Maternal Care Practices in Sri Lanka During Infant and Young Child Feeding Episodes – Findings From Ethnographic Fieldwork

OBJECTIVES: To describe typical care practices employed by urban, estate, and rural caregivers during infant and young child feeding episodes in Sri Lanka. METHODS: Study design. This ethnographic sub-study was conducted using a four-phase, mixed methods formative research design across rural, estate, and urban sectors of Sri Lanka. Data collection methods. Data were collected between Sept. 2020 – Sept. 2021 using direct meal observations (4–8 hours each) and semi-structured interviews. Infants and young children aged 6–23 months (n = 72), as well as community leaders (n = 10), caregivers (n = 58) and influencers (n = 37) were purposively sampled to participate in meal observations and interviews, respectively. Data analysis. Observational data were summarized using simple descriptive statistics while textual data were analyzed thematically using Dedoose. RESULTS: During 4–8 hour long observations, most caregivers (80.6%, 58/72) gave infants and young children their full attention during feeding. Approximately two thirds of observed caregivers (61.1%, 44/72) used positive encouragement during feeding, while a quarter (26.4%, 19/72) used negative communication approaches (e.g., threatening to give a child medicine if their food is not eaten) during feeding. The majority (81.9%, 59/72) used distractions to encourage eating while 20.8% (15/72) of observed caregivers used forceful feeding practices because they wanted their children to “maintain adequate weight,” and “adhere to a meal schedule". CONCLUSIONS: Despite caregiver knowledge of Ministry of Health recommendations, observations revealed a proportion of caregivers engaging in sub-optimal care and feeding practices with possible implications for population-level health and nutrition. FUNDING SOURCES: UNICEF Sri Lanka.