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Improving maternal and child nutrition is a family endeavor


August 2, 2021

Although most public health initiatives to improve maternal and child nutrition are aimed specifically at moms and their children, experts are gaining a clearer picture of the role that fathers, grandparents and other family members play in feeding practices and decisions. Global perspectives on family structure reveal that these roles are highly varied and contribute to a system that can include members outside the traditional nuclear family.

In an effort to develop a holistic approach that considers this family system, experts at UNC-Chapel Hill have contributed to a special compendium of research pinpointing specific methods to engage family members in nutrition education that lead to better results for caregivers and children.

Dr. Stephanie Martin

Dr. Stephanie Martin

Published this month in a Maternal & Child Nutrition journal supplement, the “Special Issue on a Family Systems Approach to Promote Maternal and Child Nutrition” was co-edited by Stephanie Martin, PhD, assistant professor of nutrition at the UNC Gillings School of Global Public Health and a Faculty Fellow at the Carolina Population Center, along with Judi Aubel, MPH, a 1983 alumna of the Gillings School, and Kenda Cunningham, DrPH. Martin co-authored three studies in the supplement, along with Gillings School doctoral student Diana Allotey, research assistants Emily Gascoigne and Kamryn Locklear, and Gillings alumnae Samantha Grounds (’21 BSPH) and Maliha Kahn (’19 BSPH).

The first study examined the acceptability of a strategy to engage fathers in Tanzania to support recommended feeding practices for children between six and 23 months of age. Fathers, many of whom felt their role was to provide resources for feeding rather than doing the feeding directly, participated in a focus group discussion on nutritional needs and practices. Fathers and mothers later received individual counseling on new strategies to try. In a follow-up after counseling, many mothers noted that these strategies improved feeding and led to increased involvement from fathers, who provided resources to acquire recommended foods, helped with domestic tasks or fed children directly. The participants also reported improvements in communication and cooperation between spouses.

The second study organized discussions facilitated by father and grandmother peer educators about strategies to improve feeding practices in western Kenya. These discussions often covered topics on maternal and child nutrition, gender inequities and power dynamics, HIV and infant feeding, family communication, and the role family members played in feeding children. Participants found the discussions to be beneficial and informative overall, with grandmothers reporting improved infant feeding and hygiene practices, while fathers reported increased involvement in child care, feeding and helping with household tasks. Both parties also noticed an improved relationship with their daughters-in-law or wives.

The third study examined peer-reviewed literature on interventions that aimed to involve fathers, grandmothers or other family members in low- and middle-income countries in improving maternal and child nutrition. Many of the approaches that the study team found were related to breastfeeding, complementary feeding and maternal and child nutrition practices, both in facility and community settings. Most interventions focused on breastfeeding and involved fathers; it was less common to involve grandmothers. This review provides examples of many different intervention approaches.

“Family members’ influence on nutrition during pregnancy and childhood has been recognized for decades, but there has been limited research to identify interventions to effectively engage these key influencers,” said Martin. “This special issue is exciting because it brings together research from around the world that has used a family systems approach to improve nutrition. It also highlights benefits of engaging family members that go beyond nutrition, such as improved relationships and communication.”

Martin’s research team, together with colleagues from UNC Global Project Zambia, is currently examining the acceptability of engaging family members to support women living with HIV in Lusaka to improve their adherence to antiretroviral therapy and infant care and feeding practices. With partners from USAID Advancing Nutrition, they also recently completed a survey with global health and nutrition practitioners in 49 countries to learn about their experiences implementing programs to engage family members, as well as their suggestions for improving future interventions.

“Since programmatic learning is rarely captured in the peer-reviewed literature, this was a way to complement our reviews,” Martin said.