Dates: March 18–20, 2025
Location: Neemrana Fort Palace Hotel, Neemrana, India
Overall Goal
Leverage the unique context and insights from India to facilitate the sharing of lessons learned across all CROWN projects — highlighting topics such as approaches to government collaboration for IFA and MMS rollouts, human-centered design (HCD) processes, and intervention implementation — while supporting the development of globally adaptable solutions rooted in locally informed strategies.
Event Objectives
- To facilitate dynamic partnerships and collaboration among CROWN implementing partners, government agencies, NGOs, and other stakeholders.
- To foster data-driven collaboration by developing a shared understanding of implementation processes and outcomes through integrating findings and methodologies from all projects.
- Promote the technical exchange of information from projects outside of CROWN that have learnings from social behavior change, supply chain and demand creation, human-centered design, and maternal nutrition in general.
Conference Summary
Project Concern International, Bihar, India
- Background: Anemia levels among women (15-49 years) are significantly high, with Bihar (64.1%) surpassing the national average (57.7%). Pregnant and lactating women in Bihar face even higher prevalence, necessitating systemic interventions.
- Project Objectives: PCI aims to develop, test, and implement behavioral interventions for both beneficiaries (pregnant and lactating women) and healthcare providers to improve anemia management by increasing adherence to IFA supplements. It follows a three-phase approach: needs assessment, ideation, and testing, incorporating workshops and behavioral research.
- Mental Models & Barriers: Adherence to IFA supplements is influenced by psychological and cultural factors, including trust in authority, cultural resistance to modern medicine, fear of side effects, preference for natural remedies, and misconceptions about medication. Healthcare provider biases also impact diagnosis and counseling, with testing seen as an escalation rather than routine care, and food counseling prioritized over IFA adherence.
- Behavioral Change Strategies: The intervention strategy focuses on making IFA supplementation personally relevant by aligning it with women’s psychological needs, clarifying its importance, addressing adherence barriers, and using both direct (emotional messaging) and indirect (social cost, urgency, goal setting) appeal methods.
Swati Das and Brijesh Rao, PCI
Johns Hopkins University Center for Communication Programs, Ethiopia
- Background 66% of women of reproductive age in Ethiopia are micronutrient deficient, with less than 20% adhering to the recommended 90-day IFA supplementation during pregnancy. Adherence is significantly lower in rural areas (13%) compared to urban areas (26%).
- Intervention Design & Adherence Solutions: Key barriers include forgetfulness, lack of household support (especially from husbands), misconceptions, and weak counseling. The project used HCD to develop solutions like counseling materials, visual reminder tools (e.g., danglers), and a voucher sticker system to improve adherence.
- Implementation & Early Impact: The intervention, tested in 8 Woredas (administrative units below the Region in Ethiopia), four of which focused on IFA and the other four on MMS. The intervention involved training 694 health workers and distributing 24,660 MMS bottles and 3,000 danglers (information meant to be hung in the home). Initial results showed improved couple discussions, better counseling practices, and increased efficiency over time. The danglers were widely accepted by users.
- Challenges & Future Plans: High staff turnover necessitated repeated training, and low ANC uptake in some centers remained a barrier. Next steps include finalizing IFA and MMS implementation in 2025, followed by a scale-up phase from July 2025 to February 2026.
Habtamu Temesghen, JHU CCP
Nutrition International, Nigeria
- Implementation & Research: The project is being implemented in Bauchi State across 84 health facilities in collaboration with the Nigerian government. It follows a structured process from formative research to implementation and evaluation, including a process outcome evaluation and a clustered randomized control trial.
- Intervention Design & Adherence Solutions: The initiative developed monitoring and supply chain tools to integrate MMS, ensuring proper documentation. Solutions like MMS calendars, group health talk posters, and adherence cards were created to help women track their supplementation. These tools were pretested with pregnant women, healthcare workers, and their families to ensure effectiveness.
- Community Engagement & Training: Extensive consultations, co-creation workshops, and training programs (for both health workers and Mama2mama groups) were conducted. Feedback from healthcare workers indicated that adherence solutions were user-friendly and successfully translated into local languages, helping engage family members in the process.
- Challenges & Future Plans: Advocacy efforts are needed to address gaps in training continuity due to staff turnover. Anemia remains highly prevalent in Bauchi state. Nigeria is moving forward with MMS scale-up, with efforts focused on collaboration between community and governmental structures for nationwide implementation.
Nkechinyere Adinoyi, NI
