Nigeria never fails to surprise. Here again, they are pushing forward with multi-pronged strategies for improved infant and young child feeding (IYCF). This research published in the July edition of Journal of Nutrition presents findings of how “Integrating Group Counseling, Cell Phone Messaging, and Participant-Generated Songs and Dramas into a Microcredit Program Increases Nigerian Women’s Adherence to International Breastfeeding Recommendations” : J. Nutr. 2014;144 1120-1124
In 1997 in Nigeria, a woman smiles while breastfeeding her baby girl at Kaduna Hospital in Kaduna, capital of the northern state of the same name.
The research in Bauchi State had 3 components (microcredit, cell phone messaging and songs/dramas). Trained credit ofﬁcers led monthly sessions on IYCF during regularly scheduled meetings for ~10 months. A cell phone was usually given to the leader of the small group. She was instructed to share the messages with her group members weekly, by either visiting them individually or inviting them to listen as a group. Eleven key messages were discussed during learning sessions and sent as voice messages to the phones. The text and voice messages were sent twice weekly for 4 months and twice every other week for an additional 3 months. The small groups also prepared songs or dramas about the messages for message retention. Pregnant clients were recruited at baseline and interviewed again when their infants reached 6 months of age.
Microcredit programs are common in the developing world but involvement in these types of programs is a form of self selection. This means that some of the population who might be the most needy for improved IYCF practices might not be allowed to participate in the microcredit scheme.
Ownership of a cell phone is another form of self selection. In this research they addressed the issue about access to a cell phone by providing one to the leader of the microcredit group (a total of 156 phones). When planning projects at scale, the purchase of phones maybe prohibitively expensive.
But what is genius in this research/intervention is that there is a social norms association being made between cell phones, exclusive breastfeeding and optimal IYCF practices. The trend leaders in the community are often cell phone owners, microcredit users and also concerned about ensuring the maximum health and well-being potential for their children.
The focus on the multiprong strategy is very astute. Group and individual counseling are important, but the outcomes can be strongly supported by using other communication channels. These should also include messaging and follow-up by health service providers, through programs of conditional and non-conditional cash transfers, food security and social safety net schemes.
Previous research was done in Australia on using SMS for promotion of breastfeeding. Also there is a 24/7 breastfeeding helpline available in Australia. This model probably should be adopted to provide support for women in developing countries
Eric J. Daza one of the authors of this paper also sings about statistics while he teaches, which is fantastic too.