Understanding what shapes maternal, infant and young child feeding in Sri Lanka
Formative research to contextualize Maternal, Infant and Young Child Feeding in Sri Lanka - 2022
Highlights
Sri Lanka has made important progress in maternal and child health, yet malnutrition among women and children remains a persistent public health challenge. Improving nutrition requires more than ensuring that families know what constitutes a healthy diet. It requires understanding the realities in which mothers and caregivers make decisions about what, when and how to feed themselves and their children.
Led by the Family Health Bureau of the Ministry of Health, Sri Lanka, in collaboration with UNICEF Sri Lanka, the South Asia Infant Feeding Research Network (SAIFRN), and The Pennsylvania State University, this formative research explored the social, cultural, economic, environmental and health-system factors influencing maternal, infant and young child feeding (MIYCF) across Sri Lanka.
Conducted from September 2020 to September 2021, the study used an iterative, mixed-methods approach across urban, rural and estate sectors, engaging approximately 700 participants. Interviews, household and mealtime observations, participatory community workshops, food-environment assessments, cultural-domain methods and social-network analysis were used to understand feeding behaviors from multiple perspectives.
Rather than looking only at individual knowledge and behavior, the research examined how feeding practices are shaped by interconnected influences at the individual, interpersonal, organizational and community levels.
Key insights from the study:
Knowing what is healthy does not always mean eating well; Pregnant women generally knew which foods were nutritious, but many did not eat them regularly. Food access, cultural beliefs, family practices and mixed advice from others influenced their diets, with women in the estate sector having less dietary variety.
Breastfeeding is widely accepted, but mothers need enabling environments; Breastfeeding was largely normalized and socially accepted across Sri Lanka. However, mothers' ability to follow recommended breastfeeding practices was affected by competing work and household responsibilities, differences in workplace policies and individual circumstances. Supportive institutional arrangements, including pro-breastfeeding practices in estate-sector Child Development Centres, emerged as important facilitators.
Complementary feeding decisions are shaped by much more than caregiver choice; What young children eat reflects an interconnected set of influences from household finances and caregiver workloads to food availability, commercial food environments, social networks and the accessibility and delivery of nutrition services. Caregivers also navigate children's preferences and demand, including requests for processed foods. Public Health Midwives remain important sources of information, but they are one of several voices influencing families.
Responsive feeding practices need greater attention; More than three quarters of observed caregivers used distractions during children's mealtimes. Around one quarter were observed using negative communication, such as threats, and forced feeding occurred in approximately one fifth of meal observations. These behaviors need to be understood alongside the substantial competing demands faced by caregivers, including childcare, household work and other daily responsibilities.
Handwashing remains an important behavioural and structural challenge; Although most observed households had running water and generally practised adequate food-related sanitation, handwashing with soap was uncommon. Before feeding children, 71 per cent of observed caregivers washed their hands, but only 7.2 per cent used soap. Reliable water supplies, access to soap, knowledge and established daily routines were important enabling factors.
Nutrition supplements are valued, but how they are used matters; Thriposha was highly acceptable but sharing it with non-beneficiary family members was widespread, often resulting in households running out before the next distribution. Micronutrient supplements presented different challenges, including changes in the taste or other sensory properties of food that contributed to child refusal. Pregnant women also reported temporary stock-outs and gastrointestinal side effects associated with antenatal supplements.
A central message from the research is clear: information alone is not enough to improve maternal and child diets. Families make feeding decisions within complex social and economic realities. Effective interventions therefore need to address the environment surrounding mothers and caregivers as well as individual knowledge and practices.
Study identified the following strategies for key prioritization, including strengthening household livelihoods and income generation; supporting homestead food production; improving nutrition education, counselling and Social and Behaviour Change Communication; strengthening social protection and food assistance; regulating unhealthy food environments; providing greater support to pregnant women and new mothers facing competing demands; and investing in the capacity of the nutrition and health workforce.
