"Expanding Our Horizons": Formative Research on Aspirations and Family Dynamics Related to Sanitation and Nutrition

This document is a summary of a longer report, originally written in Spanish, sharing the results of an investigation to identify the normative and behavioural factors influencing infant nutrition and feeding and sanitation practices in the Western Highlands region of Guatemala. It emerges from the West Highlands Integrated Program (WHIP), wherein the United States Agency for International Development (USAID) Guatemala asked the Johns Hopkins Center for Communication Program (CCP)'s Health Communication Capacity Collaborative (HC3) to provide technical assistance. (Further information about this project is available at Related Summaries, below.) Part of this technical assistance consists of supporting the development of a social and behaviour change communication (SBCC) strategy designed to contribute to positive change in existing norms and key behaviours related to chronic malnutrition.

As part of this task, a literature review was conducted that revealed gaps in information on the motivations and family strategies that influence the adoption and continuation of adequate sanitation and nutrition practices in Guatemalan homes and at the level of children under two years of age. This formative research study is an attempt to fill in some of those gaps and identify motivations, actions, and windows of opportunity for the design of a communication strategy that will help reduce chronic malnutrition and improve the development of children in the Western Highlands. The study is being carried out in four communities, selected in conjunction with four WHIP partner projects: two of them covered by food aid programmes (Title II: Paisano and Segamil) and the other two by income generation projects (Rural Value Chains: Anacafé and Agexport). The communities are (1) San Juan Bullaj, Tajumulco; (2) Flores Pajales and Pozo Verde, Cunén; (3) La Pista, Nebaj; and (4) Xequemeyá, Momostenango. The field work and data collection for this study took place between August 22 and September 8 2016.

The findings of the formative research, generated through focus group discussions and interviews, have enabled the team to identify certain motivations and windows of opportunity for the design of the communication strategy.

• In general, the study participants tended to feel optimistic, believed that their quality of life had improved, and that they were living at a time of greater opportunity. This perception of change and improvement offers an opportunity to strengthen and amplify such changes, mainly with regard to parents' aspirations for their children and grandchildren, so that the latter will benefit from better sanitation and nutrition in their homes.
• The changes that have taken place in the past few decades, in both structural conditions and norms, have opened up greater opportunities for the younger generations. This new context offers a favourable environment in which interventions aimed at improving sanitation and nutrition for minor children will be better received because they coincide with people's real aspirations for their children and grandchildren.
• Young families aspire to investing more in their children, the numbers of which have gone down because of greater access to family planning methods. Investment in children usually takes the form of giving them more schooling and better care; currently, children are more valued, and both grandmothers and parents are trying to better their conditions so that their children will not suffer the same hardships that they experienced. However, the attributes of a clean house and a clean person coincide with elements of cleanliness that are difficult to attain in households in the area covered by the study.
• The traditional division of labour by gender persists, although with less rigidity, and men are beginning to get more involved in caring for their children, although they must deal with a certain amount of social criticism aimed at men who do "women's work". For the communication strategy, these changes are an opportunity to validate and reinforce the new role of men as the spouse who supports his partner in looking after the children (better sanitation and nutrition), motivated by his aspirations for new opportunities for his children.
• Thanks to the capacity building work of various programmes, the inhabitants of the communities in the study have learned about the benefits of better nutrition, both during pregnancy and in the first years of life, but formidable barriers to achieving a more diversified diet remain. For one, the budget earmarked for food is directed and controlled by the man of the house - however, as indicated above, fathers are trying to get a little more involved and support their wives in the care and feeding of the children. Both husbands and mothers-in-law know that a pregnant woman needs to have a varied and substantial diet, but they do not seem to be very proactive, with the exception of those in La Pista. (For example, it is considered an affront to cook for just one person, whether that person is pregnant or not, and as a result, trying to give an additional snack becomes a problem of access to and availability of food.)
• The association of good size with intelligence, given parents' aspirations for a better education for their children, might be a motivating factor for giving more attention to the size, and not just the weight, of children.

This report includes only the results of the first phase of the study; the second phase, namely the collection of data in the field, will include the observation of feeding, care. and sanitation practices in a sample of homes with children under two of normal size and homes whose children show a lack of growth.