# Baby Friendly Spaces+: a process evaluation of an integrative health approach for lactating women and their babies in Nguenyyiel refugee camp, Gambella, Ethiopia

## TL;DR

A program in Ethiopia's refugee camp improved mental health and child care practices for mothers and babies through integrated psychosocial support.

## Contribution

The study evaluates an integrative health approach for lactating women and infants in a humanitarian setting.

## Key findings

- Significant improvements in maternal mental health indicators were observed.
- Mother–child relationships and breastfeeding practices improved significantly.
- Mothers expressed satisfaction but requested additional material support.

## Abstract

Poor maternal mental health has been shown to impact child health and development. Yet, there is a gap in research on integrated maternal and child care models in humanitarian settings. Action Against Hunger developed the Baby Friendly Spaces (BFS) program which bridges this gap by delivering evidence-based psychosocial support for young children under 2 years and their mothers. This multi-method study was conducted in Nguenyyiel refugee camp (Ethiopia). South Sudanese mothers were assessed at baseline and after 12 weeks on primary outcomes using the Kessler Psychological Distress Scale (K6+), PTSD Checklist (PCL-6), and Patient Health Questionnaire (PHQ-9). Secondary outcomes included mother–child relationships, breastfeeding practices and child nutritional status. Qualitative interviews explored whether and how BFS participation is related to maternal and child health outcomes. We included 201 mother and child dyads from the BFS program. Significant improvements were observed for all maternal mental health indicators as well as for mother–child relationships, breastfeeding practices, and child nutritional status. While mothers voiced satisfaction with the BFS program, they also expressed the need for additional material goods. Our study shows that BFS proves to be a successfully integrated program that improves maternal mental health, mother–child relationships, and childcare practices.

Participation in the Baby Friendly Spaces program resulted in statistically significant reductions in all mental health and functioning outcomes, as well as improvement in breastfeeding and most child-care practice, and mothers described positive experiences participating in the Baby Friendly Spaces program and a desire for increased material support.

This study adds to the growing body of evidence in humanitarian settings highlighting the importance of integrating psychosocial programming into maternal and child health services

Future programming must focus on strengthening training, supervision, and capacity of providers, and invest in effective monitoring and evaluation systems to support the implementation and tailored delivery of effective services in order to have optimal health impacts among beneficiaries.