A Multiple-Method Approach To Studying Childcare In An Urban Environment: The Case Of Accra, Ghana

This document summarizes findings from the Accra Urban Food and Nutrition Study (AUFNS) about the importance of care as an input to child nutrition and the relative contribution of various maternal and household resources to the provision of care. Findings from the quantitative survey (n = 556) and the in-depth observational study (n = 22) are reviewed and complemented with insights from the participatory rapid appraisals (PRAs) carried out at the onset of the study. Results of each phase of the research have been reported separately; this report aims to integrate findings from all three components. The key findings related to the five main questions addressed by this study are summarized as follows. ! Is care an important input into child nutrition in Accra? The Accra study provides unequivocal evidence of the critical role of childcare practices as a key input into children’s nutritional status. ! Which care practices seem to be most crucial for child nutrition? Findings from the observational study confirmed the suggestion from the quantitative survey that optimal feeding practices during the first 6 months of life contribute to the prevention of growth failure among young infants in Accra and that the benefits may linger beyond the first year of life. ! Which maternal and household resources contribute the most to enhancing care in Accra? Maternal education was the characteristic most strongly associated with good childcare practices. For the majority of women, employment did not seem to be a severe constraint for childcare and nutrition in this context. However, maternal early return to work after delivery—usually a response to economic constraints—may entail risks for children. ! What are the program and policy responses to promote optimal childcare practices in this urban context? Our findings support the universal consensus on the importance of investing in girls’ education. In the short term, effective nutrition education and behavior change strategies can simulate some of the benefits of formal education. Support for workingwomen in the form of low-cost, community-based childcare facilities should also be given priority, as well as policies to address poverty alleviation, income generation, hygiene and sanitation, and quality control of street food sales. ! How do the three research approaches used for the measurement of childcare complement each other? Each method provided unique information and also enriched and informed interpretation of other study components. The “triangulation” of findings also helped generate additional hypotheses that could be tested using an iterative process of analysis. This allowed for obtaining a richer and more complete picture of the role of care as an input into child nutrition in Accra.