Changing Their Ways

IFPRI researcher Purnima Menon is studying how to change the behavior of families and policymakers so they’ll do the right thing for children’s nutrition.

photo of Purnima Menon, blurred crowd background

Purnima Menon

Researchers know the first two years of life represent a critical time in child development, a time when an undernourished child can suffer setbacks in mental and physical development from which she may never recover.

What’s less clear is how to communicate with families so they can ensure their children get good nutrition—and with policymakers so they will set up systems to make it easier for families to do so.

That’s what IFPRI’s Purnima Menon is working to change. Menon, a research fellow at IFPRI since 2007, studies issues related to families’ behavior and nutrition interventions. She is co-leading the project Partnerships and Opportunities to Strengthen and Harmonize Actions for Nutrition in India (POSHAN), as well as leading the evaluation of Alive & Thrive, an initiative of the Bill & Melinda Gates Foundation that aims to improve infant and child nutrition in Bangladesh, Ethiopia, and Vietnam. Posted in India, which accounts for more than 40 percent of the world’s stunted children, she sees the ravages of undernutrition every day.

“What does it take to enable families to do the right thing?” Menon asked, in an interview from her New Delhi office. “It’s fascinating from a behavior change perspective.”

Understanding the details of women’s lives is a vital piece of Menon’s work. To know how to persuade women and families to change their behavior, Menon first needs to know how they live and why they make the choices they do. Menon is particularly interested in the roles of women in households, not only as mothers, but also as wives, daughters-in-law, income earners, and farmers—all of which may make it easier or harder for them to follow recommendations about feeding and caring for children.

“What do their daily lives look like? What do their routines look like? What enables or prevents them from doing a certain thing?” Menon said. “When we go out and gather data in our studies, we talk to women about what they’re feeding the babies and why they’re doing things a certain way. We also talk to health workers to understand their work environments and the things that enable them to deliver services in poor communities.”

Still, as she spent her childhood moving around India (her father was in the Indian Air Force), Menon never envisioned herself delving into the thorny problems of international food policy. She was a self-described “foodie” who imagined someday running a restaurant or hotel.

This was the future she was pursuing when she took up the study of nutrition at the University of Madras. But as she worked with women and young children in the field as part of her master’s degree program at the University of Delhi, Menon was struck by the importance of engaging communities with nutrition first-hand. She was hooked. “I just started to feel like the community side of it was much more exciting and much more relevant,” Menon said. “That’s where I wanted to go.”

Two decades later, after earning a doctorate at Cornell University and working to improve nutrition programs in Haiti and elsewhere, Menon is helping draw attention to the severity of India’s nutrition problem. A 2009 New York Times article quoted her on the challenges facing India’s efforts to improve infant undernutrition, and in 2010 she wrote a Foreign Policy op-ed calling for smarter nutrition interventions by India’s national and local governments.

As part of both POSHAN and Alive & Thrive, Menon and her staff collect voluminous amounts of data about the lives of women and children, and the systems surrounding them, through surveys and anthropological research. They then use that information to tell policymakers and program implementers how they can support women’s adoption of nutrition-promoting recommendations.

One example is the effort to persuade women to exclusively breastfeed for the first six months of a baby’s life, which has been a focus of Alive & Thrive. Breastfeeding is natural, Menon said, but exclusive breastfeeding for a full six months is often challenging for women.

“Maybe they’re not getting enough help with breastfeeding when they have problems. Or maybe other people in the house decide the child can have something other than breast milk because the dad brings home, say, a tin of formula milk,” she said.

So Alive & Thrive doesn’t just target mothers—it also uses mass media to reach fathers and engages with older women who may play a part in child rearing. And it makes use of advocacy and engagement with policymakers to support the efforts of governments and other partners to improve child feeding in the three countries. Part of the goal of the program is to learn what works. “Our team is bringing innovation and rigor to the evaluation of these interventions,” said Menon.

POSHAN aims to address a critical gap in India: less than 55 percent of mothers and children receive essential health and nutrition interventions. This gap occurs in part because it can be difficult to scale up the delivery of high-quality health and nutrition services. In addition,  policymakers lack consensus on how to address undernutrition and so adopt ineffective policy solutions.

Menon and her colleagues are starting their research by gathering evidence on health and nutrition programs in India, focusing on three or four states. Next they will turn to finding the most effective ways of communicating with program implementers and policymakers.

“We are trying to understand what the evidence base looks like,” Menon said, “but also what people are looking for when they’re making those decisions, what’s really going to work to enable the system to deliver that behavior.”