FORMATIVE RESEARCH ON MATERNAL, INFANT

AND YOUNG CHILD IN EAST JAVA

Jakarta, 20 January 2015

Background & Objective

Background
GAIN, the London School of Hygiene and Tropical Medicine (LSHTM) and
the local partner (Savica & Kadence), developed and executed formative
research to support the development and testing of a comprehensive and
multi-channel Behaviour Change Communication (BCC) campaign
Objective
These formative research (FR) aims to identify the factors constraining or
facilitating healthier maternal and infant, young children feeding (IYCF)
practices and to support the development of feasible and scalable
behaviour change interventions for the promotion of target behaviours.
The hypothesis is that this will result in more aspirational and impactful
behaviour change interventions

Methodology

Evo-Eco Theoretical Framework:

developed by LSHTM.
It is based on the inference that behaviour is produced by
brains evolved to provide adaptive responses to rapidly
changing or complex environmental conditions.

Formative Research Methodology:

full-day video ethnographies, changing practices analysis,
food attribute ranking, food life history,
physical infrastructure survey, and a motives exercise
aimed at identifying which human motives drive feeding
behaviours (e.g. nurture, status, affiliate).

Creative Design Process:

The FR insights were translated into a brief for a creative
agency to develop the campaign considering aspects of
scalability, sustainability and being provoking.
Each iteration of the creative campaign materials was
discussed with the research team to ensure the Evo-Eco
behaviour change principles were appropriately applied.
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Process & Progress

Infant Young Children Nutrition

Formative
Research
Completed &
Disseminated
on May 2013

Creative
Design

3 months
BCI Pilot

Completed, 3 TVCs
- EBF
- Healthy Snacking
- Complimentary food

Process
Evaluation

Completed, 3 TVCs
Writing report of preaired at JTV &
post and case-control
community activation evaluation by
in 12 villages
SEAMEO

BCI
Implementation
Implementation
partner selection

Completed &
Disseminated
on Dec 2014

Creative
Design
On-going for 2
TVCs

1. Health Services
Strengthening
2. Behavioural
change
3. Nutritious
product

Maternal Nutrition
Formative
Research

Baduta Program

BCI Phase 1
Implementation
Implementation
partner selection

Process
Evaluation
TBD

BCI Phase 2
Implementation
TBD

4. Safe drinking
water

FR Highlighted Findings - 1

IYCF Practices
Breastfeeding:
Breast-milk is understood to be best, but women lack confidence in
the quality and quantity of their own breast milk, which they cannot
see or measure.
Well-meant advice also undermines confidence (if I cannot afford the
food the midwife advices, my breast milk cannot be good either).
Mothers are unaware that formula does not supplement, but
displaces breast milk.
Complimentary feeding:
Mothers ultimate goal is getting her child into a routine and eating
from the family plate as soon as possible for social, economic and
practical reasons. This results in a too brief complementary feeding
phase.
Home-made porridge copies the family diet in adult proportions,
which is rice-heavy, filling up the stomach of the child with insufficient
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nutrients.

FR Highlighted Findings - 2

IYCF Practices
Snacking and processed foods:
Feeding is about keeping the child happy, and is led by the child,
resulting in uncontrolled snacking habits.
Snacks (biscuits, deep-fried snacks) are being given often just
before the next meal.

Maternal & Adolescent Nutrition

The life history from key informants can be summarized into following
diagram

FR Highlighted Findings - 3

marriage is the major event after which the lives of women change
dramatically,
clear distinction with respect to our target audience namely;

Adolescence (unmarried female):

live at home,
working/studying (high school/university).
No assignments as worker.
Mother does the cooking.
Rebellion, eat kid food/snacks.
Marriage is still aspiration (don't rebel against that).
Reproductive (married female):
live either with own parents or husbands parents (negotiated).
Many role changes: now needs to cook for husband, self and kids (to be a
complete woman);
becomes obedient wife, eats mature food, more meals.
Some degree of independence of the new couple within the larger
household.

Main insights from the formative

research IYCF

Three key behaviours were identified

Reducing use of formula and increase exclusive breastfeeding
Increase the diversity of complementary foods, reduce rice-heavy meals
Reducing unhealthy snacking just before meals
The umbrella campaign idea Healthy Gossip is built around the insight that
the mother is being judged by her social environment, including nosy
neighbours, whom she likes to please, to be seen as a good mother.
Key characters in the campaign are:
Lady Gossip who gossips and gets corrected;
An authority figure: the midwife, the grandmother;
The Perfect Mom whos got it all right.

Main insights from the formative

research Maternal Nutrition-1
A. Fear of having a large baby
Pregnant women are worried about the pain of childbirth, and their
perception is that a bigger baby will produce more pain even lead to Csection.
The fear of C-section is caused by its hugely expensive costs (5 25 million
Rupiah, which will be very hard for them to afford), and a wide-spread belief
that a C-section more likely happens if the baby is large.
There is also a belief, which is perceived by all of them that small babies
can catch up later in life.
In addition, as they also face so many food taboos, they become more
careful of what they eat while pregnant.
The combination of these factors makes the pregnant women uncertain and
fearful of having a baby that is too big, and thus restrict their food intake
(particularly fruit) while pregnant, with the potential consequence of having
an underweight baby at birth.

Main insights from the formative

research Maternal Nutrition-2
B. Food and Financial Issues
Food is not seen as a financial priority, so no one spends a lot on it. Food is
considered ephemeral: you eat it, and then it is gone. It is not an investment
like making your house nicer. If someone has extra money, they will spend it
on something that lasts, like house, clothes, or a childs education.
Thrift or ngirit, is a part of the life philosophy and cultural training of all
Indonesians. It is one of the reasons why having high quality food is seen as
a wasteful luxury. There is also the concept of a food wallet (food
allowance), which means that people only spend a certain proportion of
their income on foodand disregarding its variations. This amount of money
spent tends to be the same regardless of social class. People spend
roughly IDR 10.000,00/day irrespective of how many people are in the
family.

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Main insights from the formative

research Maternal Nutrition-3

People deprive themselves of food in daily life in order to be able to save

some to give it to the neighbors at special occasions:
Life-events (for social display)
Getting married (ceremony)
Getting pregnant (ceremony at 7 months to feed the neighborhood)
Giving birth (potential C-section)
Money for Ramadan
Helping family and relatives who needed (to reduce income variability)

While there is special considerations provided: to pregnant women (this

related more with workload and any cravings she may have) not for a
pregnant women, let alone a women not yet pregnant, to consume any form
of special foods which are different from the diet of the remainder of the
family.

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Conclusions from the formative

research Maternal Nutrition-1

There is lack of awareness amongst women of reproductive age

about the benefits of regularly consuming animal protein
There is a belief that eating too much during pregnancy will result in
a larger baby, which is painful to deliver and might require having an
expensive C-section where as it is commonly believed that a child
born small will catch up later in life
Food which they consume is more about satisfying basic hunger
needs than nutrition needs.
The daily meal prepared at home is the same for the whole day,
which results in minimum appetite.

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Conclusions from the formative

research Maternal Nutrition-2

Snacking becomes part of their daily habit to avoid boredom.

There is a culture of buying good (expensive) food only on special
occasions.
It is not common for pregnant women to be fed differently and
women avoid asking for special food during pregnancy out of fear of
being seen as spoiled.
The use of high quality foods are considered luxury foods eaten on
special occasions and served during social and cultural ceremonies,
e.g. the naming celebration.

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THANK YOU

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