Peanut+Butter+Mamas

**OUR KICKSTART VIDEO:**
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**PROBLEM STATEMENT:**
According to World Health Organization and United Nations Children Funds (UNICEF), **39% of infants are exclusively breastfed for 4 months or less**. Exclusive breast feeding in Malawi in particular is uncommon. In a separate study examining the breastfeeding and supplemental feeding practices in Malawi, of 160 caregivers of children ages 6 months to 2 years, "**65% of the children were given food in their first month, and only 4% of the children were exclusively breastfed for 6 months**"(Kerr).

Breastfeeding places a high demand on a mother’s energy and protein stores. It is important to both the mother and the child that these stores are well established, conserved, and replenished. It is recommended by the Mother and Child Health and Education Trust to increase caloric intake through two additional meals a day, or **an extra 550 calories a day**. This is because she is the sole provider of energy and nutrients for herself and her child.

World wide, malnutrition is estimated to contribute to more than one third of all child deaths. According to Undernutrition, poor feeding practices, and low coverage of key nutrition interventions, “in 2010, globally, an estimated 27% (171 million) of children younger than 5 years were stunted and 16% (104 million) were underweight”. The author also states that Africa and Asia tend to have more severe burdens of undernutrition and that few children in the developing world benefit from optimal breastfeeding and complementary feeding practices. According to WHO, “if every child was breastfed within an hour of birth, given only breast milk for their first six months of life, and continued breastfeeding up to the age of two years, about 800 000 child lives would be saved every year”. According to UNICEF, interventions to promote exclusive breastfeeding have been estimated to have the potential to prevent 13% of all under-5 deaths in developing countries and are the single most important preventive interventions against child mortality.

Malawi is home to 6.8 million children. The average mother in Malawi has about 8 children. Even though there have been improvements in the rates of child mortality, about 1 in 8 children still die. Unfortunately, malnutrition remains high and is the single biggest contributor to child death. Child malnutrition also leads to other consequences. “**Around 46 percent of children under five are stunted (low height for age), 21 percent are underweight, and four percent are wasted (low weight for height)” and “micronutrient deficiencies are common”**(UNICEF). Stunting usually happens before the age of 2 and can lead to delayed motor development, impaired cognitive functions and poor progress in school. The effects of stunting are irreversible. Among the causes of child malnutrition is chronically under-nourished pregnant and breastfeeding women. Malawi also has one of the worlds highest maternal mortality rates; 807 mothers die due to pregnancy and childbirth related causes for every 100,000 live births. Again, among the causes is nutritional deficiencies.

Mother, infant and young child feeding and nutrition is an issue related to both supply and demand, access and **behavior**. **Changing behavior interventions are an essential component of our goals to improve infant feeding practices, notably breastfeeding, and maternal and child eating habits.** In order for mothers to make a change in their behavior we must create a more supportive environment at multiple levels for breastfeeding.

We intend to accomplish this by:
 * Providing education in the existing antenatal clinics to health care workers on how to promote early and exclusive breast feeding for the first six months.
 * Providing education to mothers and family units on appropriate feeding practices for infants through the first two years of life.
 * Creating mother to mother support groups so that mothers have greater access to support within their villages.

**PROJECT GOALS: **

 * Create Baby Friendly Communities by educating all members of the community on the importance of early and exclusive breastfeeding and appropriate feeding practices of mothers and babies.
 * Support early (within the first hour after birth) and exclusive breastfeeding for the first six months, and continually for the first two years of the child's life.
 * Develop supplemental educational material to better inform lactating women on the benefits of breast feeding.

PROJECT PRE-IMPLEMENTATION PLANNING AND DESIGN:

 * To provide education to the healthcare workers in the existing antenatal clinics we will use existing training manuals made by UNICEF on how to promote early and exclusive breast feeding. These manuals teach the healthcare workers how to effectively communicate with the mothers and what actions to take in order to support early and exclusive breast feeding.
 * Healthcare workers will be trained to say "breast milk is specifically made with all of the nutrients for your baby" or "when your baby is sick, breast milk will help your baby fight his sickness best" in conjunction with "breast is best" because actually hearing the reason will stick with the mothers better.
 * Healthcare workers will be trained to put newborns immediately following birth on the mothers chest which significantly helps breastfeeding success.
 * Healthcare workers will also be given tools to help them teach mothers about the importance of early and exclusive breastfeeding.
 * UNICEF has made pictorial cards that show mothers appropriate feeding practices. Including: not letting family members offer the infant water or porridge, feeding on demand throughout the day and night, keeping a low birthweight/premature infant against the mothers chest, washing hands after changing diapers and before feeding, how to correctly express milk, and continuing to breastfeed when the baby is sick.
 * We are planning on making posters showing appropriate attachment as well as appropriate feeding practices for the clinics to put on their walls.
 * We are planning on making a song about appropriate feeding practices. Songs are already being used in the clinics about how to use the peanut butter supplements. We feel this is a great way to help the mother remember.
 * To create a stronger support system within the villages or communities of the mothers, we want to go out and spend time with the mothers, their families, and specifically the respected elders of the community. We want to see how these mothers are living and what they are eating. We want to see what the elders are recommending to the new mothers to keep their children healthy. We then want to work with the communities and explain how to better help the mothers and babies.
 * Through our research we have learned that in Malawi they tend to eat a lot of corn and their meals are full of carbohydrates. "Corn is life" is a phrase that we have read. We want to see if that is true and we want to help the community realize that mothers do need a variety of food and that all an infant under six months of age needs is breast milk.
 * Teaching the members of a community is important because we want this new information about the importance of breastfeeding and how to correctly do it to be passed down. Many women still give birth at home and so they need to know information such as putting the baby immediately on the mothers chest following birth.

EXAMPLES OF EDUCATIONAL MATERIAL:
This picture shows that the mother needs to breastfeed both day and night and needs to tell the grandmother no to supplementary foods before 6 months age.

This picture illustrates the difference between a mom who only gives breast milk for the first 6 months and a mom who supplements with water, food, or formula.

This illustrates that mothers need to feed on demand at all times during the day and night.

This illustrates some different positions to breastfeed as well as shows the mom how to keep low birthweight babies skin to skin.

This illustrates how a working mom can continue to breastfeed even while working. She can either express milk or take her baby with her to work. There are other cards that show how to safely express milk and store.

This picture shows that even when babies are sick they need to be breastfed and sometimes when a baby is sick they will breastfeed more often. It is important for the mother to continue to feed on demand because breast milk will help the baby fight the sickness.

These are the instructions to make a "Sock Boob" which is a great teaching tool to help health care workers demonstrate different feeding positions, appropriate latching as well as how to express milk. The sock boob is a good teaching tool because it allows both men and women to help teach new moms about breastfeeding and it is not expensive.

SONG/CHANT:
One tool that they frequently use in villages in Malawi are songs and chants to memorize details about what they have learned. We have developed a chant for the trainers to adopt while instructing the breastfeeding mothers on the "whats" and the "whys" of feeding breast milk as opposed to other sources of nutrients.

Leader: Don’t give up. I won’t give up. We won’t give up.

Leader: My skin to baby’s skin makes us happy Class: My skin to baby’s skin makes us happy All: Breast milk is all my baby needs
 * Maybe : my skin to baby's skin helps baby grow**

Leader: Feeding baby shouldn’t hurt, change position Class: Feeding baby shouldn’t hurt, change position All: Breast milk is all my baby needs

Leader: Start feeding baby on the breast last fed Class: Start feeding baby on the breast last fed All: Breast milk is all my baby needs

Leader: Nurse baby even when we are both sick Class: Nurse baby even when we are both sick All: Breast milk is all my baby needs

Leader: More milk baby drinks, the more I make Class: More milk baby drinks, the more I make All: Breast milk is all my baby needs

Leader: Don’t give up. Class: I won’t give up. All: We won’t give up.

{Insert chant video here}

**INTERVIEW WITH A LACTATION CONSULTANT** **:** ====I, Cara, took it upon myself to go visit a lactation consultant here in the US and see what type of problems they encounter here and how they address them. It was very interesting to hear how common it is for women in the US to bottle feed rather than breastfeed. Yvonne, the consultant, informed me that it is for several reasons that she sees this including: cosmetics, misinformation about the health of breast milk compared to formula, and cultural differences. Yvonne made a point to stress that she feels the biggest issue she faces is the lack of education about the health benefits of breastfeeding. Part of this is tied into culture. For instance, she has noticed that many Vietnamese woman ask for formula before even trying their breast, or many Mexican families give their baby tea rather than colostrum (the first milk that the mothers produce that is full of antibodies and immunoglobulins.) She also mentioned that there are often communication barriers that she must overcome in these situations and that is almost never easy. There are no shortcuts when it comes to being relational with a new mother from a different background. It is best is to be patient, learn what mothers want or need, and educate them on the health benefits.==== ====When I asked her what she believed to be the most important thing to have these new mothers do, she responded with "go back to the basics!" If a mother and baby are able to have skin to skin contact with one another right after the baby is born, many breastfeeding problems may be eliminated. Skin to skin before the infant is bathed helps the mother and baby bond due to pheramones released, triggering the release of oxytocin. Oxytocin production plays a key role in milk let down as well. Yvonne said that the infant should stay in contact with its mother until it has fed for the first time, preferably within the first hour of birth, However, even if it takes longer, the mother should allow the child to do what is termed the "Baby Crawl" up to her breast until he can manage to latch on and feed. Again, we are taking it **back to the basics** and allowing the baby to do what it knows best, eat! Our interview ended with this message that she wanted me to be aware of as well as promote, "**Natural is Better!**"====

BUDGET:

 * Description: || Cost: ||
 * Materials: Posters, training booklets, etc. || 2,000 ||
 * Lactation Consultant || 50,000 ||
 * Assistant || 30,000 ||
 * miscellaneous || 2,000 ||
 * Total: || 84,000 ||

STAKEHOLDER ANALYSIS:

 * Stakeholder || Interests || Effect (,0,-) || Importance (1-5) || Influence (1-5) ||
 * Mothers || health of infant || + || 5 || 5 ||
 * || personal health || 0 || 5 || 5 ||
 * || decrease # of pregnancies || + || 5 || 5 ||
 * Elders || health of community || + || 4 || 5 ||
 * || sticking to tradition || - || 4 || 5 ||
 * Men/Husbands || health of infant || + || 1 || 2 ||
 * Local Clinics || decrease malnutrition in youth || + || 5 || 3 ||
 * NGO's || support and spread health of youth || + || 4 || 2 ||
 * || monetary gain || - || 3 || 2 ||
 * Media || use of formula || - || 1 || 4 ||
 * Church || health of family/community || + || 3 || 5 ||

DATA:


This graph shows that there is a relationship between the number of children a woman will have and child mortality. This is important for our project because we are aiming to improve the nutrition of newborns and infants with the hope of decreasing the mortality rates.



This graph shows weight in comparison with clean water sources. This is important for our project because we are advocating breastfeeding over any other method including formulas. The lack of clean water is important in discouraging formulas because the infants do not have strong immune systems to fight any microbes in the contaminated water.



This graph shows that there is a relationship between underweight children and child mortality. This is important for our project because we are aiming to keep infants at healthy weight with the hopes of decreasing child mortality. If a child is a healthy weight they are less likely to die.

**SCALABILITY:** This type of program would be beneficial all over the globe. Our goal is to make a basic program that could easily be modified for many different countries cultures. Our program will most effectively work in developing countries.

Based on our hypothesized stakeholder analysis, this type of program would be highly accepted as long as the educators approach each community with respect and are willing to adapt to each person's individual needs.

PROJECT RESOURCES:

 * WHO
 * UNICEF
 * UNICEF Webinar Manual Improving Breastfeeding Practices
 * Project Peanut Butter
 * Malawi Breastfeeding Initiative
 * World Alliance for Breastfeeding Action
 * GAIN
 * Rehydrate.org
 * MotherChildNutrition.org
 * Davis, T. E., Fischer, E. F., Rohloff, P. J., & Heimburger, D. C. (2014). Chronic malnutrition, breastfeeding, and Ready to Use Supplementary Food in a Guatemalan Maya town. //Human Organization, 73(1)//, 72-8
 * Kerr, R.B., Berti, P. R., Chirwa, M., (2007). Breastfeeding and mixed feeding practices in Malawi: reasons, decision makers, and child health consequences. //Food and Nutrition Bulletin, 28(1),// 90-9
 * Lutter, C. K., Daelmans, B. G., de Onis, M., Kothari, M. T., Ruel, M. T., Arimond, M., & ... Borghi, E. (2011). Undernutrition, poor feeding practices, and low coverage of key nutrition interventions. //Pediatrics, 128(6)//, e1418-e1427. doi:10.1542/peds.2011-1392

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Kylie Garcia (kgarci18@calpoly.edu) Beatrice Lunday (blunday@calpoly.edu) <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 16px; text-decoration: none; vertical-align: baseline;">Cara House (cehouse@calpoly.edu)
 * <span style="background-color: transparent; color: #000000; font-family: Arial; font-size: 16px; text-decoration: none; vertical-align: baseline;">Contact Information: **