Malnutrition as an indicator of social justice: A comparison between three countries

Background: Because of its lasting effects on immunity, cognitive development and physical wellbeing, nutrition is critical to human development — cutting across all areas of health and economic wellbeing. CARE's rights-based approach uses nutrition as an entry point to support families and communities to achieve the minimum conditions for living with dignity by identifying underlying structural and societal causes of poverty and marginalization. CARE's work in this area includes the Window of Opportunity (Window) program which works to promote, protect and support optimal infant and young child feeding (IYCF) and related maternal nutrition (rMN) practices in six countries.

Research methodology: Over the past two years the Window team has conducted formative research to asses the human, economic, and organizational conditions that facilitate and impede practices and behavioral change related to optimal infant and young child feeding. A mixed methods approach was utilized with a variety of participants including pregnant and lactating women, fathers, grandmothers, and health workers in Nicaragua, Indonesia, and Sierra Leone.

Results: The data were compared across intervention communities in the three countries. Findings identified social factors such as women's lack of voice in household decision making and food prescriptions and proscriptions as roots of malnutrition and sub-optimal maternal and child nutrition practices.

Discussion: This research has aided in the identification of acceptable, feasible, affordable, sustainable and safe approaches to overcome barriers to optimal IYCF and rMN. Findings are being used to design appropriate interventions that develop self-confidence, equity of participation, social cohesion, and collective efficacy.