As global development experts with decades of experience, it was hard for us to believe we hadn’t crossed paths sooner. But the silos of gender, early childhood development, and nutrition across our sector can mean that proven approaches are not merged to deliver effective multi-input programs that address multiple early childhood outcomes and common risk factors.
On March 22, Global Communities presents results from EFFECTS, a five-arm cluster randomized trial implemented in northern Tanzania.
Globally, 250 million children are at risk of not meeting their developmental potential in the first five years of life, with significant long-term consequences for future health, learning, and economic productivity. With funding support from the Eleanor Crook Foundation and the Conrad N. Hilton Foundation, we aimed to break down those barriers and test bundled interventions with the potential to improve early childhood nutrition and development, as well as household gender equality.
Our team — Global Communities, the Harvard T.H. Chan School of Public Health, Purdue University, and the Africa Academy for Public Health — in 2019 launched Engaging Fathers for Effective Child Nutrition and Development in Tanzania, or EFFECTS. This five-arm cluster randomized controlled trial was implemented in the Mara region of northern Tanzania and designed to evaluate the effects of engaging fathers and bundling nutrition and parenting interventions on a range of child- and caregiver-level outcomes.
Primary study outcomes included child diets and child cognitive, language, socioemotional, and motor development. We also measured changes in child growth, maternal and paternal care practices and mental health, and household gender equality. A total of 960 families with children ages 0-18 months from 80 villages were enrolled into one of five trial arms.
Global Communities led the development of four gender-transformative behavior change packages after extensive formative research and pilot testing, including unique packages designed for fathers.
Interventions were delivered by community health workers to groups of mothers or fathers, with some sessions delivered jointly with couples. A total of 24 sessions were delivered over 12 months. Due to the COVID-19 pandemic, there was a break in sessions, which then resumed as home visits. Sessions aimed to address immediate drivers of diet quality and child development, as well as the enabling environment for care, including hygiene and sanitation, food access, gender norms and roles, and couples’ communication and decision-making.
By working across disciplines, we can deliver interventions that holistically meet the needs of young children and their families.
—Multisectoral and father-inclusive approaches
The results are exceptionally clear. Engaging fathers in nutrition and parenting interventions had greater benefits to child and maternal diets; maternal and paternal nutrition, hygiene knowledge, and care practices; household gender equality; and women’s empowerment compared with interventions that engage only mothers. Moreover, bundling nutrition and parenting content has greater benefits to child development, child diets, nutrition and parenting practices, and household gender equality compared with nutrition-only interventions.
A few specific highlights include:
• Bundling nutrition and parenting interventions improved children’s cognitive development and receptive language development, improved mothers’ use of behaviors that stimulate early learning, and increased the variety of learning materials in the home, compared with nutrition interventions alone.
• Engaging fathers while providing bundled nutrition and parenting content had the greatest impacts on child and maternal dietary diversity.
• Any intervention reduced maternal exposure to intimate partner violence, but bundled interventions had the greatest impact on reduction.
• Engaging fathers in either nutrition or bundled parenting interventions improved fathers’ use of behaviors that stimulate early learning.
• Engaging fathers led to greater maternal and paternal rejection of inequitable attitudes toward women, an increase in fathers’ daily time spent on domestic chores, and an increase in women’s decision-making power.
Based on these results, global health and international development practitioners working in early childhood nutrition and development should aim for collaborative, multisectoral, and father-inclusive approaches to maximize benefits to child, maternal, and overall family well-being.
The EFFECTS study highlights the feasibility and benefits of addressing early childhood development, nutrition, and gender in one program. By working across disciplines, we can deliver interventions that holistically meet the needs of young children and their families.
Please join us as we share our results from the EFFECTS trial with a panel of global nutrition, child development, and gender experts on Tuesday, March 22, at 9 a.m. ET. Click here to learn more and register for free.
About the authors
Lauren Galvin
Lauren Galvin is a senior technical adviser for health and gender at Global Communities. She has 10 years of experience in research, program design, implementation, and evaluation of reproductive, maternal, and child health, nutrition, parenting, and father-engagement programs. She recently co-designed and managed the Tanzania EFFECTS randomized trial measuring impact of engaging fathers and bundling nutrition and parenting interventions on child diets, growth, development, and gender equality. Galvin has a master’s degree in Public Health from Columbia University and a bachelor’s degree in Philosophy from Smith College. She works in South Asia, Central and East Africa, and Latin America.
Nilupa Gunaratna
Nilupa Gunaratna is an associate professor of public health at Purdue University. A statistician by training, she has worked in global public health and nutrition for 18 years. Gunaratna’s research, teaching, and professional engagement focus on food systems, food security, and nutrition for at-risk populations, particularly in low- and middle-income countries. Her research aims to develop and evaluate interventions that equitably and sustainably improve food security and nutrition, while promoting rigorous and ethical quantitative methods.
Ramya Ambikapathi
Ramya Ambikapathi is a nutrition epidemiologist and a research scientist at Purdue University in the department of public health. She completed a postdoctoral fellowship at the Harvard School of Public Health evaluating nutrition-sensitive agriculture intervention in Ethiopia. She received her master’s and doctorate from Johns Hopkins School of Public Health. She has a bachelor’s degree in environmental science with a focus on aquatic and terrestrial ecology. Her research broadly focuses on how environmental and ecological factors translate to poor nutrition outcomes, and efforts to mitigate these negative impacts.
