Focused Ethnographic Study of Infant and Young Child Feeding:  Behaviours, Beliefs, Contexts and Environments

To identify and design appropriate strategies for improved infant and young child feeding, it is critical to more fully understand the social, cultural and environmental contexts in which infant and young child feeding occurs. The Focused Ethnographic Study (FES) methodology offers a suite of methods and protocols that have been developed for use in nutritionally vulnerable, low- and middle-income country populations and can be adapted for different objectives.  The Global Alliance for Improved Nutrition has worked with researchers to develop and apply these protocols and is pleased to make a user manual and protocols available for public use.

Poor complementary feeding in the period when breastmilk alone is insufficient to meet nutrient requirements and children are not yet fully integrated into family diets is an important driver of malnutrition. It is responsible for a significant part of the burden of stunting, micronutrient deficiencies, and their associated consequences for suboptimal health and development. GAIN works to improve access to and utilization of good quality, affordable, nutritious foods and food supplements, which include fortified complementary foods and food supplements, nutrient-dense fresh foods, or minimally processed foods obtained through local agricultural markets. However, improving feeding and care practices and diets in vulnerable populations is a complex challenge and finding effective solutions requires a clear understanding of prevailing beliefs and behaviours, the social, environmental, and physical constraints, as well as the motivations of caregivers, families and communities that influence their response to interventions.

The application of Focused Ethnographic Study methods offers the opportunity to design more effective strategies. The purposes of these methods include:

  • identifying potential interventions that are appropriate for a given population;
  • planning interventions that are appropriate for local conditions;
  • identifying potential bottle-necks that are likely to affect the success of an intervention;
  • informing the design and development of communication strategies and content (especially for behavioral change communication);
  • deciding whether a proposed intervention is likely to be feasible or effective in a given environment.

GAIN supported the adaptation of Focused Ethnographic Study methods to inform on infant and young child feeding in low income country settings in the context of improving access to specially formulated, packaged, complementary feeding products. This initial application aimed to bridge the gap between the rigorous research needs to inform nutrition programming, and the needs of businesses for information on the potential for demand creation for such products and business planning purposes. These methods were then extended to identifying intervention opportunities and informing behavior change communications in agriculture-nutrition and multi-sectoral nutrition programming.

In collaboration with GAIN, the development of the methods and protocols for the Focused Ethnographic Study of Infant and Young Child Feeding 6-23 Months was led by Dr. Gretel H. Pelto (Cornell University) and supported by Dr. Margaret Armar-Klemesu (Noguchi Institute for Medical Research, University of Ghana) and Dr. Faith M. Thuita (School of Public Health, University of Nairobi). The method is constructed as a set of research protocols for interviewing caregivers of infants and young children, as well as people who are involved in food distribution and marketing foods that are used by families to feed them. It combines use of open-ended and guided questions with in-depth probing, and complemented with cognitive mapping tools, including modules for rating and ranking. The framework used to develop the study modules covers topics for the domains that influence infant and young child feeding and potential nutrition-specific and nutrition-sensitive interventions, including:

  1. The social environment (e.g., social programs, opportunities for income earning, informal and formal markets for acquiring food, transportation infrastructure, media)
  2. The physical environment (e.g., resources related to food production including land, water, and fuel, and seasonal challenges)
  3. Available technology (e.g., implements used in the production, preparation, and consumption of food, covering storage, washing, sanitation, and cooking fuel)
  4. Social organization (e.g., household level resources and constraints, including economic, time allocation, family organization, and child care)
  5. Culture (e.g., knowledge, values, and attitudes related to the preparation and consumption of food, and to child health, nutrition and development).

To support the application of these methods, the following tools are available for download:

Focused Ethnographic Study of Infant and Young Child Feeding 6-23 Months:  Behaviours, Beliefs, Contexts and Environments. Manual on Conducting the Study, Analyzing the Results, and Writing a Report 

Protocol I. Interview with caregiver key informants (7 modules)

Protocol II. Caregiver respondent interview (8 modules)

Protocol III. Formal economic sector food acquisition/marketing interview (4 modules)

Protocol IV.  Informal economic sector key informant protocol (1 module)

Selected protocols have been used extensively in Kenya and Ghana to support identification of nutrition interventions and behavior change communication and demand creation strategies for nutrition programming involving multiple-sectors, and in Ghana, Kenya, Afghanistan, South Africa, Bangladesh, Ethiopia and Mexico to assess feasibility and support intervention approaches and design.

Read more about the use of ethnography for nutrition programming and the results of the Focused Ethnographic Study of Infant and Young Child Feeding applied in GAIN’s work:

The focused ethnographic study ‘assessing the behavioral and local market environment for improving the diets of infants and young children 6 to 23 months old’ and its use in three countries. (2012) Gretel H. Pelto, Margaret Armar-Klemesu, Jonathan Siekmann, Dominic Schofield. http://onlinelibrary.wiley.com/doi/10.1111/j.1740-8709.2012.00451.x/full

Balancing nurturance, cost and time: complementary feeding in Accra, Ghana (2011) Gretel H Pelto, Margaret Armar-Klemesu.  http://onlinelibrary.wiley.com/doi/10.1111/j.1740-8709.2011.00351.x/full

Using ethnography in implementation research to improve nutrition interventions in populations (2016).  Alison Tumilowicz, Lynnette M. Neufeld and Gretel H. Pelto.  http://onlinelibrary.wiley.com/doi/10.1111/mcn.12246/full

Identifying interventions to help rural Kenyan mothers cope with food insecurity: results of a focused ethnographic study (2016).  Gretel H. Pelto and Margaret Armar-Klemesu.  DOI: 10.1111/mcn.12244  http://onlinelibrary.wiley.com/doi/10.1111/mcn.12244/full

Constraints and opportunities for implementing nutrition-specific, agricultural and market-based approaches to improve nutrient intake adequacy among infants and young children in two regions of rural Kenya. (2016).  Christine Hotz, Gretel Pelto, Margaret Armar-Klemesu, Elaine F. Ferguson, Peter Chege and Enock Musinguzi.  DOI: 10.1111/mcn.12245  http://onlinelibrary.wiley.com/doi/10.1111/mcn.12245/full

Kenya Policy Brief: Feeding Infants and Young Children in Kitui County. (2016). Gretel Pelto and Faith Thuita.

Kenya Policy Brief: Feeding Infants and Young Children in Vihiga County. (2016). Gretel Pelto and Faith Thuita.