the process of developing program strategies, especially those involving approaches to behavior change to prevent malnutrition. Many materials and documents are available on infant and young child feeding and formative research methods. However, despite (or perhaps in part as a result of) the relatively large number of guides and documents, it remains a challenge to know how to select between the various methods and approaches to conducting formative research for infant and young child feeding. Often, those (individuals and firms) who are contracted to conduct formative research either are not ‘subject matter experts’ in infant and young child feeding, or they may have limited formative research experience. This guide is intended to bridge the gap between those who have some of the knowledge and skills, but lack the specific experience in formative research for infant and young child feeding. It is intended to offer a brief orientation to the key infant and young child feeding topics; major formative research methods and techniques to apply in this area; a process for determining the appropriate formative research approach depending on program needs; and preparations for analyzing the information collected. It also includes samples and examples of formative research tools and plans and suggestions for analytical tools and formats. I. Knowing the general context Infant and young child feeding practices fit within the broader ‘causal framework’ of the determinants of child nutrition (see Box 1). Infant and young child feeding practices are part of broader child care practices, and are also affected by household food security/access to food, the availability of safe water and sanitation, and access to quality health services. Our understanding of the determinants of infant and young child nutrition status goes well beyond this general conceptualization. For infant and young child feeding, specific ‘guiding principles’ for optimal feeding and care practices are available from the World Health Organization for both breastfed and non-breastfed children, as well as for those at risk for HIV/AIDS. In addition, ‘core’ indicators for measuring infant and young child feeding have been developed (see Annex B). Practitioners conducting formative research on infant and young child feeding must understand the international conceptual framework and be familiar with the internationally recognized feeding recommendations and indicators. Box 1. Infant and young child feeding practices and determinants of child nutrition framework Adapted from: United Nations Children’s Fund (UNICEF). Food, Health and Care: The UNICEF Vision and Strategy for a World Free from Hunger and Malnutrition. New York, NY: UNICEF, 1992. 2 II. Knowing the country, region, or project context Research practitioners also should understand the country and/or program context: what is already known and documented about nutrition and infant and young child feeding in the country where the formative research will be undertaken. Multiple sources of country-level information are available to develop a nutrition and infant and young child feeding profile (see Box 2). Box 2. Nutrition and infant and young child nutrition literature review sources Source of information and where to access Description of available data Demographic and Health Surveys www.measuredhs.com Household and female and male questionnaires, including data on: · Breastfeeding: Initial breastfeeding; breastfeeding status, median duration, and frequency; percentage of children breastfed six or more times. · Complementary feeding: Percentage of children 6–23 months who are fed according to three infant and young child feeding practices (minimum meal frequency, minimum dietary diversity, consumption of specific foods). · Nutritional status: Anthropometric indicators for women during pregnancy and for children. · Micronutrients: Iodization of household salt, micronutrient intake among children and mothers, prevalence of anemia in children and women and by anemia status of mother, consumption of vitamin A–rich foods, vitamin A supplementation rates. · Feeding during diarrhea practices. Multiple Indicator Cluster Surveys www.childinfo.org Modular surveys, including one for nutrition with data on early initiation of breastfeeding; exclusive breastfeeding; continued breastfeeding; breastfeeding and complementary foods; anthropometrics on stunting, wasting, and underweight; vitamin A supplementation; and iodized salt consumption at household level. World Health Organization database on vitamin and mineral deficiencies www.who.int/vmnis/en/index.html National, in-country regional, and first administrative-level data on vitamin and mineral nutritional status of populations in United Nations Member States. Contains information on anemia, vitamin A deficiency, and iodine deficiency. United States Agency for International Development knowledge, practices, and coverage surveys www.mchipngo.net/controllers/link .cfc?method=tools_kpc_modules Rapid knowledge, practices, and coverage survey questionnaires: Module 2 includes 14 questions on breastfeeding and infant and young child feeding and optional questions on fortified foods, iron supplements, and deworming. Module 3 includes growth monitoring and child anthropometry questions. Additional resources to check at this stage for more quantitative survey data as well as for qualitative information include: · Ministries of health/health management information systems. Many countries now have websites. 3 · Relevant journal articles and project documents: o Multidisciplinary journals: www.ingentaconnect.com. o National Library of Medicine: http://gateway.nlm.nih.gov.gw/Cmd. o International Information Support Center: www.asksource.info/databases.html. o All United States Agency for International Development-funded project reports and documents: http://dec.usaid.gov. The review of the literature will help to identify the gaps that the formative research will attempt to fill. Quantitative information alone can reveal much about