Household Agriculture-Nutrition Do-able Actions to Reduce Maternal Anemia: The HANDS Framework for Social and Behavior Change Communication Interventions in Integrated Nutrition Programming

Abstract

Objectives: Our objective is to increase pregnant and lactating women's access to iron-rich foods through effective agriculture-nutrition social and behavior change communication (SBCC) programming at household and smallholder farm level.  Methods: Formative research and a comprehensive review of the literature on maternal nutrition, agriculture and food security, and maternal health leads to the development of country-specific matrices. The information summarizes the evidence base of family, community, and smallholder farming actions that increase consumption of iron-rich foods by pregnant and lactating women. The information also includes maternal anemia-related behavioral profiles, including household-level behavior barriers and motivators for pregnant/lactating women and their husbands. The matrices are refined to sort do-able actions for smallholder farming families, including gender roles and family support, into five distinct categories: (1) Raise & Grow; (2) Earn & Buy; (3) Prepare, Process and Store; (4) Rest, Share and Eat, and (5) Discuss and Decide Together. Each category promotes specific behaviors, skills, and enabling technologies such as solar drying or sack gardens to increase access to animal source foods and iron-rich vegetables.  Results: This process results in a completed Household Agriculture-Nutrition Doable Actions ("HANDS") Framework. "HANDS" has helped Feed the Future programs in Tanzania and Ethiopia to develop evidence-based maternal anemia SBCC materials and interventions for agriculture extension workers, pregnant or lactating women, and their families.  Conclusions: "HANDS" can be easily adapted for other countries by inputting country-specific content in each of the five categories of doable actions for maternal anemia reduction.