The Power of Counseling: Changing Maternal, Infant and Young Child Nutrition and Family Planning Practices in Dhamar, Yemen

Presentation at the Global Maternal Newborn Health Conference, October 20, 2015

Background: This study was conducted in two rural districts of Dhamar, Yemen to inform the development of evidence-based programming to address high rates of malnutrition, short inter-pregnancy intervals, and low contraceptive prevalence. Malnutrition and closely-spaced pregnancies increase maternal and child morbidity and mortality; linking efforts to improve nutrition and FP use can be mutually beneficial for maternal and child health outcomes. Conducted during December 2013-January 2014, this study assessed mothers’ and couples’ ability to adopt recommended nutrition and FP practices, identifying barriers and facilitating factors.

Methodology: Trials of Improved Practices (TIPs) methodology was used to collect information on nutrition and FP practices and involved a series of three visits: an exploratory visit, counseling visit, and follow-up visit. Thirty-two mothers and 16 fathers of children younger than two years of age took part. Key informant interviews were conducted with 4 grandmothers, 4 health providers, and 4 community leaders.

Results: The majority of mothers and couples tried a new MIYCN or FP practice and felt positive about the practice they tried. Barriers prevented couples from obtaining FP services, namely: absence of female providers at the health facility, contraceptive stock-outs, cost of private sector contraceptives, and availability of unregistered methods. The main reason for introducing liquids and/or food before six months was the perception that mothers’ breast milk was insufficient. Several mothers were able to return to exclusive breastfeeding after being counseled.

Conclusions: In rural communities of Yemen, families can improve use of optimal practices, if given information and support to use them. Future recommendations include: 1) address information gaps among community members and health workers; 2) capitalize on the power of counseling; 3) engage husbands and strengthen couple communication; 4) identify and involve champions; 5) address structural barriers; 5) involve the private sector; and 6) integrate MIYCN and FP within existing platforms.