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

To describe typical care practices employed by urban, estate, and rural caregivers during infant and young child feeding episodes in Sri Lanka. 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. 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". 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. UNICEF Sri Lanka.