Rasheed Sabrina, Roy Swapan Kumar, Das Susmita, Chowdhury Syeda Nafisa, Iqbal Mohammad, Akter Syeda Mahsina, Jahan Khurshid, Uddin Shahadat, Thow Anne Marie
Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh (ICDDR,B), Dhaka, Bangladesh.
Bangladesh Breastfeeding Foundation, Dhaka, Bangladesh.
BMC Public Health. 2017 Jun 13;17(Suppl 2):402. doi: 10.1186/s12889-017-4338-0.
Appropriate infant and young child feeding (IYCF) practices are essential for nutrition of infants and young children. Bangladesh has one of the highest levels of malnutrition globally along with sub-optimal IYCF practices. A supportive policy environment is essential to ensure that effective IYCF interventions are scaled up. The objectives of our study were to assess the support for IYCF in the national policy environment through policy analysis and stakeholder analysis and in so doing identify opportunities to strengthen the policy environment.
We used a matrix developed by SAIFRN (the South Asian Infant Feeding Research Network) to systematically identify supportive national policies, plans and guidelines for IYCF. We adapted narrative synthesis and descriptive approaches to analyze policy content, based on four themes with a focus on support for mothers. We conducted three Net-Map interviews to identify stakeholders who influenced the policies and programs related to IYCF.
We identified 19 national policy documents relevant to IYCF. Overall, there was good level of support for IYCF practices at policy level - particularly regarding general support for IYCF and provision of information to mothers - but these were not consistently supported at implementation level, particularly regarding specificity and population coverage. We identified gaps regarding the training of health workers, capacity building, the monitoring and targeting of vulnerable mothers and providing an enabling environment to mothers, specifically with respect to maternity leave for working women. Urban populations and providers outside the public sector remained uncovered by policy. Our stakeholder analysis identified government entities such as the National Nutrition Service, as the most influential in terms of both technical and funding support as they had the mandate for formulation and implementation of policies and national programs. Stakeholders from different sectors played important roles, demonstrating the salience of IYCF.
Although there is strong supportive policy environment for IYCF, it is important that policies cover all populations. Our analysis indicated that opportunities to strengthen the policy environment include: expanding population coverage, increasing inter-sector coordination, improving translation of policy objectives to implementation-level documents, and the engagement of non-public sectors. In addition, we recommend explicit strategies to engage diverse stakeholders in the formulation and implementation of IYCF policies.
适宜的婴幼儿喂养做法对婴幼儿营养至关重要。孟加拉国是全球营养不良水平最高的国家之一，同时婴幼儿喂养做法也不尽如人意。一个支持性的政策环境对于确保扩大有效的婴幼儿喂养干预措施至关重要。我们研究的目的是通过政策分析和利益相关者分析，评估国家政策环境对婴幼儿喂养的支持情况，并借此确定加强政策环境的机会。
我们使用了由南亚婴幼儿喂养研究网络（SAIFRN）开发的矩阵，系统地识别支持婴幼儿喂养的国家政策、计划和指南。我们采用叙述性综合和描述性方法，基于四个以支持母亲为重点的主题来分析政策内容。我们进行了三次网络地图访谈，以确定影响与婴幼儿喂养相关政策和项目的利益相关者。
我们确定了19份与婴幼儿喂养相关的国家政策文件。总体而言，政策层面对婴幼儿喂养做法有较高水平的支持——特别是在对婴幼儿喂养的总体支持以及向母亲提供信息方面——但在实施层面这些支持并不一致，特别是在具体性和人口覆盖方面。我们发现，在卫生工作者培训、能力建设、对弱势母亲的监测和针对性以及为母亲提供有利环境方面存在差距，特别是在职业女性产假方面。城市人口和公共部门以外的提供者仍未被政策覆盖。我们的利益相关者分析确定，诸如国家营养服务局等政府实体在技术和资金支持方面最具影响力，因为它们有权制定和实施政策及国家项目。不同部门的利益相关者发挥了重要作用，表明了婴幼儿喂养的重要性。
尽管存在支持婴幼儿喂养的有力政策环境，但政策覆盖所有人群很重要。我们的分析表明，加强政策环境的机会包括：扩大人口覆盖范围、加强部门间协调、改善政策目标到实施层面文件的转化，以及非公共部门的参与。此外，我们建议制定明确战略，让不同利益相关者参与婴幼儿喂养政策的制定和实施。
