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
CROWN Projects Background and DesignStorytelling Activity: Hero’s JourneyPeripheral PerspectivesPhoto Gallery
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
t
The second day of the convening included a Hero’s Journey Activity, which allowed CROWN partners reflect on their project’s challenges, transformations, and key takeaways.
This interactive storytelling session allowed partners to draw their ‘heroes’ using the following structure:
- Identify your hero:
- Define the hero of your journey– your project team
- Describe your hero. What makes your hero special and unique?
- The Call to Adventure:
- What were the hero’s initial project goals/scope of work?
- What were the key defining moments/milestones for the project?
- Trials and Challenges:
- What challenges did the hero encounter?
- What unexpected obstacles emerged?
- How did the hero address these challenges and obstacles?
- The Transformation:
- How did the hero change during your journey?
- What lessons did the hero learn?
- How is the hero different now than when the project began?
- Returning with the Elixir:
- What valuable takeaways and insights did you glean from your adventure?
- How can these lessons be transferred to other CROWN projects?
- How can these lessons be transferred beyond CROWN?
- Tell Your Hero’s Story!
Project Concern International
Project Concern International (Bihar, India) depicted their hero as a Mighty Mouse, a community champion who can sniff out insights and doesn’t let challenges slow him down!
PCI’s "Mighty Mouse"
Nutrition International
Nutrition International’s (Nigeria) woman warrior has many arms to accomplish her many goals – when obstacles come her way, she can soar above them to reach pregnant women in Bauchi State!
NI’s "Woman Warrior"
JHU Center for Communication Program
JHU Center for Communication Program (Ethiopia) drew inspiration from the lions on the Neemrana Fort Palace crest (our host for the Convening) to create a pride of lions who call on their partners to achieve complex missions for rural women.
CCP’s "Pride of Partners"
During the Convening, the CROWN projects heard a diverse array of perspectives from outside of CROWN: from governmental prioritization of nutrition issues in Ethiopia to the application of behavioral science in interventions in India, this was truly a global experience!
Read more about each presentation in the drop-down menus below!
Ethiopia Federal Ministry of Health: Governmental Priorities in Nutritional Supplementation
- Significant Rural–Urban Disparities in Women’s Nutrition
Nutritional status varies sharply between rural and urban areas. In cities like Addis Ababa and Dire Dawa, a third of women are overweight, while in rural regions like Afar and Gambela, underweight prevalence is highest. Diet diversity and micronutrient intake are also much better in urban areas, highlighting a major rural–urban nutrition gap.
- MMS Pilot Programs Show Promise but Need Scale-Up Support
Multiple MMS pilots have reached 250,000 pregnant women through partnerships (e.g., UNICEF, JHU). Scaling up requires strong evidence, phased implementation, health system integration, and sustainable financing and supply chains.
- Behavioral and Social Factors Affect Adherence
Adherence to MMS is influenced by individual factors (side effects, workload), and social dynamics (husband involvement, cultural norms, support networks). Effective SBCC and community-based support (e.g. community health workers, women’s groups) are key to improving uptake.
Uttar Pradesh Technical Support Unit: Improved IFA supplementation in UP through strengthened Supply Chain Management
- Strengthened Supply Chain Transformed IFA Availability
One of the key challenges in providing IFA in Uttar Pradesh (population 239 million) is demand estimation: an 200 million tablets have been estimated against the actual requirement of 2.25 billion tablets annually. By improving demand estimation, centralized procurement, and quality control, IFA availability in most districts rose from under 50% to over 90% in just two years. - VHSND Used as a Community Delivery Platform
Village Health and Nutrition Days (VHSNDs) were leveraged to bring IFA directly to communities. Integrating IFA into existing platforms like routine immunizations made access easier and more consistent. - Behavior Change Needed Alongside Supply Fixes
Due to past scarcity, frontline workers and providers were hesitant to distribute IFA freely. Changing this mindset and building trust in the new supply system were key to increasing distribution and consumption.
Intem Labs: Applying Behavioral Science & Non-Conscious Design in Business
- Behavior Change Happens Most Effectively Through the Unconscious Brain
Designs that influence behavior without triggering conscious decision-making—like yellow lines on train tracks or fun musical stairs—can be more effective because they work subtly. Behavior change interventions should therefore not just be about raising awareness, and should instead appeal to the unconscious brain.
- Social and Emotional Anchors Strengthen Commitment and Adherence
Commitment deepens as it becomes more socially embedded. For example, in credit card collections, a simple call evolved into a social and written commitment by involving a supervisor and sending a text. Similarly, factory workers improved safety behavior when responsibility was shared with a “Safety Buddy,” leveraging emotional accountability over just rules or knowledge.
- Understanding Emotion Is Key to Effective Design
Instead of just identifying cognitive heuristics or biases, focusing on emotional experiences in different contexts provides deeper insight. Behavior is often emotional, not just logical, and understanding why people feel what they feel leads to better, more empathetic and effective design solutions.
DataDENT: Improving Measurement of Maternal Micronutrient Supplement Coverage
- Understanding Supplement Use Requires Clearer Questions and Visual Aids
Formative research in Ethiopia and Bangladesh showed that women often confuse IFA and MMS. Visual aids helped clarify recall in Bangladesh but were less effective in Ethiopia, highlighting the need to tailor tools to local contexts. - Small, Diverse Samples Revealed Key Terminology Gaps
Women frequently used general terms like “iron,” “vitamin,” or “prenatal” rather than product-specific names, suggesting surveys must use locally meaningful language to capture accurate data on supplement consumption. - DataDENT’s Vision for Generating Consolidated Measurement Guidance for IFA/MMS
By bringing key MMS stakeholders around the table, DataDENT aims to consolidate existing evidence and experiences across partners and prioritize and fill evidence gaps about design of effective national MMS monitoring systems in early adopter countries.