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Child Feeding Practices Report

14 August 2015 Share: facebook share twitter share

In 2014, PACS (in partnership with UNICEF) initiated a community level assessment of knowledge, attitude and practices of Infant and Young Child Feeding (IYCF) in 656 PACS intervention villages in Jharkhand. Surveys were carried out by 5 PACS partners and the resulting report was launched at an event on 14 August 2015. Based on the findings, a joint pilot intervention to improve IYCF practices is being carried out.

Combatting undernutrition through good practices

The Lancet Maternal and Child Undernutrition series reports that maternal and child undernutrition is an underlying cause of 45% of child deaths worldwide. However, malnutrition is largely preventable through good IYCF practices.

Initiating breastfeeding within the first hour of birth has shown to prevent between 19 - 22% of neonatal deaths. Evidence also shows that child deaths could be reduced by 13% through exclusive breastfeeding for the first 6 months of a child’s life and by another 6% through the practice of optimal complementary feeding – the process of introducing other foods (in addition to breast milk) after 6 months.

In Jharkhand, undernutrition is a big problem – 57.1% of children under 5 are underweight and it was the second worst performing state in the India State Hunger Index (2008).

In order to better understand why this is the case, UNICEF commissioned a study to find out the current IYCF practices being carried out in communities whilst, at the same time, sensitising communities on optimal IYCF practices through community meetings.

Two malnourished children from the Pahariya tribe stand in their community in the Sahibganj district of Jharkhand. Two malnourished children from the Pahariya tribe stand in their community in the Sahibganj district of Jharkhand.

Carrying out the study

To help them carry out the study, UNICEF worked with PACS to train staff from 5 PACS partners - ASRA, Badlao Foundation, Ekjut, Prerana Bharati and SHARE - to carry out surveys in 656 PACS intervention villages spread across 6 districts of Jharkhand - Deoghar, Giridih, Gumla, Jamtara, Sahibganj and West Singhbhum.

There were three different surveys: one that was asked to caregivers of children under 6 months, one that was asked to caregivers of children between 6-23 months old and one that was asked to Anganwadi Workers (community health workers employed under the Integrated Child Development Services scheme to provide maternal and infant health advice).

In August 2014, 49 Master Trainers from our partners were trained in survey techniques by the UNICEF team. Then, in the first week of September 2014, these Master Trainers trained 108 field staff at district-level training events.

The field staff then carried out the surveys in September and October 2014.

Sharing the findings

On 14 August 2015, a consultative meeting to share and explore the findings of the study was organised by PACS and UNICEF. The event was attended by civil society organisations working in Jharkhand (including all PACS partners), officials from the Government of Jharkhand’s Department of Health and Family Welfare and Department of Social Welfare.

For those caregivers of infants under 6 months, the following results were found:

  • 97% of babies had been breast fed at some point the previous day/night although 12% had been given another source of nutrition too.
  • 81% of caregivers knew that breast milk should be the first food that a new-born receives. However, only 67% knew how long breastfeeding should continue and only 63% understood the benefits of exclusive breastfeeding.
  • There was a huge gap between knowledge and practice in terms of frequency of feeding: although 74% of caregivers knew that babies should be fed around 8 times a day, only 20% were actually following this.
  • Personal hygiene practices were poor - only 62% knew to wash hands after washing a baby’s bottom, 45% after handling rubbish and 18% after handling raw food. In addition, only 49% were practicing the correct method of hand washing: using running water and soap.

For caregivers of those aged 6-23 months, the following findings were reported:

  • 95% of infants were still being breastfed as part of their diets, but the diversity and range of other foods through complementary feeding was very varied.
  • In many cases minimum meal frequency was not being met, especially for those children who were not being breastfed: for those who weren’t being breastfed, 94% were not being fed the required number of meals per day. Even for those who were being breastfed, 34% of 6-8 month olds and 36% of 9-23 month olds were being fed less than the recommended minimum meal frequency.

For Anganwadi workers, the surveys showed:

  • Knowledge about undernutrition was mixed – 84% knew that loss of weight or thinness was a sign of undernutrition and 70% knew that lack of energy was also a sign. However, only 49% knew that a cause of undernutrition was watered down food with not enough nutrients or how hygiene relates to undernutrition.
  • Whilst 84% knew that infants under 6 months should be breastfed exclusively, only 48% knew how growth monitoring for infants at local health centres could help prevent undernutrition.
  • Only 10% of Anganwadi workers knew all five prevention methods of undernutrition for children over 6 months – giving them more food, feeding them more frequently, paying attention to them during meals, ensuring they had all immunisations and visiting the health centre regularly.

Complementary nutrition - solid food from a range of food groups - is vital (in addition to breast milk) to promote growth once children are over 6 months old. Complementary nutrition - solid food from a range of food groups - is vital (in addition to breast milk) to aid growth once children are over 6 months old.


The study concluded that more action is required to translate knowledge of the causes and prevention of undernutrition into practice. It also highlighted the importance of improving practices and knowledge on WASH (Water, Sanitation and Hygiene) practices and integrating this into IYCF programming.

More needs to be done to improve the dietary diversity of infants aged 6-23 months through providing information about complementary feeding and recipe demonstration. There also needs to be a focus on improving the Minimum Meal Frequency through appropriate counselling at the field level.

For Anganwadi workers, there needs to be a focus on the importance of growth monitoring and improving their knowledge base on complementary feeding.

After the launch of the report on 14 August, there were 4 group discussions to discuss these themes:

  1. How to improve the capacities of service providers on breastfeeding and complementary feeding.
  2. How to improve the quality of complementary food and improve nutrition education.
  3. How to improve community-level WASH education about handwashing at critical times and ensuring safety of complementary foods.
  4. How to identify the contact points (health facilities, Village Health and Nutrition Committees, Anganwadi workers) and optimising them.

Going forward

Based on the report findings, PACS in partnership with UNICEF will now undertake a planned intervention on a pilot basis in 500 villages where PACS partners are working. This will be a 6 month intervention to improve IYCF practices after which, based on its impact, further interventions may be designed.

At the report launch, UNICEF also released a flipbook on Essential Nutrition Actions, which will be used in communities to improve awareness of the importance of IYCF practices including breastfeeding and complementary feeding.

Officials from government, PACS and UNICEF launch the flip book to promote the importance of breastfeeding and child nutrition. Officials from the Government of Jharkhand, PACS and UNICEF launch the flip book to promote the importance of breastfeeding and child nutrition.

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