A qualitative assessment of barriers and facilitators to implementing recommended infant nutrition practices in Mumbai, India

Abstract

Background Childhood malnutrition has been a longstanding crisis in Mumbai, India. Despite national IYCF (Infant Young Child Feeding) guidelines to promote best practices for infant/toddler feeding, nearly one-third of children under age five are stunted or underweight. To improve child nutrition, interventions should address the cultural, social, and environmental influences on infant feeding practices. This study is an in-depth qualitative assessment of family barriers and facilitators to implementing recommended nutrition practices in two Mumbai slum communities, within the context of an existing nutrition education-based intervention by a local non-governmental non-profit organization. Methods The population was purposively sampled to represent a variety of household demographics. Data were collected through 33 in-depth semi-structured interviews with caregivers (mothers and paternal grandmothers) of children age 0–2 years. Transcripts were translated and transcribed, and analyzed using qualitative analysis procedures and software. Results A complex set of barriers and facilitators influence mothers’/caregivers’ infant-toddler feeding practices. Most infants were fed complementary foods and non-nutritious processed snacks, counter to IYCF recommendations. Key barriers included: lack of nutrition knowledge and experience, receiving conflicting messages from different sources, limited social support, and poor self-efficacy for maternal decision-making. Key facilitators included: professional nutrition guidance, personal self-efficacy and empowerment, and family support. Interventions to improve child nutrition should address mothers’/caregivers’ key barriers and facilitators to recommended infant-toddler feeding practices. Conclusions Nutrition interventions should prioritize standard messaging across healthcare providers, engage all family members, target prevention of early introduction of sugary and non-nutritious processed foods, and strengthen maternal self-efficacy for following IYCF recommended guidelines.

Facilitators, barriers, and perceived changes of a social behaviour change nutrition programme and economic development programme in rural Bangladesh: A qualitative study

“…While some mothers struggled to balance the housework and programme participation, some fathers, those not in pairs, failed to even recognise that housework was a burden and even served as an obstacle for mothers' participation in the programme. Women in low‐income countries, although living in extended families, not only found it challenging to receive physical and emotional support from their families but also faced the pressure of living up to other family members' expectations (i.e., mothers‐in‐law) (Athavale et al, 2020; Jones et al, 2012). This pattern tends to aggravate when family members lack an understanding of the programme's main purpose.…”

The usefulness of nutrition and health videos displayed on mobile phones in rural Uganda: Experiences of community health workers and mothers

“…Competence is crucial for CHWs to advise mothers consistently and correctly. Additionally, competence is required to reassure mothers of the correctness of promoted practices while increasing their confidence to implement these practices (Athavale et al, 2020; Burns et al, 2016). Furthermore, improving competence is crucial, as incorrect beliefs among CHWs have been associated with negative practices involving newborn babies (Smittenaar et al, 2020).…”

“…However, mothers who are adequately informed and encouraged can defy adverse traditions and follow recommendations (Burns et al, 2016). By contrast, receiving conflicting information on IYCF may cause uncertainty among mothers about their own abilities, leaving them unable to translate information into practice (Athavale et al, 2020).…”

“…However, mothers who are adequately informed and encouraged can defy adverse traditions and follow recommendations (Burns et al, 2016). By contrast, receiving conflicting information on IYCF may cause uncertainty among mothers about their own abilities, leaving them unable to translate information into practice (Athavale et al, 2020). Shortages of health care workers have emphasized the role of community health workers (CHWs) in nutrition, hygiene and health education, especially in low-income countries (Braun et al, 2013;Lehmann & Sanders, 2007).…”

Early life migration and undernutrition among circular migrant children: An observational study in the brick kilns of Bihar, India

“…This pattern suggests that some migrant families may have a better ability to implement recommended infant feeding practices compared to the overall population. One study conducted in informal settlements in Mumbai comprising of mainly migrants found that social support and self-efficacy for decision making are important factors determining mothers’ feeding behaviors [ 29 ]; it is possible that for some women, these constructs can improve during migration, as they are removed from traditional, sometimes oppressive, family structures. Additionally, migration can influence children’s diets (positively or negatively) through increased household income as well as exposure to new health and nutrition practices [ 30 ].…”