Total country population (2001): 1 billion

Project area: CARE, CRS, and World Vision pilot and scale-up sites

Project Duration:1997 to 2004

• Download a complete copy of World LINKAGES/India
• Download LINKAGES/India Project 1997-2004 Final Report
• Download counseling cards developed by LINKAGES and its country program partners

Background
LINKAGES-supported activities in India originated in 1997 at the request of its three private voluntary organization (PVO) partners to develop a community-based program model to improve infant feeding and maternal dietary practices within their existing programs. CARE, Catholic Relief Services (CRS), and World Vision (WV) tested an innovative behavior change methodology that introduced or reinforced simple, culturally appropriate, and nutritionally effective practices. PVO partners then targeted suboptimal behaviors identified during formative research including delayed initiation of breastfeeding, discarding of colostrum, incomplete feeding from the breast, improper timing of the introduction of other foods and liquids, and reduced food intake during pregnancy. They tested innovations to address these behaviors and then adapted them more broadly in their programs.

Program Design and Implementation
A results-oriented behavior change approach was implemented by the PVO partners in different program contexts, including food-assisted, child survival, and community development programs. The following were key elements and activities of the PVO partners' behavior change programs:

Key Elements

• Formative research to understand local feeding and dietary practices, identify simple changes in practices that are affordable and culturally acceptable, and test strategies for their feasibility
• Strategy Development Workshop to identify key messages and develop an implementation plan
• Materials and Media Development to communicate key messages through counseling cards, wall charts, cassettes with jingles and songs, and hanging messages at small shops and public places
• Participatory Training for community development organizers, traditional birth attendants, and registered medical practitioners
• Community Interventions including home visits, women's groups, and community events (such as health fairs, baby shows, and meetings with community leaders)
• Monitoring and Evaluation through baseline and endline surveys

Results
Timely initiation of breastfeeding (within one hour of birth) increased from less than 1% in 1999 to 6% in 2001 in CARE pilot sites and from less than 1% to 22% in World Vision pilot sites. During this period exclusive breastfeeding up to 6 months more than doubled in CARE sites - from 12% to 28%. One of the outcomes of the program is the ongoing process of the PVO partners to apply the systematic, results-oriented behavior change communication approach in additional sites, states, and technical areas.