Linkages Project - Formative Research and TIPS Training Report-527

Linkages project- Formative research and TIPS training report CRS Lucknow
1. INTRODUCTION: CRS
Catholic Relief Services (CRS) was founded in 1943 by the Catholic

Bishops of the United States of America to assist the poor and disadvantaged
outside the country. It is administered by a Board of bishops and lay people,
and is staffed by men and women committed to the Catholic Church‟s
apostolate of helping those in need. It maintains strict standards of efficiency
and accountability. The fundamental motivating force in all activities of
CRS is the Gospel of Jesus Christ as it pertains to the alleviation of human
suffering, the development of people and the fostering of charity and justice
in the world. The policies and programs of the agency reflect and express the
teachings of the Catholic Church. At the same time, Catholic Relief services
assists persons on the basis of need, not creed, race or nationality.
India is one among the worldwide network of 82 nations where CRS

operates. CRS has operated in India since 1946. The Lucknow state office is
one among the 11 state offices of CRS, India. It started its operation in the
state of Uttar Pradesh since 1995 with development activities in the field of
health, education, agriculture and relief during emergencies. The health
program of CRS India is known as the Safe Motherhood and Child Survival
(SMCS) program.
With a Goal to empower women, particularly those from the marginalized

castes and tribes, to address the health and development needs to address
their own health needs as well as those of their children and communities,
the SMCS program emphasizes building capacity in communities to address,
manage health and nutrition problems. To strengthen the different
component of SMCS program, the Behavior Change Communication (BCC)
strategy was integrated in to the program at partner GVS area covering the
implementing areas of 40 village health workers.
2. BACKGROUND
CRS and LINKAGES, India is piloting the Behavior Change

Communication (BCC) methodology in SMCS program to improve infant,
children and maternal feeding practices. The activities related to
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improvement in maternal feeding practices are focused during pregnancy

and lactation. The BCC methodology involves the following steps:
 Capacity Building of staff in BCC to improve behavioral practices

of the communities and develop behavior change model sites.
 KPC (Knowledge, Practices, Coverage) Survey
 Conduct Formative Research using Trials for Improved Practices
(TIPS) to test recommendations
 IEC (Information, Education and Communication) material review
 Development of BCC strategy and project related MIS.
 Implementation of activities as per the plan.
 Monitoring and evaluation of activities as per the plan.
 End line Survey
Formative research has been used extensively by the ADP (Area

Development Project)-Jagriti of World Vision, a PVO partner of
LINKAGES, India project to design appropriate behavior change
communication strategies to improve infant feeding practices. Other PVO
partners of LINKAGES, India has appreciated this methodology.
In this context, CRS and LINKAGES organized a workshop on formative

Research for the representatives of various PVO partners in the month of
January 2003. The objective of the workshop was to train the participants in
formative research so that they can facilitate formative research, in their
project sites to explore the social, cultural and institutional factors that
influence infant feeding behaviors and maternal nutrition during pregnancy
and lactation period.
In accordance with this plan, CRS, Lucknow conducted formative research

from 6th June to 28th June 2003 for developing a strategy for project
implementation.
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3. FORMATIVE RESEARCH TRAINING OBJECTIVES
The objective of the formative research is to explore the social, cultural and
institutional factors that influence infant feeding behaviors and maternal
nutrition practices.
4. RESEARCH QUESTIONS
a. What is the current knowledge, attitude and practice of key audience

groups with respect to:
 Maternal diet i.e. both pregnant and lactating
 Breastfeeding behaviors for infants in 0-6 months of age.
 Complementary feeding behaviors for children in the age
group of 6-9 months.
b. What is the present nutritional intake and deficit of pregnant and lactating
women with infants less than six months of age and infants of 6-9 months
of age?
c. What are the barriers to optimal maternal nutrition during pregnancy,

lactation and infant feeding practices?
d. How can women be motivated to try recommended dietary practices

during pregnancy, lactation, breastfeeding and complementary feeding?
e. Who influences mother‟s decisions on infant feeding and maternal

nutrition?
f. What are the roles of various service providers in the community with
respect to maternal nutrition and infant feeding practices?
g. What food items are available and utilized during different months of the
year?
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h. What is the role of husband, mother in law and other family members in
improving infant feeding and maternal dietary practices?
i. What is the attitude and practice of key audiences to the receipt and
consumption of IFA tablets distributed in PHCs and sub-centers?
5. METHODOLOGY
Phase 1: Reviewing existing information

Review existing data (baseline survey)  To gather and summarize available
information
 To identify maternal nutrition and
child feeding problems
Phase 2:Formative research Methods

Exploratory research (FGD, Observations, 24  To learn about current feeding
hr dietary recall, food frequency, and food practices and the related belief,
seasonality) attitude
 To obtain advice from families on ways

to improve feeding practices.
Trials of Improved Practices (TIPs)  To assess feeding practices and

provide appropriate recommendations
 To test mother and child responses to

recommended feeding practices

To learn about motivations and
constraints for adopting recommended
child feeding practices
Phase 3: Building a bridge from research to action
Analysis and presentation  Integrate all the information collected
and analyzed during Phase 1 and
Phase 2 into one document
 Interpret the findings and make

recommendations accordingly.
Share and discuss results in strategy

development workshop.
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6. SELECTING RESEARCH METHODS AND DEVELOPING

RESEARCH TOOLS
Research methods Respondent Research Tools

24 Hour Recall & Food Lactating mother (0-6 months) 24 hour dietary recall and food
Frequency Lactating mother (6-9 months) frequency questionnaire
Pregnant woman
TIPS Lactating mother (0-9 months) TIPS-1 and TIPS -2
Pregnant woman questionnaires
FGDs Lactating mother (0-9 months) FGD topic guides
Pregnant woman
Family support system
Mother-in-law, Husband
Note: The Linkages India team developed the tools used for formative
research during15-30th, March 2003 (worked out tools attached)
7. CORE RESEARCH TEAM
 The training was conducted by Technical specialist (BCC) – Mr.

Laxmikant Palo, Linkages, India and Ms. Sona Sharma, Linkages, India,
Delhi, Dr. T. Tripathy, Partner Support Officer, CRS, Lucknow, Mr.
Sridhar, Monitoring & Evaluation Technical Advisor, CRS India and Ms.
Seema Singh, Formative Research Consultant from Patna. They
were collectively involved in taking decisions on research design,
sampling and conducting training.
 Research team members consisted of Mr. Kamal Rizvi, BCC
Coordinator, GVS, Bachhrawan, Assistant Project Coordinator,
Supervisors and Village Health Workers. The counseling guide used for
TIPS 1 and 2 during the both the training is attached as annexure 1.
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8. TRAINING PLAN
Time Content Methods and process
DAY 1; 6th June’03
9.00-12 .00 Introduction of research team
 Review of base line data
and other existing Background information on infant feeding
document, and practices and maternal nutrition.
identification of the
behaviors to be promoted
in the project area
10.00-1.00 Define the research objectives

and questions.
1.00-5.00
Review of qualitative research Discussion on research design
methods  TIPS
 FGD
 24 hour recall
 Market Survey
 Food Seasonality
 Counseling guide
9.00-11.00 Sampling  population groups (caste, away from
Choose population segments PHC, roadside etc.)
 Mothers and primary caregivers
Choose categories of  Other family members
participants
 Other influential people
Choose age groups of children  age groups to reflect feeding practices

to be included  Overall age range of children
Select sites (population units)  Number of sites

within each segment.  Criteria for site selection
 Developed research plan based on the
above information
11.00-3.00 TIPS training with practice in Presentation, discussion and practice

pairs
3.00-5.00 Preparation of questionnaires Group exercise and presentation
and topic guides for FGDs
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5.00-5.30 Logistics for FGD  Number needed per site/method

 Quality control
 Field visit plan
DAY 3;8th June, 03
9.00-1.00 Preparation of  Discussion and documentation

recommendations and
counseling guide for TIPS 1
Finalizing questionnaire for
TIPS 1.
2.00-5.00  Practice in pairs

Practice for TIPS 1 and field  Number needed per site/method
visit plan  Plan transport
9.00-5.00 Field visit for FGD  Field visit
9.00-4.00 Sharing of FGD experience Discussion and documentation of FGD

experience in group
9.00-4.00 Field visit for TIPS 1 Meeting with mothers and administering
the questionnaire
9. TIME LINE FOR FORMATIVE RESEARCH
Activity Number of days

1. Preparation, research plan, sampling etc 2
2. Orientation 1
3. FGDs (to develop recommendations) 1
4. TIPS round 1 2
5. Trial gap 8
6. TIPS round 2 field visit 1
7. Data analysis and final recommendations 5
8. Final formative research report writing 7
10. PROCEEDINGS OF THE TRAINING PROGRAM

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10.1 DAY 1: 6TH JUNE 2003

KEY SESSIONS HELD:
 Introduction of the team members and icebreaker sessions

 Discussion of Baseline survey, categorize and prioritize indicators as per
the feasibility of the SMCS program
 Discussion of technical information on infant feeding practices and
maternal nutrition practices.
 Discussion on counselling guide
10.2 DAY 2: 7TH JUNE 2003
 Discussion of detailed methodology for the survey: Selection of the

research methods, villages and sampling
 An overview of qualitative research methods FGDs, 24hr dietary recalls,
food frequency and TIPs
 Planning logistics for the field visit
o Number of members per team
o Number of FGDs to be conducted per team
o Number of villages to be visited by each team
OUTCOMES OF DAY 2
The detailed research methodology for the survey was finalized on second
day. Information to be covered in the survey determined the research
methods and respondents to be chosen. The research methods adopted is
given below:
A. INFORMATION AREAS
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 Mother‟s diet during pregnancy.

 Mother‟s diet during lactation period for children in the age group of 0-
6 months.
 Infant feeding practices in the age group of 0-6 months.
 Infant feeding practices in the age group of 6-9 months.
B. RESEARCH METHODS
 FGDs
 24 hr dietary recall and food frequency
 TIPS
 Market Survey
 Food Seasonality
C. RESPONDENTS
 Pregnant women
 Lactating women having children in the age group of 0-6 months.
 Husbands of these pregnant and lactating women.
 Mothers-in-Law of these pregnant and lactating women
A detailed list of the information area, research methods and respondents

for the formative research are depicted in table 1.
Table 1: Detailed description of research methods used
Research Aspect Target Group Topic No. of

Tool Used FGDs/
TIPs
FGD Pregnancy Pregnant Women Her diet, IFA consumption, 3 2
ANC and rest during pregnancy
Husband Diet of wife and rest during 1
pregnancy
MIL Diet of daughter-in-law and rest 2
during pregnancy
Lactation Lactating mother Her diet, PNC and rest during 1
0-6 months lactation
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MIL Diet, PNC and rest during 1

lactation
Infancy Lactating mother IFP (0-6 months) 2

(0-6 MIL 1
months)
Infancy Lactating mother IFP (6-9 months) 2
(6-9 MIL 2
months) Husband 2
Total number of FGDs 16
TIPs Pregnancy Pregnant Women1 Her diet, IFA consumption, 15
(Includes ANC and rest during pregnancy
24 hr Lactation Lactating mother1 Her diet and rest during lactation 15
dietary 0-6 months
recall and Infancy Lactating mother1 IFP (0-6 months) 15
food (0-6
frequency months)
questionn Infancy Lactating mother1 IFP (6-9 months) 15
aire 1 ) (6-9
months)
IFP= Infant Feeding Practices
PLAN FOR CONDUCTING FGDS FOR THE FIELD VISIT
 Each Team consisted of 3 members (Observer, Recorder & Facilitator)

and conducted three FGD (except one group in village, Himmatgarhi
group ) and Food Seasonality
 Three groups assigned to do Market Survey in three alternate villages
 The FGD plan is given as in table 2.
Table 2: FGD Plan
S.N Village Selection Group Member FGD topic and group

o. Category
1. Bedaru Roadside Sangeeta, Pregnancy

Shammo & 1. Pregnant Mother
Shail 2. MIL
3. Husband
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2. Pindauli Away from road Preeti, 6-9 months Infancy

Santosh &Vishnnu 1. Lactating Mother
2. MIL
3. Husband
3. Madhavkhera Near to PHC Sohanlal, 1.Lactation (MIL)

Kharonisha & Vimla 2. 6-9 months Infancy (Father)
3. 0-6 months Infancy (Grand
mother)
4. Himmatgarhi Away from PHC Ramkhilawan, 1.Pregnancy (MIL)
Rama & Maya 2. Lactation (Mother)
5. Barjorkhera Relatively Urmila, 1.0-6 month Infancy (mother)
higher Suman & Jitendra 2. 6-9 month Infancy (mother)
proportion of 3. 6-9 month Infancy (Grand
schedule caste mother)
population
6. Khajuro Relatively Shivsaran, Pregnancy
higher Shivdulari & Shashi 1. Pregnant Mother
proportion of 2. MIL
other backward 3.0-6 month Infancy(mother)
caste population
DISCUSSION OF RESEARCH TOOLS
The participants sat in two groups, and each team role-played on one of the
FGDs they were to conduct. After the role-play, a discussion was held where
all doubts were clarified.
The counseling guide, 24 hr recall and food frequency questionnaire was

also discussed in detail. All the participants were given equal opportunity to
clarify doubts and add inputs. After this session the participants understood
the above, provided inputs and were confident that they could use these
methods in the field
It was also decided that each team would also conduct food seasonality
exercise using PRA techniques inquiring about the types and frequency of
foods the community consumes in different months of the year. This
exercise would enable a clear understanding of the recommendations that
can be given in the following visits of TIPS-I
A market survey was also planned to be conducted in three villages that

would represent locally available, accessible and commonly consumed foods
in the research sites. The findings of the market survey is given in
annexure6.
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10.3 DAY 3: 8TH JUNE 2003
KEY SESSIONS HELD:
One member from the research core team was assigned one group each for
supervision and smooth functioning of the research activities.
FIELD VISIT TO: Bedaru, Pindauli, Madhavkhera, Barjorkhera,

Himmatgarhi & Khajuro
PURPOSE OF THE FIELD VISIT:
 To understand the current dietary practices among pregnant women,

lactating women and infant feeding practices in the age group of 0-9
months through FGDs
 To understand the reasons, barriers and facilitators affecting adoption of
the above current behaviors by target groups
 To conduct a PRA exercise using seasonality charts to understand the
general food consumption pattern of the community members and the
frequency of consumption of these foods
 To conduct market survey to understand the locally available, accessible
and commonly consumed foods in the community.
TARGET GROUP: as given in table 2
10.4 DAY 4: 9TH JUNE 2003
KEY SESSIONS HELD:
Documentation, presentation and discussion of the findings of the FGD,

market survey and food seasonality
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OUTCOME OF FIELD VISIT: DAY 4
GENERAL FOOD CONSUMPTION PATTERN
The general food consumption pattern was elicited collectively applying the
PRA technique to a seasonal calender in six villages. Annexure 2 provides
the details of the nutritive value of the commonly consumed food stuffs in
the project area. Annexure-3 provides the format of the food calendar used
for this purpose.
OBJECTIVE:
1. To understand the types and frequency foods commonly consumed

in different months of the year.
2. To enable a clear understanding among the research team about the
most feasible and yet effective recommendations that can be given
during their TIPS-1 visit.
Family consumption of food in the summer month of May was studied.

Frequency of some selected foodstuff and their availability at family level
according to source is presented in annexure 4.
CEREALS AND PULSES:
People of two villages Kosut and Rupaspur are agricultural laborers. They
got the rice, wheat, maize, gram, peas, masoor, and mustard as per the
season as their labor cost. However these crops were only sufficiently
available for three to four months.
GREEN LEAFY VEGETABLES:
Palak, Chaulai, Bathua, Gram leaf, Khesari leaf and mustard leaves are
available in the season. Bathua, Gram leaf, Khesari leaf are available only in
winter. Remaining vegetables were available throughout the year.
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OTHER VEGETABLES:
Kaddu, Nenua, Brinjal, Lady‟s finger, Parwal, Ol, bitter gourd, tomato,
cabbage, were available during summer and few months in winter also.
These vegetables were locally available and cheaper.
ANIMAL FOOD:
More than 50 % sample population were non-vegetarian, Mushhar tola of

Rupaspur village rear pig to be used for eating. Meat, fish and egg were used
weekly or fortnightly. In winter some people ate these foods and it was sold
only in winter.
SUGAR & JAGGERY:
It was sold throughout year in village shops and people use them regularly
for preparing tea.
MILK:
Milk consumption was poor. It was not sold in the village.
WORKLOAD:
During harvesting period male and female were engaged in agricultural

farming. After that period, men work as laborers and women were busy in
household chores. Before rainy season, they were economically weak.
CASH VALUE:
During harvesting season, people had money uptoRs 4000/- per month.
People lived four months on farming, four months on crop and four months
on borrowing. See Annexure-4.
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10.5 DAY 5: 10TH JUNE, 2003
KEY SESSIONS HELD:
The TIPs questionnaires and methodologies were discussed in the following

manner-
 A demonstration of the 24-hour dietary recall

 The logistics planning of the field visit for TIPS-1
 It was planned that TIPs 2 field visit would be scheduled for 19th June,
2003.
 Same team was planned for TIPs 2 field visit with the same area and
responsibility.
 Based on the findings of the FGDs a list of recommendations and the
counseling guide was discussed. Emphasis was laid on forming specific
recommendations/messages such that the changes can be measured after
8 days.
 Classroom practice was done on recommended behavior with the
selected categories like mothers of 0-6months old children etc.
OUTCOME:
A. KEY RECOMMENDATIONS FOR TIPS-1 COUNSELING

EMERGED AS:
1. FOR PREGNANT WOMEN
 As compared to the quantity of food you are eating at present, try to eat
one extra meal every day.
 Take breakfast early in the morning.
 Add whole dal in your diet.
 Consume Green Leafy vegetables like, „Chaulai‟, Lal Sag, Palak in
greater amount and frequency than you are currently consuming.
 Include milk & milk products in your daily diet.
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 Eat seasonal fruits 2-3 times in a week.

 Consume 90-100 IFA tablets during pregnancy. Take one tablet every
day at night after dinner with a glass of water or milk. (From the 4th
month of pregnancy)
 A two-hour rest during the day is necessary for you & your baby‟s health.
 Meet ANM for 3 ANCs.
2. DIET OF A LACTATING MOTHER
 As compared to the quantity of food you are eating at present, eat one
extra meal in a day
 Have a mid day meal snack each day like channa, laiya &gur, daliya etc.
 Consume green leafy vegetables (if available) in greater amount and
frequency than you are currently consuming
 Include milk & milk product in your daily diet.
 Eat seasonal fruits 2-3 times in a week
 Rest for 2 hours in the afternoons each day.
 Take breakfast early in the morning everyday.
 Add whole dal in your diet.
 Ensure 1st PNC within 48 hours of delivery.
3. INFANT FEEDING PRACTICES (0-6 MONTHS)
1) Exclusive breastfeeding
a. When the child is sick continue to breast feed and in serious
illness immediately take the child to the doctor.
b. Do not feed un-boiled water, diluted milk or mishri water,
honey to the child upto six months of age.
2) Feed Hind milk: Breast-feed at least for 15-20 minutes from one
breast before switching to the other. In the first 5 minutes, only fore
milk ejects. After that, hind milk comes out. Hind milk is nutritious.
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3) When the infant reaches 6 months of age start giving soft and mashed
foods (not watery) and continue to breast feed
4 INFANT FEEDING PRACTICES (6-9 MONTHS)
1) Initiation of complementary feeding: When the infant reaches 6

months of age start giving soft and mashed foods (not watery) and
continue to breast feed
2) QUANTITY AND FREQUENCY: As the infant grows increase the

quantity and frequency of food being fed
a. 6-7 months –1/2 katori twice a day

b. 8-9 months –1/2 katori thrice a day
3) QUALITY
 As the child becomes 6 months old, start feeding the child foods apart
from breast milk e.g. animal milk (buffalo, cow), daliya, dal gur,
fruits, GLVs like chaulai, palak.
 Infants do not have enough iron reserves in the body.. Give iron rich
foods like dark green leafy vegetables (chaualai, palak) and if a
„Loha‟ „karahi‟ is available in the home prepare food in that for
increasing the availability of iron from the foods rich in iron
 Give your infant seasonally available fruit 2-3 times a week
 Always give the infant a cereal (C) together with a pulse (P) in the
ratio C: P=2:1
 Give your infant a modified family pot nutritious energy dense food
o ½ Katori (C: P=2:1)+1tbsf of GLV+ ½ tbspf of oil/ghee
 Feed your infant a nutritious energy snack daily as per the following
measure-
o 6-7 months- once a day
o 8-9 months-twice a day
o This snack can be of a cereal roti/biscuit/puffed rice/fruit
dipped in milk/dal
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 Feed food from the family pot. Separate food for the child before
adding masala in the family pot.
4) CONSISTENCY:
Start feeding the child liquid food (not watery consistency) if you have
not started and gradually increase the consistency from semi-solid to
thick food.
5) ACTIVE FEEDING:
Serve the infant in a separate bowl and actively encourage him/her to eat
so that you know how much the infant has eaten.
6) FEEDING IN ILLNESS:
a. Even if the child falls ill, continue to feed your breast milk,
animal milk (if available) and soft as well as mashed
complementary food.
b. If you feed your child with GLVs and fruits regularly your child
is less likely to fall ill.
Based on the TIPS experience, it was realized that all messages needed
to be addressed and their importance needed to be emphasized at the
family level to all family members (especially the MIL) so that the
mother finds it easier to accept the recommended behavior
B. ROLE PLAY OF TIPS-1
A role-play in pairs was conducted to enhance the understanding of TIPS-1

amongst the participants. In role play while one interviewed the other
responded on maternal nutrion and infant feeding practices. This exercise
provided a better understanding to participants on how to conduct TIPS-1.
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C. PREPARATION OF LOGISTICS FOR TIPS-1 FIELD VISIT
Table 3: Team members for TIPS-1
S. Village Selection Group TIPS 1 topic No.

No Category Member of
. Tria
ls
1. Bedaru Roadside Sangeeta,
Shammo & 1. Pregnant 3
Shail Mother 3
2. Lactating 2
Mother 2
3. 0-6 months
Infant
4. 6-9 months
Infant
2. Pindauli Away from Preeti, 1. Pregnant 4

road Santosh Mother 2
&Vishnnu 2. Lactating 2
Mother 2
3. 0-6 months
Infant
4. 6-9 months
Infant
3. Madhavkh Near to PHC Sohanlal, 1. Pregnant 2

era Kharonisha & Mother 2
Vimla 2. Lactating 2
Mother 4
3. 0-6 months
Infant
4. 6-9 months
Infant
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4. Himmatgar Away from Ramkhilawan 1. Pregnant 2

hi PHC , Mother 2
Rama & 2. Lactating 2
Maya Mother 4
3. 0-6 months
Infant
4. 6-9 months
Infant
5. Barjorkher Relatively Urmila, 1. Pregnant 2

a higher Suman & Mother 2
proportion of Jitendra 2. Lactating 2
schedule caste Mother 4
population 3. 0-6 months
Infant
4. 6-9 months
Infant
6. Khajuro Relatively Shivsaran, 1. Pregnant 2

higher Shivdulari & Mother 2
proportion of Shashi 2. Lactating 2
other Mother 4
Backward 3. 0-6 months
caste Infant
population 4. 6-9 months
Infant
1. A total of 60 TIPS visit was planned. (10 TIPS in each village). The
following topics were discussed in each category during the visits.
1) Pregnant woman – about her diet, IFA consumption, no. of

ANC and rest during pregnancy
2) Lactating mother (0-6 months) - about her diet, PNC within 48
hrours and rest during lactation
3) Lactating mother (0- 6 months) – about her infant feeding
practices.
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4) Lactating mother (6-9 months) about her infants diet

(complementary Feeding)
10.6 DAY 6: 11TH JUNE 2003
KEY SESSIONS HELD:

Field visit to villages such as Bedaru, Pindauli, Madhavkhera, Berjorkhera,
Himmatgarhi & Khajuro for TIPS 1.
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TIPS 2 WAS CONDUCTED FROM 18TH JUNE TO 23RD

JUNE 2003
11.PROCEEDINGS OF THE TIPS 2 TRAINING PROGRAM
11.1DAY 1: 18TH JUNE 2003
KEY SESSIONS HELD:

 Introduction of the team members and icebreaker sessions
 Sharing Agenda
 Recap of the TIPS 1
 Review the summary sheet of TIPS 1
 Orientation on TIPS 2
 Detailed discussion of TIPS 2 questions
 Logistic plan for TIPS 2 field visit
OUTCOMES OF DAY 1 :
 Recommendations were reviewed one by one.

 12 forms were rejected as the forms had inappropriate recommendations.
 48 forms were finalized for TIPS 2
 TIPS 2 were explained in detail. Questions in the TIPS 2 were read one
by one for clarification.
 Logistic plan was same as in TIPS 1 i.e. the groups went to the same
village that they went for TIPS 1. (Table 3)
 The participants sat in two groups to discuss on maternal nutrition and
IFP. Each team role-played on one of the topics on which they were to
conduct FGDs. After the role-play, a discussion was held where all
doubts were clarified. This made the exercise simple and easy to
understand the TIPS 2 process.
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11.2 DAY 2: 19TH JUNE 2003
KEY SESSIONS HELD:

Field visit to villages such as Bedaru, Pindauli, Madhavkhera, Berjorkhera,
Himmatgarhi & Khajuro.
PURPOSE OF THE FILED VISIT:

1) To meet with mothers and administer the TIPS 2 questionnaire.
2) Repeat the dietary assessment to find out any modification in the
nutritional intake.
3) To find out how mothers followed the suggested practice, why or why
not, how & why they modified the advice, their positive and negative
reactions
11.3 DAY 3: 20TH JUNE 2003
KEY SESSIONS HELD:
 Number of dropouts in TIPS 2.

 Discussion of analysis formats.
 The participants were divided into four groups category wise and
were named as Ujala, Adarsh, Abhilasha and Gangadhar to do the
analysis of the data related to the pregnant women, lactational women,
mothers of 0-6 and 6-9 months infants respectively.
 Tabulate the results of the trials
 Presentation of the findings along with following points:
o Current behavior (FGD, TIPS 1)

o Feasible behavior ( TIPS 2)
o Food Calendar
o TIPS 2 findings
o Case studies
o A list of quotes (responses of mother and family members
regarding behavior change in their own words)
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OUTCOMES OF DAY 3:
 Revisits to the trial participants on day 2 revealed seven dropouts in

TIPS 2. Number of trials available for analysis were:
 Pregnant Mothers - 12
 Lactating Mothers - 9
 0-6 months Infants - 4
 6-9 months Infants - 16
 Group wise presentation on the above topic was carried out.
 List of quotes was prepared, as these will help in making messages
during strategy development for project implementation.
 For each recommendation; each of the modalities were seen - how
many mothers agreed to do, how many tried, who will be willing to
continue, what were the successful, key constraints and motivations.
Findings of TIPS 2 is attached in annexure – 5.
 Case studies were presented by four groups on all aspects i.e.
pregnancy, lactation, infants (0-6 months) and (6-9 months).
 Thus a total of 41 respondents were contacted for TIPS 2. Concerning
the drop-outs, while 10 women were out of station, one of the mothers
was not ready to talk because her husband had beaten her and she did
not feel comfortable to talk with anyone.
11.4 DAY 4: 21ST JUNE 2003
KEY SESSIONS HELD:
 Food frequency analysis
OUTCOMES OF THE DAY 4:
Frequency of consumption of listed food items updated by seasonal food

calendar were analyzed and presented by four groups.
26
11.5 DAY 4: 22ND JUNE 2003
KEY SESSIONS HELD:
 Dietary Calculation
OUTCOMES OF THE DAY 5:
24 hour diet recall information collected for mother and infants aged 6-9
months were analyzed by the participants.
12. FINDINGS
AGE: Most of the mothers are between the age of 25-35 yrs. Few mothers
are between 20 -24 years.
LITERACY STATUS: Most of the mothers are illiterate. Very few mothers
have passed primary school
NUMBER OF LIVING CHILDREN AND SEX: Most of the mothers

have four children and more than half of them are boys.
OCCUPATION OF THE FAMILY: Agricultural laborers.
MONTHLY INCOME OF THE FAMILY: monthly income of family

was mostly between Rs. 500 – 700/-. Very few families were able to earn
above Rs. 3000/- per month.
FAMILY COMPOSITION: The family size ranges between 4-7 members

in most of the households. It directly affects the distribution of food within
the family.
PURCHASING AND COOKING RESPONSIBILITY: The

pregnant/lactating women were usually responsible for preparing the family
meals, while the responsibility for purchasing food was shared with husband
or mother in law. Husband purchases vegetables mostly twice a week.
27
12.1 CURRENT NUTRITION AND HEALTH STATUS OF MOTHER

AND CHILDREN
12.11 STAPLE DIET: The staple diet was cereal (rice + roti) based.
12.12 DIET PATTERN: Currently, a typical daily family meal consisted of

cereals consisting of mostly rice and often roti with vegetables which was
often a leafy vegetable. Other vegetables like torai, lauki, karela, ladyfinger
etc were consumed 1-2 times in a week in the months that these vegetables
were available.
12.13. MEAL PATTERN: Most of the families consume three meals a day.
There was no concept of increasing the number of meals for
pregnant/lactating women.
12.21. PERCEPTIONS OF DIET DURING PREGNANCY
 Belief:(Jyada khane se baccha dab jayega.) Pregnant mothers and

Mothers-in-law believe that if the pregnant mother eats more, the
child will be compressed in the uterus. All pregnant mothers knew
that diet of pregnant women should be something additional from
non-pregnant women but they did not include any extra nutrition in
their diet and ate as usual, because of their low socioeconomic
condition and lack of awareness. Most of the mothers have 3 meals
per day
 Most of the PW were eating less due to nausea and vomiting. Few
were eating only two times in a day as they are busy in household
activities.
 Most of the husbands agreed on the extra nutritious diet during
pregnancy but they did not take care of their wives during pregnancy.
However, they agreed that if pregnant women ask them to bring
something to eat, they would bring.
o Foods avoided during Pregnancy; Milk & buttermilk (belief:

dudh aur mathha khane se bachha chipak jayega. People think
28
these items create problem during delivery) Chilly; mirch khane

se bache ke ankhein choti hoti hai.
o Foods Preferred during Pregnancy; roti, dal, saag-sabji, fish and
dry fruits etc.
 They increase secretion of breast milk
 Mother-in-law advises that these foods are good
12.22. REST DURING PREGNANCY
BELIEF: Some mothers mentioned that women should not take rest
during pregnancy. When probed and asked why, they mentioned “our
MILs have told us that if a woman rests too much during pregnancy she
faces a lot of problems during her delivery”.
 Pregnant mothers and MIL didn‟t feel that rest is necessary for
pregnant women. Most MIL had the opinion that doing hard
work would provide comfort during delivery.
 Most of the PW take rest but not regularly, they were not aware
of the benefits of rest during pregnancy. They take rest for easy
digestion.
 Some mothers mentioned that walking is more important than
rest during pregnancy period.
 Most of the husbands help the pregnant women in performing
heavy work during pregnancy.
BARRIERS FOR NOT TAKING REST AS FOLLOWS:
a. Workload: Daily routine like cooking, taking care of children and

other family members, work outside home (harvesting etc.)
b. Attitude of the MIL: Most women do not take rest due to the attitude
of the MIL. They mentioned that our MIL says, “ if you work hard
delivery will be easier.”
29
12.23. IRON FOLIC ACID TABLET CONSUMPTION:
BELIEF: Most of the women believe that IFA tablets are beneficial. They
mentioned that VHW has told us that this tablets helps in blood formation.
 Most of the PW consume less than 90 IFA tablets.

 Most of the PW were not told about the side effects of IFA tablet
consumption. Usually they suffer from nausea and vomiting and that‟s
why they stop taking tablets.
 Some of the PW reported non-availability of IFA tablets with the
public health system.
 Most of the MIL and husbands had no information about the number
and benefits of IFA tablet consumption.
 Very few husbands remind their wives to take IFA tablets.
Reason for non-consumption of IFA tablets were nausea, vomiting

and non-availability of IFA tablets
12.24. SERVICES PROVIDED BY ANM AND VHW FOR

PREGNANT WOMEN
 Most PW and husbands were not satisfied by services provided by the

ANM in their village for pregnant women.
 Few PW were satisfied by ANM services.
o Most of the PW appreciated that VHW tells achchi achhi batein
batati hai.The informations are on the importance of IFA
consumption, immunization and also registration of the name of
pregnant mothers in the SMCS program as early as possible.
12.25. ANTENATAL CHECK UPS
 Pregnant women had no information regarding the complete ANC.

They consult only when they have some problem..
30
BARRIERS: Lack of information among pregnant mothers, Mothers-in-law

and husbands regarding complete ANC. Traditional belief regarding ANC
that baby would be born weak, if the pregnant woman does the ANC. The
medical equipment required to do ANC was not available, & if available,
then they were not in working condition. Some mothers mentioned
economic constraints as the reason for not availing the facility.
12.31. DIET DURING LACTATION
 Till 20 days, after delivery most of the LW eat some special food like
Harira (Batisha), milk with dry fruits, meal without salt, boiled water
to increase milk secretion and recover post delivery weakness. Salt is
not added upto first 20 days after delivery in their diet.
 Most of the LW eat more (in frequency and quantity, quality is
ignored) than the pregnancy period because they feel hungry when
they breast-feed their child.
 The diet of a lactating woman should be different from a non-lactating
woman. All LW agreed on this point but mentioned about non-
consumption of extra diet due to their low socioeconomic condition.
 Most LW said that roti, arhar dal, GLVs and other vegetables are
enough to increase breastmilk.
Food preferred: GLVs are good to consume during lactating period, as
they help to make breast milk.
Restricted food: pickles, mango
Belief: Bachha dhoodh dalega; child will vomit if mothers eat these
above-mentioned foods. Potato curry decreases milk secretion.
12.32. REST DURING LACTATION
 LW take rest only when they breastfeed their child.

 Most MIL‟s of the LW discouraged on taking rest.
31
12.33. POST NATAL CHECK UPS WITHIN 24 HOURS

 TBAs attended most of the deliveries in the village.
 Put the infant on soop (soft hand-woven basket) after delivery for
cleaning the child.
 Dais and MIL took care of mother and child after delivery.
 Most of the LW were not aware regarding mother and child
healthcare.
 Local doctor gave TT injection to some mothers and children after
delivery. Few mothers mentioned that only in serious conditions when
the mother was referred to ANM/ private doctor, TT injection is
given.
12.4 0 - 6 MONTHS INFANT FEEDING PRACTICES
12.41 INITIATION OF BF AND PRE-LACTEAL FEEDING
Most deliveries were conducted by untrained dais. Mothers breast-feed their

babies. However, they did not know the method, frequency and benefits of
breast milk.
 First thing that is given to the baby immediately after the childbirth
was Mishri Pani, cow‟s milk, goat's milk, honey and water. Most of
the LW adopted this practice.
 Most of the LW initiated BF after six hours and within 1-3 days. They
believed that breast milk did not secrete so early. This is also advised
by MIL.
 Few mothers started other milk like cow/buffalo milk in one- two
month‟s time after delivery.
12.42. COLOSTRUM FEEDING
Dais and MILs believed that first milk is not for feeding the child and
advised the lactating mother to squeeze out two to five drops and give to
Earth/Moon. Now some mothers do not adopt this practice
 Some of the LW starts breastfeeding the child within 1-2 hours of

delivery to their child after squeezing out the initial 3-4 drops. This
32
practice is hidden from their MIL. LW heard from the VHW in their
health education class that colostrums is beneficial for the health and
well being of their child. This was a good practice among few
mothers regarding colostrums feeding.
12.43. BREAST FEEDING DECISIONS
 Lactating mothers took decisions on breast-feeding the child. Mostly

LW knew the importance and convenience of BF. Most of the
Lactating mothers were breast-feeding their youngest child.
Sometimes husband and MIL told the mother to BF the Child.
12.44. EXCLUSIVE BREAST FEEDING
 All lactating mothers didn‟t know the term EBF. They included water
and honey with BF.
Belief: Gala sukhata hai bachhon ka, maa ka dhodh bachhe ka khana hai
pani to dena hi hai.( the child’s throat dries up, breast milk is food for
the baby. Water has to be given.)
 Most of the mothers provided cow‟s milk, and canned milk to their
child which starts just after three months of childbirth.
Belief: after three months, mother's milk is not sufficient for the child.
12.45. ABSENCE OF EXCLUSIVE BREAST FEEDING IN

MATERNAL ILLNESS:
 The MIL advised that the mother should not BF in maternal illness, as
this will make the child more ill. However most of the mothers feed
their baby in their illness.
12.46. FREQUENCY OF BF IN DAYS:
 Most of the child was put to the mother breast as they cried. The
concept of feeding hind milk and feeding the child once in every two
hours was not in practice.
33
 Most of the mothers have little recollection of night feed to the child.
They usually fall asleep. The question that arises is -did the baby get
enough milk?
 Most of the LW feed 8-12 times in a day but for few minutes at one
time. The child does not get sufficient milk. Some feed 5-6 times in a
day.
12.5 INFANT FEEDING PRACTICES (6-9 MONTHS)
12.51. BREAST FEEDING
 Most of the LW were giving BF to their child. Few mothers start

cow‟s milk after three months of childbirth. All grand mothers agreed
with continuation of BF after 6 months of age.
12.52 INITIATION OF COMPLEMENTARY FEEDING AND FIRST

FOOD
 Along with breast milk, biscuits, fruits like banana, rice water, dal ka
pani, boiled potato are given to the child for taste development.
 Most of the LW started CF from six months of age. Few mothers start
complementary feeding in 8-9 months but quality and quantity is
totally ignored
 Few grand mothers responded that BM was not sufficient for a baby
after 6 months of age.
Reason for not starting Complementary Feeding: (bachha abhi chhota
hai) the child is too young to be fed..
12.53. TYPES OF CF
 Dal ka Pani, Maad, cows milk, biscuits (karara), saboodane ki khichri,

boiled potato etc. All mothers used it as CF. Husbands and Grand
Mothers agreed with this practice. Feeding GLVs to the child was
totally not in practice. They believed that these were spicy food and
the child cannot eat them.
34
12.54. AMOUNT OF CF
 Most of the mothers give CF only for taste development of their child.
This would not be sufficient amount for their child in a day, but
mothers, grand mothers & even fathers had no information about the
quantity and quality of CF.
 The concept of active feeding in a separate bowl was not practiced in
the community.
12.55. DENSITY OF CF
 All mothers, GM and father agreed with mashing of food to make it

semi solid to feed the child. But they didn‟t cook semi solid food
especially for their child.
12.56. BEST AND WORST FOOD.
 According to Lactating Mothers, Grand Mothers and fathers of child,

banana, pomegranate, dal water, cooked rice, milk with biscuits,
cerelac etc are supposed to be best food for 6-9 months old child.
Spicy vegetables were supposed to be the worst food for the child.
12.57. FEEDING DECISION
 All mothers decide the type and frequency of food that child will eat.
Sometimes grandmothers take decision to feed the child. Husband and
MIL went out to market to purchase food items for the family, thus
the mother had no authority to choose the food she wished to feed the
child.
12.58.DALIYA
 All child get daliya from the distribution center.

 Some mothers give daliya to their child .
35
12.59 FEEDING IN ILLNESS
 All mothers, GM and fathers agreed to feed only BM during illness of

the child. They didn‟t give any complementary food during illness.
Belief: mothers thought that during illness, the child became weak and they
could not chew, digest the food properly & , therefore food was not required
during illness.
14. 1 DIETRY ASSESSMENT OF PREGNANT MOTHER
Diet as a single factor has probably a profound influence on the health of the
mother. The diets consumed by a large majority of population lack in protein
rich and health protective foods. The most adversely affected are pregnant,
lactating and infants.
Consumption of ill-balanced and inadequate diets leads to deterioration in

physical and mental strength, development of deficiency diseases and
3000
2500
2000
1500 Mean Intake TIPS 1
Mean Intake TIPS 2

1000
RDA of Lactating
mothers
500
0
Energy(Kcal) B- carotene Vitamin C(mg)
general weakness. The technique of 24-hour dietary recall was carried out
36
and have shown that the diets of pregnant/ lactating women /infants (6-9
months) of low-income groups are deficient in almost all-dietary essentials.
The diets lacked in adequate calories, proteins, essential minerals and
vitamins. As depicted in the diagram, the mean nutrient intake has increased
slightly except Vitamin C. However, it is far below than the RDA. Therefore
there should be strong message for the pregnant mother to increase quantity
and quality of the diet. A strong message that can relate pregnant mother diet
to her child‟s as well as her own capacity to perform household chores
Food Frequency Of Pregnant Mother
12
10
6
TIPS1
TIPS2
0
Rice potato Masoor dal Torai Mango Milk(Buffalo) Cooking oil Sugar Biscuit
daily consumption of food items
should be developed.
According to food frequency data, when the daily food intake of pregnant
mothers was compared for TIPS 1 & TIPS 2, it was found that there was no
difference between the two. The difference was only in “intake of rice”
though they had a daily practice of having it. Besides in TIPS 2, the daily
intake of roti, lentil, vegetables, mango and lemon showed an increase as
compared to TIPS 1.
37
14.2 DIETRY ASSESSMENT OF LACTATING MOTHER
3000
2500
2000
Mean Intake TIPS 1

1500
Mean Intake TIPS 2
1000
RDA of Lactating
500 mothers
0
Energy(Kcal) B- carotene Vitamin C(mg)
There are slight changes in the „intake‟ regarding mean energy, protein,
B-carotene and iron from TIPS 1 to TIPS 2. There is still a large gap in
respect to the RDA. If mean nutrient intake of pregnant mother is
compared with that of the lactating mother, it is found that it is easier to
improve the daily diet intake of lactating mothers than the pregnant
women. A strong IEC component that can relate lactating mothers‟ diet
to her child‟s well being as well as her own capacity to feed the child
more should be developed.
38
Food Frequency Of Lactating Women
TIPS1
5
TIPS2
0
Rice Urd/Kali dal Palak Lauki/kaddu Jackfruit watermelon Egg Meat Jaggery
According to food frequency data, the daily food intake of lactating mothers
when compared between TIPS 1 & TIPS 2, it was found that there was no
difference between the two in “intake of rice & wheat”. But in TIPS 2, the
daily intake of vegetables, meat, fish egg & jaggery has increased as
compared to TIPS 1. This change was definitely due to the recommendation
given during TIPS1. This is a positive indication for project implementation.
39
14.3 DIETRY ASSESSMENT OF 6-9 MONTHS INFANTS
1200
1000
800
600 Mean intake Tips1

Mean intake Tips2
400 RDA of 6-9 months
200
0
Energy(Kcal) B- carotene
It is clearly depicted in the diagram that Formative Research has

succeeded in introducing complementry feeding to the child among 6-9
months infant. The above graph shows that the mean energy intake has
decreased after TIPS 1 counseling. This was because the mothers had
tried to feed foods such as cereals, fruits and green leafy vegetables while
decreasing the amount of usual feed like milk in the period between TIPS
1 and TIPS 2. Proper counseling and message during home visit, health
education session & food demonstration for infants can improve the
mean energy intake.Universal breast feeding on demand and early
introduction to the family pot are some of the positive findings of the
study. The child should be seen as an individual with special food needs.
The general finding was that the child was usually fed whenever it was
restless or crying . Breast feed or foods like biscuit & rice were given to
soothe the child rather than to satisfy his hunger or meet the required
nutrient intake of the child.
40
food frequency
Linkages project- Formative research and TIPSoftraining
infants(6-9)
report CRS Lucknow
16
14
12
10
8
TIPS1
TIPS2
0
Rice potato Palak Mango Biscuit
This is very clear from food frequency data that giving complementary food
to the children has been successful but it has reduced milk intake due to
which calorie intake has also reduced. There is no doubt that this step is
positive. The concept on types of complementary food (*Chalo- Badho-
Bacho) if properly implemented, it will definitely help to improve the
dietary practices.
* Chalo – Carbohyderates and fats (Health promotive)

Badho- Proteins (Health building)
Bacho- Vitamins, minerals, essential nutreints (Health
protective)
15. RECOMMENDATIONS ACCEPTED MOST
41
Findings of TIPS analysis are attached in annexure – 5.
PREGNANCY
DIET
 Increase your quantity of daily diet by eating small servings
frequently.
 Eat green leafy vegetables daily.
 Add milk and milk products daily in her diet.
 Eat at least 2-3 times meat/fish in a week.
 Add yellow fruits in your diet.
IFA TABLETS
 Take( 90- 100 IFA tablets) in all.Take one tablet daily with water
before bed time from 4th month of pregnancy.
ANC
 Ensure 3 ANC
REST
 Take two hours rest daily in daytime.
LACTATING MOTHER
DIET
 Increase the quantity of your daily diet.
 Intake of green leafy vegetables and pulses should be more than the
current intake.
 Eat yellow fruits in your diet.
 Takes 2-hours rest in daytime.
6-9MONTHS INFANTS
 Feed in separate bowl (bowl and spoon)
42
 Start giving complementary food such as overly cooked rice, Cooked

pulses(thin consistency) and green vegetable soup (geela chawal,patli
dal,hari sabji ka soup.)
 Start to give half bowl food twice in a day (recommended for 7 months
old child)
 Start to give half bowl food thrice in a day (recommended for 8 months
old child)
TRIED BUT MODIFIED BEHAVIOR 6-9 MONTHS INFANTS
 Feed in separate bowl1-2 times a day & not every time.
0-6MONTHS INFANTS
 Exclusive breast-feeding should be for first 6 months of life of the

infant.
 Breast-feed 8-12 times in a day.
RECOMMENDATIONS THAT COULD NOT BE SUGGESTED
LACTATION
 Ensure postnatal check up within 48 hours.
INFANT FEEDING PRACTICES (6-9) MONTHS
 Increase the quantity of complementary feeding according to the

age of the child.
 Night feeding for infants.
 When the infant completes 6 months of age start giving soft and
mashed food (semi solid but not watery) and continue to breast-
feed.
INFANT FEEDING PRACTICES ( 0- 6 )MONTHS
 Start feeding the child within one hour of birth.
43
 Breast-feed at least for 15 to 20 minutes from one breast before

switching to other.
CONCLUSION
0-6 MONTHS INFANTS
During first visit none of the children were being exclusively breastfed. The
major barrier to breastfeeding was water, honey, cow‟s milk and canned
milk. Breastfeeding on demand was found as the positive finding of the
study. Frequency of feeding was 8-12 times a day, which matched with the
recommendation. The barrier was that the child did not get hind milk.
Results of the follow up visit were encouraging. The infants who were
receiving water were now being given only breast milk and nothing else.
The infants now get hind milk. All mothers accepted this and were willing to
continue with the recommended behavior.
6-9 MONTHS INFANTS
The 24-hour dietary recall and food frequency data during the first visit
revealed that the infants were being given small amount of food. The diet
was therefore inadequate both in terms of quantity & quality. During the
second visit, the 24-hour dietary recall revealed an increase in the number of
infants consuming foods and the quality & quantity also improved as well.
Food frequency data also showed an increase in the number of infants
consuming the various food items as well as in the amount of food item
consumed at one time. A trend towards acceptance of behavior was
observed. However, the infants weren‟t consuming recommended quantities.
This change was observed over only a one-week trial period. Mothers said
that they would gradually increase the quantity of food being given to
infants.
PREGNANCY
The 24-hour dietary recall and food frequency data revealed an increase in
the number of meals as well as in the amount consumed. Initially the
44
mothers ate only 2-3 meals while starting to take small servings frequently.
Those mothers who were feeling weak in spite of receiving 2-3 meals per
day are now adding green leafy vegetables in their diet, which makes them
feel comfortable to perform household chores. All mothers accepted this and
showed keenness to continue with the recommended behavior.
LACTATION
The 24-hour dietary recall and food frequency data revealed an increase in
the number of meals as well as in the amount consumed. Initially the
mothers ate only 2-3 meals but are now starting to consume one snack also.
Earlier, the mothers who received 2-3 meals comprising of cereals only are
now adding green leafy vegetables and other vegetables in their diet. All
mothers accepted this and are willing to continue with the recommended
behavior.
IMPACT OF COUNSELING
Response of mothers during the follow up visit indicated that counseling was
effective and mothers seemed convinced.
FAMILY SUPPORT
Some mothers could try these recommendations due to family support.

Grandmothers, fathers and older siblings helped the mother to adhere to
recommendations.
17. FINAL RECOMMENDATIONS BASED ON THE TIPS
FOR PREGNANT MOTHERS

 Ensure 3 ANC before delivery.
 Take one extra meal than your current normal diet.
 Add one recommended nutritious snack in your daily diet.
 Eat one-table spoon (100g.) green leafy vegetables daily.
 Eat egg/fish/meat 2-3 times in a week (for non-vegetarians)
45
 Eat milk and milk products 4-5 times in a week.

 Eat locally available seasonal fruits 2-3 times in a week
 Take (90- 100 IFA tablets) in all during pregnancy. Take one tablet
daily with water before bed time from 5th month of pregnancy
 Take two hours of rest daily in day time
 Conduct delivery by trained dais while ensuring the five cleans.
 Initiate breastfeeding within one hour of delivery.
 Take breakfast early in the morning everyday.
 Add whole dal (pulses) in your diet.
FOR LACTATING MOTHERS
 Take one extra meal than your current normal diet.

 Add one recommended nutritious snack in your daily diet.
 Eat one-table spoon (100g.) green leafy vegetables daily.
 Eat egg/fish/meat 2-3 times in a week (non-vegetarian)
 Eat milk and milk products 4-5 times in a week.
 Eat locally available seasonal fruits 2-3 times in a week.
 Lactating mothers should take two hours of rest daily in daytime.
FOR INFANTS ( 0-6) MONTHS
 Exclusive breast-feeding up to first 6-monthsof life.

 Feed hind milk (15-20 minutes of breast feeding from each breast).
 Continue breast-feeding the child during illness of mother/child.
 Breast-feed at least 10-12 times in a day (day and night).
 Start to give soft & smashed complementary food when child
completes 6 months of age.
46
FOR INFANTS (6-9) MONTHS

 As child grows, increase the quantity and consistency of
complementary food.
 Encourage having child‟s own plate, bowl, and glass. Supervise the
feeding.
 Feed the child in separate bowl.
 Promote active feeding.
 Feed the child during his illness (according to the doctor‟s advice)
 Give your child locally available seasonal fruits (smashed) 2-3 times
in a week.
18. SUGGESTIONS
 Strengthen the distribution and consumption of CRS supported Title II

food commodities.
 Plan food demonstration of field-tested recipes by VHW to achieve

nutritional improvement through this program. (List of recipe given in
Annexure- 6). This will be a dual approach of food demonstration cum
nutrition education session for pregnant/lactating mothers, husbands and
mother-in-law.
 Plan Nutrition & health education will help considerably in improving

the diets of the mothers (pregnant and lactating) and their infants. VHW
have an excellent opportunity to disseminate information about the role
of balanced diet in maintaining good health and the value of low-cost
nutritious snacks i.e. wheat ladoo, daliya porridge etc. in making up the
diets delicious. (Attached in Annexure 6).
 Permanent exhibitions relating to health and nutrition of mother and

infant should be organized and VHW encouraged to visit them.
 Promote kitchen gardening to produce yellow & orange fruits, vegetables

and GLVs
47
 Review plan for this program to balance, sequence nutrition and health
information ensuring that the nutritional focus is appropriately achieved.
 Carry out focused monitoring system to define the extent and

determinants of changes in maternal nutrition and infant feeding
behavior. Use the results to strengthen and promote the feeding behavior
component of the program.
 Strengthen behavior change capacity and develop a systematic approach

and toolkit for dealing with behavior change. This will catalyze the
nutritional & health information
 Emphasize community approaches to behavior change, not simply

communication or messages directed to individuals.
 Discuss an explicit focus on improving quality by service provider

including TBAs, ANM, VHWs & RMPs
 Link with SHG, Mahila Mandal, Village development committee, small

group of change agents such as dais and adolescent girls, empowered
village women and women who have become effective agents for
behavior change among their peers.
Voices of Mother and Her Family Members Regarding Behavior

Change in their own words
WHAT MOTHER SAYS ABOUT HER 6-9 MONTHS BABY
 Upur ka khana bitiya khay laagi humka khushi hai. (I am happy to say
that my daughter has started to eat)
 Abay shishi ka dodh pelavey ka parat hai,lakin dherey dherey choot
jayee. ( At present she is taking lesser bottle-feed but I can
confidently say that she will leave bottle-feeding very soon)
 Bachcha khana ki taruf dekhey lagi hai. (Baby has started to look
towards food.)
 Bachcha rowat nahi hai, abb khela karat hai. (Now the baby stops
crying and indulges himself in play.)
48
 Ghar ka kamm karai ka milat hai. (I am getting more time to perform

all the household chores.)
 Betiya bhookhii nahi rahat hai. (Now the baby doesn’t cry with
hunger.)
 Hamare larika sehat achhi rahi. (My baby is healthier now.)
 Hamaka dibbey ka dhoodh na kllarithe ka pari. ( Now I don’t need to
buy canned milk.)
 Hamare baccha ka dhire dhire khai ki adat ban jai. (Now the child has
gradually started to take the food.)
WHAT MOTHER-IN-LAW THINKS ABOUT HER 6-9 MONTHS

BABY
 Paise ki bachat hovay. (Now I am able to save money.)

 Bachha takatbar ho javey. (Child has became more healthier and
strong)
 Bachha swastha rahava kari. (Child is healthier.)
 Bachha rowat nahi. (Child doesn’t cry.)
 Ghar ka karya asani se ho jawat hay.( Now its easier to perform
household chores.)
WHAT MOTHER SAYS ABOUT HER 0-6 MONTHS BABY
 Bache ka takat ayee aur bahar se dhoodh na kharidey ka pari.( Now the
child looks healthier and no need of buying of other milk.)
 Paisa ki bachat ho jaat va larika ke kauno rog na hoi. (Even money is
saved and child does not get sick.)
 Samy ki bachat hoi jat hai. (Now I can save time.)
 Pani pilaeai se dast ho jawat hai. (My child is infected with diarrhea
when I fed him water.)
49
WHAT GRANDMOTHER SAYS ABOUT HER 0-6 MONTHS BABY
 Abb larikba ka hamar bahuriya pani nahi pilawati. (Now my daughter-

in-law doesn’t give water to her baby.)
 Amma ka dhoodh bachhe ke liye bahut rahat hai. (Now I can say that
mothers’ milk is enough for her baby.)
HOW DOES PREGNANT MOTHER FEELS ABOUT HERSELF
 Pet dara nahi karat hai. (Now stomach doesn’t ache.)

 Thoda thoda khaye se aram milat hai.(Its more comfortable when I
take small serving frquently.)
 Kaam karey maa man lagat hai.(Its became more comfortable to
perform household chores.)
 Khoon banat hai.(Blood is formed.)
 Hari sabji ke sath jayeda khay lagen hai.(Now my diet has increased by
taking green leafy vegetables.)
 Bhookh jayda lagat hai.( Now I feel hungry.)
 Khay ke bad dehi furti awat hey.(I feel more energetic after taking
meal.)
 Pati talab se machali pakarkar lat hey.( My husband brings fishes from
pond for me.)
 Pati bajar se sabji kharid lat hey.(My husband buys vegetables from
market for me.)
 Pati ne PHC se janch karane mein madad ki.(My husband helped me in
getting check up through PHC.)
HOW DOES HUSBAND FEELS ABOUT HIS PREGNANT WIFE
 Din me tin bar khana ko chahi. ( Three meals must be taken a day.)
 ANM didi se tohara khatir iron ki goli layali hey.(I have brought IFA
tablets for you from ANM.)
50
WHAT LACTATING MOTHER SAYS ABOUT HERSELF
 Dehi pahale se jayada achi rahat hey.(Feels better.)

 Dhoodh jyada banat hey.(Breastmilk secrets more.)
 Bachha abb dhoodh nahi dalat hey.(Child doesn‟t vomits.)
 Dehi main furti rahat hai.(Feels active.)
HOW DOES HUSBAND FEELS ABOUT HIS LACTATING WIFE
 Hari sabji khay se atane fayde hey to ham annaj bech kar sabji lauwe.(If
green leafy vegetables are so nutritious, I will sell food grains and
buy the green leafy vegetables.)
 Hari sabji khay se pachan sakti sahi rahat haiin.(Green leafy vegetables
are good for the digestive system.)
HOW DOES MOTHER-IN-LAW FEELS ABOUT HER LACTATING

DAUGHTER-IN-LAW
 Sabji khay se tumhar (maa) swasth achha rahi aur bacha tandurust rahi.
( Green leafy vegetables are good for mother and child as well.)
Following the TIPS &FR activities, the strategy development workshop for
the detailed implementation plan was held at Lucknow in July 03. Annexure
7 provides the selected behaviors, the behaviors on which IEC materials are
being printed along with the detailed implementation matrix for each
behavior. The monitoring and evaluation formats that are used to track
behavior are attached as annexure8. One is the time line form and the other
being used by the VHW to track behavior change at household level.
51

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Linkages project- Formative research and TIPS training report CRS Lucknow

Catholic Relief Services (CRS) was founded in 1943 by the Catholic

India is one among the worldwide network of 82 nations where CRS

With a Goal to empower women, particularly those from the marginalized

CRS and LINKAGES, India is piloting the Behavior Change

improvement in maternal feeding practices are focused during pregnancy

 Capacity Building of staff in BCC to improve behavioral practices

Formative research has been used extensively by the ADP (Area

In this context, CRS and LINKAGES organized a workshop on formative

In accordance with this plan, CRS, Lucknow conducted formative research

3. FORMATIVE RESEARCH TRAINING OBJECTIVES

a. What is the current knowledge, attitude and practice of key audience

c. What are the barriers to optimal maternal nutrition during pregnancy,

d. How can women be motivated to try recommended dietary practices

e. Who influences mother‟s decisions on infant feeding and maternal

Phase 1: Reviewing existing information

Phase 2:Formative research Methods

 To obtain advice from families on ways

Trials of Improved Practices (TIPs)  To assess feeding practices and

 To test mother and child responses to

 Interpret the findings and make

Share and discuss results in strategy

6. SELECTING RESEARCH METHODS AND DEVELOPING

Research methods Respondent Research Tools

7. CORE RESEARCH TEAM

 The training was conducted by Technical specialist (BCC) – Mr.

10.00-1.00 Define the research objectives

Choose age groups of children  age groups to reflect feeding practices

Select sites (population units)  Number of sites

11.00-3.00 TIPS training with practice in Presentation, discussion and practice

5.00-5.30 Logistics for FGD  Number needed per site/method

DAY 3;8th June, 03

9.00-1.00 Preparation of  Discussion and documentation

2.00-5.00  Practice in pairs

9.00-5.00 Field visit for FGD  Field visit

DAY 5; 10th June’03

9.00-4.00 Sharing of FGD experience Discussion and documentation of FGD

9. TIME LINE FOR FORMATIVE RESEARCH

Activity Number of days

10. PROCEEDINGS OF THE TRAINING PROGRAM

10.1 DAY 1: 6TH JUNE 2003

 Introduction of the team members and icebreaker sessions

10.2 DAY 2: 7TH JUNE 2003

 Discussion of detailed methodology for the survey: Selection of the

 Mother‟s diet during pregnancy.

A detailed list of the information area, research methods and respondents

Research Aspect Target Group Topic No. of

MIL Diet, PNC and rest during 1

Infancy Lactating mother IFP (0-6 months) 2

IFP= Infant Feeding Practices

PLAN FOR CONDUCTING FGDS FOR THE FIELD VISIT

 Each Team consisted of 3 members (Observer, Recorder & Facilitator)

Table 2: FGD Plan

S.N Village Selection Group Member FGD topic and group

1. Bedaru Roadside Sangeeta, Pregnancy

2. Pindauli Away from road Preeti, 6-9 months Infancy

3. Madhavkhera Near to PHC Sohanlal, 1.Lactation (MIL)

DISCUSSION OF RESEARCH TOOLS

The counseling guide, 24 hr recall and food frequency questionnaire was

A market survey was also planned to be conducted in three villages that

10.3 DAY 3: 8TH JUNE 2003

KEY SESSIONS HELD: