Banana Bags encourage baby and infant nutrition

Baby Nu Lin is now seven months old and his mother Kim Te worries because her baby is not eating the food she makes. She fears he does not like her cooking and feels helpless every time she tries to feed him, and he cries. 

The birth of a baby brings joy to a family, yet it comes with a flood of concerns. Kim Te lives in Tun Zang Village, Tedim Township, Chin State, and is experiencing a problem faced by many other mothers in Myanmar who are unsure of how to feed their babies properly and when to introduce new foods. Their default meal is rice porridge, which is a poor source of nutrients for a growing baby.

Myanmar has improved maternal and child health, yet complementary feeding, when breast milk alone is no longer sufficient to meet the nutritional requirements of the baby, is still a challenge. 

With support from UNICEF China, UNICEF Myanmar and Save the Children International, partnered with 17 Triggers, a social behaviour change lab, to investigate the most significant barriers that Myanmar families face during the first 1,000 days and the results from this investigation are revealing.

Parents are unsure of how or when to gradually introduce foods, which results in a lack of diversity within the food given to a baby. This comes from strong cultural beliefs that range from the fear of the baby choking on green vegetables, to the perception that the family is too poor to provide meat as protein. Available information is confusing, and other viable alternatives are unknown.\

“Three (food) groups? Four stars? Ah no! I mixed it up. The meat makes you grow, the corn one makes you strong," wondered one respondent.

Families don’t know the correct frequency for feeding or the proper portion size according to the baby's age. They struggle to crush food to the type of texture which will help the baby accept it. As a consequence, complementary feeding is started either too early or too late.

So, how can Myanmar families begin to feed their baby clean, diverse and age-appropriate foods?

Different physical tools, messages and information channels were prototyped and tested with families. The Baby Box, a simple cardboard box distributed to new mothers in Finland since the 1930s comes filled with essentials like diapers and clothes and functions as a crib. This was taken as the inspiration for how an effective tool can facilitate the execution of a behaviour.

The concept of Superfoods won the hearts of Myanmar families. Delightful food characters demonstrate the benefits provided by each food category. Rice for energy, beans and meat for strength, and fruits and vegetables for good health.

The Banana Bag was developed, filled with a variety of useful tools including beans and egg boxes that encourage food diversity, a crushing tool set to assist in correct food preparation, bowls in different sizes for feeding the right portions, and soap and a baby towel to promote hygienic behaviours. These tools were wrapped in a campaign message delivered by the Superfood characters. “Every day feed your children not only rice, but beans, eggs, and vegetables.”

The Banana Bags were delivered to mothers at their local health care centres in small interactive group sessions, alongside three instructional videos which were transferred to families via Zapya, a free and data less file transfer app. To reinforce the intervention, weekly voice messages with tips and recipes were sent to families promoting key behaviours.

Testing in Shwe Pyi Thar township, a peri-urban area of Yangon and Tun Zang, a rural mountain town in Chin State began in November 2019. After three months, the trial resulted in a clear finding that when mothers are properly equipped, they adopt the correct feeding behaviours for their baby and observe the positive impact on their baby’s development.

“I can see the difference in my baby. He seems healthier and shows no signs of illness. He eats more than his brother did at this age,” reported a test participant.

Findings across all key behaviours showed early promise of how the Banana Bag could be a successful intervention to improve complementary feeding. All mothers used every tool and 75 percent fed their baby the correct number of times per day. More than 80 percent fed their child a greater variety of foods, introducing eggs, beans and vegetables daily. More than 90 percent of the mothers used the masher tool every day and learned quickly how to create the right texture. As a result, their babies ate more food.

One of the biggest takeaways was the empowerment the Banana Bag gave to mothers, who gained confidence in complementary feeding practices and even became advocates amongst their communities, spreading good practices, recipes and tools.

“I gave the sieve and the small bowl to my neighbour because she has a six-month-old baby,” shared one participant.

Showing positive results in the two locations with different languages, food accessibility and feeding practices, the Banana Bag proved to be an effective solution that can change the behaviour of diverse groups of users. This intervention is a scalable solution which could be produced locally and made available to families across Myanmar. The limited stock of products remains a challenge to developing this promising intervention.

Moving to the next stage requires an investment of time, money, and personnel, as well as close collaboration with the Myanmar government. Save the Children International and UNICEF believe now is the time to redefine traditional approaches to complementary feeding, giving babies across Myanmar a better chance for healthier and happier futures.