Baby Friendly Spaces+ (BFS+)

Process evaluation of an integrative health approach for lactating women and their babies in humanitarian emergencies

Integrating maternal and neonatal health interventions have rarely been assessed in humanitarian settings. Indeed, maternal mental health is essential for child growth but is rarely taken into consideration in global health programming. Since 2006, AAH has implemented «Baby Friendly Spaces» (BFS) programmes in humanitarian contexts. Those programmes include breastfeeding and feeding counseling, psychosocial support to mothers, stimulation activities with children in order to enhance the health status and well-being of mothers and babies. To date, there has been a lack of formal research to assess their impact on the lives of the beneficiaries and their effectiveness to strengthen program implementation.


The study is evaluating the current effectiveness of an integrated health approach, as well as strengthening the implementation and acceptability of the Baby Friendly Spaces intervention programs delivered to lactating women and their babies in humanitarian emergencies. The fieldwork takes place in Nguenyyiel refugee camp in Gambella, Western Ethiopia. The camp currently hosts around 74,000 South Sudanese refugees who have fled conflict and hunger. About 88% of the refugees in the camp are women and children and 5% of the camp population constitutes under-two children. The physical and psychosocial wellbeing of refugees are poor and the prevalence of malnutrition in the camp is alarmingly high (14.3% SENS survey 2018).
We use mixed-methods triangulation design that draws on new data collection and analysis of routine monitoring data collected through a strengthened and streamlined system. Qualitative in-depth interviews are conducted to explore the uptake, acceptability and participation of women benefiting from the program and to identify the perceived needs of mothers of young children (under age 2) in the BFS catchment area. The needs and experiences of staff delivering the BFS program are also included in this research. The prospective quantitative survey, we want to assess whether and how participation in BFS activities is associated with improved maternal (mental health, breastfeeding practices, mother-child interactions) and child (morbidity and growth) outcomes. More specifically, we want to understand: what the overall pattern of health and well-being is among women, and how these outcomes vary by participation in activities and/or participant characteristics (demographics, baseline problems, etc.).


BFS programme contributes to reducing vulnerabilities related to maternal status and child age and to enhancing early child development. By ensuring a follow up over several months based on the beneficiaries’ needs, BFS programme supports behaviour changes around maternal and child care. Early childhood is widely considered a cost-effective period for intervention, given that child development proceeds sequentially – later development of competencies builds on earlier developmental successes. Therefore, BFS+ project intends to provide convincing evidence to humanitarian actors on how to implement BFS programmes in emergency settings. As a consequence, it will allow designing a tested scalable intervention package that can be adapted to different settings.
The dissemination and uptake will be conducted at all levels. At local level, stakeholders are involved in the project and their contributive role will facilitate the uptake of the findings. At national level, review meeting with stakeholders will be organized. At international level, Action Against Hunger will disseminate the results through scientific articles and non-technical policy briefs. This is aimed at a wider humanitarian audience including presenting the findings at relevant global, regional, and national working groups (Child protection working group, health cluster, IASC MHPSS working group, Infant Feeding in Emergencies Group) and conferences.

Project Information

Thematic Area: Nutrition and Health
Intervention Area: Ethiopia
Implementation Period: October 2018
Partners: John Hopkins University (USA), Jimma University (Ethiopia), Administration for Refugee et Returnee Affairs (ARRA, Ethiopia), and UNHCR (Ethiopia)
Donors: ACF Research Foundation


Karine Le Roch, MHCP Research project coordinator, Action Against Hunger France
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