A focused ethnographic tool provides insights into socially normative infant and young child feeding (IYCF) practices in the context of a behavior change communications (BCC) intervention in rural Bangladesh

Abstract

Social norms influence IYCF practices in all cultures. Challenges remain in studying social norms and tracking them over time. We used an ethnographic tool, free‐listing, to assess socially normative IYCF patterns in the context of a process evaluation of a BCC intervention. Groups of 3–4 women in 90 households in 3 sub‐districts listed all foods usually given to children from 0–24mo and reasons for giving each food. Data on normative age of introduction were analyzed in Stata; text data were analyzed in NVivo. Intervention exposure (IE) was viewing a TV spot, a visit by a frontline health‐worker (FHW), or both. Data analysis captured overall social norms, and by intervention exposure. Under 6mo, breast milk was highly normative (94%), but prelacteals (water (58.9%), sugar‐water (36.7%), honey (43.3%)) were also normative, for ritualistic, cultural and pacifying reasons. Cow's milk and “tinned milk” were normative (76.7%; 1.7 ±2.3 mo & 70.0%; 2.9± 3.6 mo), as was rice gruel (83.3%; 4.7 ± 2.7 mo), and were linked to perceptions of infant need and insufficient breast milk. Fewer households with full IE mentioned breast milk‐substitutes, prelacteals, and cow's milk as early foods. The results highlight that although some BCC recommendations are influencing normative practices, entrenched norms may hamper impact. Support: Alive & Thrive, funded by Bill & Melinda Gates Foundation & managed by FHI360; NIH (5T32HD007331).