A&T Framework for Scaling up IYCF Programs

"The three A&T country programs reached more than 11 million mothers of children under two years of age within the first three years of implementation through interpersonal communication and/or mass media."

This series of 4 briefs (each 4 pages in length) provides practitioners with insights about how to communicate and advocate the importance of scaling up actions to protect, promote, and support breastfeeding as a key intervention for achieving the Millennium Development Goals (MDGs). It also includes lessons learned and evidence from the first five years of Alive & Thrive (A&T), an initiative funded by the Bill & Melinda Gates Foundation to improve infant and young child feeding (IYCF) by increasing rates of exclusive breastfeeding and improving complementary feeding practices in Bangladesh, Ethiopia, and Viet Nam, as well as to inform policies and programmes around the world. (For more information, see the 4-page country briefs on A&T in Bangladesh [PDF], A&T in Ethiopia [PDF], and A&T in Viet Nam [PDF], as well as the Related Summaries section below. Also search "Alive & Thrive" on The CI website for many more postings. )

• Overview Framework for Delivering Nutrition Results at Scale [PDF]: This brief provides background for the A&T multi-stakeholder, multi-component initiative, as well as presenting an overview of its framework's 4 main components: advocacy, interpersonal communication and community mobilisation, mass communication, and strategic use of data. It also offers a summary of results; e.g., results from external process evaluations in 2013 reveal that, in programme areas, the programme achieved over 80% exclusive breastfeeding in Bangladesh and Ethiopia and tripled the prevalence of exclusively breastfed children in Viet Nam (where initial levels were lower than 20%). Results also suggest that several complementary feeding practices improved over the course of the study and that the percentage of children who had minimum dietary diversity in 2013 doubled compared to 2010 in Bangladesh and Ethiopia (although it was still very low in Ethiopia).
• Advocacy Brief [PDF]: "Results show that well-designed and implemented advocacy programs work. This brief summarizes the role of advocacy, the process for achieving change, results, and lessons learned." For example, A&T's advocacy approach involved:
  • "Clear, specific policy goals and actions, not general statements about the need to prioritize infant and young child feeding to reach national goals
  • Tailored country strategies based on what was attainable and the level of engagement from government and partners
  • Evidence-based advocacy drawing on global and national evidence, stakeholder mapping, and opinion leader research to inform policy strategies and 'asks' (actions requested), develop convincing messages, and identify the right stakeholders
  • Advocacy at national and subnational levels with different yet reinforcing and complementary activities
  • Engagement with nontraditional stakeholders such as women's associations, religious organizations, and journalists"

  In each of the 3 countries, advocacy efforts resulted in changes in policy, priorities, and resources, as illustrated in the brief. For example, in Bangladesh, a 3-year media engagement and capacity building programme as part of A&T included journalist trainings, fellowships, study circles, and site visits. An independent evaluation found a significant increase in coverage of IYCF in the media: from 24 reports in 2009 to 261 in 2011, as well as improvement in the quality of the reporting. Lessons learned relate to factors such as careful selection of advocacy partners, the need for multiple types of evidence to persuade policymakers, and the importance of continuous dialogue to open opportunities for policy change.

• Interpersonal Communication-Social Mobilization Brief [PDF]: "This brief highlights the value of direct, face-to-face communication with mothers and community opinion leaders; provides an overview of interpersonal strategies Alive & Thrive used to achieve scale and behavior change; and outlines lessons learned." For example, "in Bangladesh, a pocket-size reminder card helped standardize messages for thousands of frontline workers in different stakeholder programs. Ethiopia and Viet Nam developed more elaborate print materials to support frontline workers. Multiple rounds of pretesting ensured that materials were readily understood, easy to handle, acceptable, appealing, and persuasive. Showing TV spots and other video materials enhanced community mobilization." Results are shared - for instance: interpersonal communication (IPC) reached approximately 3.7 million mothers of children under 2 years of age in programme areas in the 3 countries. Where A&T's intensive IPC component was implemented, the majority of mothers with children under 2 years of age discussed IYCF with a frontline worker at home or in a facility. Lessons learned suggest that IPC can be implemented at scale, but a systems approach is essential. Insights about improving frontline worker performance and using monitoring data to hold workers accountable for keeping the focus on behaviour change are also offered.
• Mass Communication Brief [PDF]: A&T's mass communication approach is described here as: mother-centred, data-driven, prioritised and sharply focused on the behaviours with greatest impact on health, of sufficient intensity and saturation to make campaigns memorable, created with commercial advertising firms and media partners, emotionally appealing in order to get noticed and motivate change, and frequently monitored. A&T's communication approach is detailed (e.g., crystalise priority behaviours into a small number of doable actions) with results also outlined. For example, preliminary findings from A&T's study in Viet Nam show that:
  • "Mass communication helps nutrition programs achieve scale. In study areas, 85% of mothers interviewed reported exposure to an A&T message. In 2013, an estimated 800,000 Vietnamese mothers with children under 6 months saw at least one of A&T's TV spots.
  • Mass communication helps change social norms. The campaign increased mothers' perceptions that exclusive breastfeeding was the norm (66% of mothers exposed to the campaign agreed, compared to 47% of those not exposed).
  • Mass media contributes to changes in behavior - fast. During the campaign's first year, exclusive breastfeeding rose from a pre-campaign rate of 26% to 48%. Mothers who recalled the campaign's messages were more likely to be giving only breastmilk. Exposure to the TV spots alone accounted for an estimated 149,000 additional exclusively breastfed Vietnamese babies in 2012 and 138,000 more in 2013.
  • Change is greater with interpersonal + mass communication. In the areas of Viet Nam where the campaign offered TV spots only and no A&T interpersonal counseling, exclusive breastfeeding increased from 26% (pre-campaign, in 2011) to 51% (in 2013). In areas where, in addition to TV spots, A&T's interpersonal counseling was available, the rate increased from 26% in 2011 to 60% in 2013."

Visit the A&T website for tools and resources, such as case studies on how to design a media campaign on child feeding, an evaluation plan for using behavioural theory to evaluate the impact of mass media on breastfeeding practices in Viet Nam, journal articles, and A&T-related media and materials such as TV spots, a music video, and posters. In addition to the contact information below, please find more A&T information at the following: blog, Facebook page, YouTube channel, and Twitter feed: @aliveandthrive