 107 192  192 133 132 Begusarai 8 76 73 75 70 203  202 81 Total 20 240 226 230 225 218 477 475  252 243 More than 57,000 pregnant and lactating women, mothers-in-law, fathers, fathers-in-law, school children, teachers and adolescent girls took part in the campaign

Campaign Measurement Two rounds of cross sectional quantitative sample surveys among mothers having 0-6 months old children were conducted using structured interview schedules. A multi-stage systematic random sampling was used to select respondents using a random start. Sample size: Round District Block Village VO Women Baseline 3 8 67 89 608 End-line

CAMPAIGN EFFECT Improvement in Knowledge on breastfeeding Improvement in exclusive breastfeeding practices All figures in % Significant rise not only in knowledge but also in actual practice observed after the campaign! Note: * shows 10% level of significance ,** shows significant at 5% level of significance and *** shows 1% level of significance

Lessons Learnt and Way Forward Quality Execution Meticulous planning, optimal involvement of JEEViKA ground force, convergence with other depts. Efficient Delivery No gap between planned and actual activities – universal campaign coverage as planned Effective outcome Spike in desired results among intended audiences The campaign’s protocols, guidelines and resources can serve as a blueprint to drive smooth scale-up for organizing such community-based events - 1,16,856 members from 2,367 VOs participated in the village level awareness rally on EBF organized by ICDS during the World Breastfeeding Week (1-7 Aug, 2016) Jeevika platform can be used in launching similar other campaigns aimed at reinforcing critical HNS outcomes besides other regular touch points.