EBioMedicine | 2021
Improving childhood nutrition in Indonesia through an innovative behavioural change programme
Abstract
Preventing malnutrition is meaningful to me. In Indonesia, in 2018, 31% of children under five were stunted [1]. As a trained medical doctor working in one of the poorest areas in Indonesia, I saw first-hand that emergency assistance and one healthy meal per day schemes did not go far enough to change people’s behaviour. Once the intervention was gone, so were the new habits. I wanted to find another way to prevent illnesses and serve the community. Learning from HIV initiatives focusing on changes in behaviour, I became interested in the intersection between behavioural change and nutrition. How parents feed their children is influenced by socio-cultural factors in Indonesia. We have a strong communal culture, where status and reputation affect how parents feed their children under two years old, who are referred to in Bahasa Indonesia as Bawah Dua Tahun or “Baduta”. With this in mind, Global Alliance for Improved Nutrition (GAIN) developed The Baduta programme in 2013 [2]. This programme uses an approach based on behaviour-centred design which was developed by the London School of Hygiene and Tropical Medicine to improve maternal and infant nutrition [3]. As senior programme manager, I have been involved in this project from the design phase in 2014; now, it has been adopted and scaled-up in more than 50 districts in Indonesia. The programme targets four behaviours: exclusive breastfeeding, complementary feeding, eating healthy snacks and encouraging nutrient-rich diets for expectant mothers. It uses emotional demonstrations or ‘emo-demos’ and is complemented with health system strengthening activities, including the revival of the Baby Friendly Hospital Initiative, a global effort launched in 1991 by WHO and UNICEF to implement practices that protect, promote and support breastfeeding in maternity facilities. The ‘Emo-demos’ use elements from evolutionary psychology, commercial marketing, and neuroscience, to engage mothers and