Advocating for Paid Maternity Leave and Workplace Lactation Policy Reform and Implementation: Lessons Learned From Indonesia, Nigeria, the Philippines and Vietnam.

Maternity protection policies are designed to preserve the health of working women and their infants, support optimal infant and young child nutrition through breastfeeding and prevent workplace discrimination against women. The aim of this study was to identify how advocates may be able to effectively advance maternal leave and workplace lactation policies, two key maternity protection policies, and does so through an exploration of advocacy efforts in Indonesia, Nigeria, the Philippines and Vietnam. A desk review of programme and policy documents and 20 key informant interviews with diverse stakeholders explored advocacy efforts in each of the four countries.

Strengthening nutrition policy and service delivery: Lessons learned from a six-country assessment of Alive and Thrive's technical assistance.

Alive & Thrive (A&T) provides strategic technical assistance (TA) to develop effective policies; improve maternal, infant, and young child nutrition (MIYCN) programme design and implementation and enhance system capacity to sustain quality MIYCN service delivery at scale. A qualitative assessment was conducted using document review and stakeholder interviews (n = 79) to describe a selection of A&T's TA in six countries and systematically assess the contextual and TA process-related factors that influenced the results achieved and document the lessons learned about MIYCN TA design and implementation. To facilitate the selection of different types of TA, we classified TA into two levels of stakeholder engagement and intensity.

Feasibility and acceptability of integrating a multicomponent breastfeeding promotion intervention into routine health services in private health facilities in Lagos State, Nigeria: A mixed methods process evaluation.

Most health care providers in Lagos State, Nigeria are private and are not required to offer breastfeeding counseling to women. From May 2019-April 2020, Alive & Thrive implemented a multicomponent breastfeeding promotion intervention in private health facilities in Lagos that included training and support to implement the Baby-Friendly Hospital Initiative and provide breastfeeding counseling and support to pregnant women and lactating mothers in person and on WhatsApp. We conducted a mixed methods process evaluation in 10 intervention and 10 comparison private health facilities to examine the feasibility and acceptability of integrating the intervention into routine health services.

Changing maternal, infant and young child nutrition practices through social and behaviour change interventions implemented at scale: Lessons learned from Alive & Thrive.

Alive & Thrive (A&T) is an initiative designed to advance the implementation of maternal, infant and young child nutrition (MIYCN) social and behaviour change (SBC) at a large scale. The aims of this research were to: (1) describe A&T's SBC implementation processes and their impact based on a review of programme documents and peer-reviewed publications and (2) gather lessons learned from key informant interviews (N = 23) with A&T staff and stakeholders in Bangladesh, Burkina Faso, Ethiopia, India, Nigeria and Vietnam. A&T's SBC approach used interpersonal communication, community mobilization and mass media to address knowledge gaps, strengthen self-efficacy and shift social norms.

Attitudes, beliefs and social norms regarding infant and young child feeding among Nigerian mothers, fathers and grandmothers across time.

Infant and young child feeding (IYCF) interventions in low-resource countries mainly target pregnant women and mothers of young children; however, fathers and grandmothers also influence IYCF practices. We conducted focus group discussions with mothers, fathers and grandmothers of young children across three time points in areas where an IYCF social and behaviour change intervention was implemented in Nigeria to explore differences by participant type and shifts over time in attitudes, beliefs and social norms related to breastfeeding and dietary diversity (DD). Overall, across time points, we found more discrepancies in attitudes, beliefs and social norms for early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) among different participant types than for DD.

Impacts of a social and behavior change communication program implemented at scale on infant and young feeding practices in Nigeria: Results of a cluster-randomized evaluation.

Background: Infant and young child feeding (IYCF) practices are important for child survival and healthy growth, but IYCF practices remain suboptimal in Nigeria. The objective of this study was to measure the impact of Alive & Thrive's IYCF social and behavior change communication intervention on early initiation of breastfeeding, exclusive breastfeeding, and minimum dietary diversity in Kaduna and Lagos States.

Methods: Local government areas were randomly allocated to intervention or comparison.

Fathers' Complementary Feeding Support Strengthens the Association Between Mothers' Decision-Making Autonomy and Optimal Complementary Feeding in Nigeria.

Background: Evidence about the effects of mothers' decision-making autonomy on complementary feeding is not consistent, generating hypotheses about whether complementary feeding social support moderates the relation between mothers' decision-making autonomy and the practice of complementary feeding.

Objectives: This study examined the moderation effect of fathers' complementary feeding support on the association of mothers' decision-making autonomy with the WHO complementary feeding indicators of minimum dietary diversity, minimum meal frequency, and minimum acceptable diet, and post hoc secondary outcomes of feeding eggs or fish the previous day. The study also examined the concordance between mothers' and fathers' perspectives of mothers' autonomy and fathers' complementary feeding support.

Complementary Feeding Social and Behavior Change Communication for Fathers and Mothers Improves Children's Consumption of Fish and Eggs and Minimum Meal Frequency in Kaduna State, Nigeria.

Background: Fathers are key influencers of complementary feeding practices, but few studies in low- and middle-income countries have measured the effects of complementary feeding social and behavior change communication (SBCC) targeted at both fathers and mothers.

Objectives: The aims of this study were to measure the effects of an SBCC intervention on children's dietary diversity (primary outcome) and other complementary feeding indicators, fathers' and mothers' complementary feeding knowledge, and fathers' support for complementary feeding (secondary outcomes).

Methods: The 12-mo intervention in Kaduna State, Nigeria, engaged parents through community meetings, religious services, home visits from community health extension workers (CHEWs), mobile phone messages (fathers only), and mass media.

Maternal and paternal involvement in complementary feeding in Kaduna State, Nigeria: The continuum of gender roles in urban and rural settings.

Household gender roles influence infant and young child feeding behaviours and may contribute to suboptimal complementary feeding practices through inequitable household decision-making, intra-household food allocation and limited paternal support for resources and caregiving. In Igabi local government area of Kaduna State, Nigeria, the Alive & Thrive (A&T) initiative implemented an intervention to improve complementary feeding practices through father engagement. This study describes household gender roles among A&T participants and how they influence maternal and paternal involvement in complementary feeding.

Breastfeeding Interpersonal Communication, Mobile Phone Support, and Mass Media Messaging Increase Exclusive Breastfeeding at 6 and 24 Weeks Among Clients of Private Health Facilities in Lagos, Nigeria.

Background: Although most health facilities in urban Nigeria are privately owned, interventions to promote optimal breastfeeding practices in private facilities have not previously been implemented.

Objectives: We tested the impact of a breastfeeding promotion intervention on early initiation of breastfeeding and exclusive breastfeeding among clients of private facilities in Lagos, Nigeria.

Methods: The intervention included training for health-care providers on the Baby-Friendly Hospital Initiative and breastfeeding counseling skills, provision of interpersonal communication and support to women at facilities and on WhatsApp, distribution of behavior change communication materials, and mobile phone and mass media messaging.

Trends and inequalities in the nutritional status of adolescent girls and adult women in sub-Saharan Africa since 2000: a cross-sectional series study.

Introduction: Evidence on the rate at which the double burden of malnutrition unfolds is limited. We quantified trends and inequalities in the nutritional status of adolescent girls and adult women in sub-Saharan Africa.

Methods: We analysed 102 Demographic and Health Surveys between 1993 and 2017 from 35 countries.

The effectiveness of contracting-out primary health care services in developing countries: a review of the evidence.

The purpose of this study is to review the research literature on the effectiveness of contracting-out of primary health care services and its impact on both programme and health systems performance in low- and middle-income countries. Due to the heightened interest in improving accountability relationships in the health sector and in rapidly scaling up priority interventions, there is an increasing amount of interest in and experimentation with contracting-out. Overall, while the review of the selected studies suggests that contracting-out has in many cases improved access to services, the effects on other performance dimensions such as equity, quality and efficiency are often unknown.

Addressing the phenomenon of bypassing in Albania: the impact of a primary health care strengthening intervention.

The purpose of this study is to assess the impact of a primary health care strengthening intervention on bypassing behavior in Albania, a middle-income country that has experienced substantial structural changes that affect PHC and where bypassing among health care clients is common. The intervention aimed to improve the quality of health care in low-level facilities through improved availability and use of health information, the adoption of clinical practice guidelines, and provider training. The study employs a quasi-experimental research design to evaluate the impact of the intervention on health care utilization.

The impact of contracting-out on health system performance: a conceptual framework.

Despite the increased popularity of contracting-out of health services in developing countries, its effectiveness on overall health system performance is not yet conclusive. Except for substantial evidence of contracting-out's positive effect on access to health services and some evidence on improved equity in access, there is little evidence of contracting-out's impact on quality and efficiency. Most studies on the subject evaluate specific contracting-out projects against narrowly specified project objectives, not against more broadly defined health system goals.