1. A SOCIAL NORMS PERSPECTIVE FOR IMPROVING INFANT FEEDING IN WEST AND CENTRAL AFRICA ***** FROM PROMOTING SCIENTIFIC EVIDENCE TO ADDRESSING FACTUAL BELIEFS AND NORMATIVE EXPECTATIONS Felicite TCHIBINDAT – UNICEF WCARO Advances in social norms and social change University of Pennsylvania, 07/12/2012

2. Outline of the presentation Introduction Main behaviour problem and analysis What has been done and analysis How to address the behaviour problem through a social norms’ perspective LLikouala Lekoumou Brazzaville Pool Cuvette Sangha Cuvette Ouest Plateaux Niari Kouilou Bouenza

3. Global recommendations on IYCF early initiation of breastfeeding with one hour of birth; exclusive breastfeeding 0-5 mos (reduction of mortality 13%); Nutritionally adequate and safe complementary foods 6-23 mos (reduction of stunting 19.8%).

4. SSA – 34%; ESAR – 49% WCAR – 24% Congo – National (19%); Brazzaville (41%), Plateau (15%)

5. Main behaviour problem The main problem for infant feeding in Plateau region is the fact that most mothers do not exclusively breastfeed because they give water with breast-milk and they introduce semi-solid food much earlier than the recommended six months.

6. Giving water is a social norm in Plateau region influenced by factual beliefs and social expectations Analysis of the behaviour

7. 7 Strategies promoted globally Community- based counselling and support Skilled support by the health system (Maternity and PHC) Legislation (Code and maternity protection) Additional complementary feeding components (optimized use of local foods, agriculture, supplements and social protection) Communication (multiple channels) IYCF in difficult circumstances (HIV and emergency)

8. Strategies implemented in Congo Draft national code for marketing breast-milk substitutes (legal framework) Baby-friendly hospital initiative (HW capacity development) Capacity building of Community Resource Persons Interpersonal communication (mothers with young children) on benefits of BF/EBF Group communication on how to improve complementary feeding (use of germinated maize, peanut butter) Evaluation (knowledge change but not behaviour)

9. Analysis of the intervention Training limited to scientific facts and did not address the factual beliefs. Communication materials not based on the results of the formative Communication activities targeted young mothers and not mothers in law. The group communication focused on technology improvement but not on addressing factual beliefs and scripts.

10. Using social norms perspective to improve infant feeding CHANGING FACTUAL BELIEFS  Water in breast-milk  Hot/cold RE- CATEGORISATION  A good mother is one who exclusively breastfeed her baby LEVERAGING THE COHERENCE  Involving mothers in law and other central nodes (network analysis)  Core group (network analysis)  Organised diffusion (bridges) FOSTERING COMMITMENT  Interactive popular theatre, use of stilt walkers or puppets  Common hut (“Mbongui”)  Sisterhood societies  Public declarations

11. RECOMMANDATIONS 1.Formative research (behaviour, factual beliefs, scripts, social expectations, network groups) 2.Creative ways of changing factual beliefs or changing social norms; 3.Creative ways of organising the diffusion 4.Documentation and lessons learnt 5.Monitoring and evaluation (developing tools..) 6.Capacity development on social norms for nutrition specialists

12. THANK YOU MERCI OBRIGADO ASANTE