During a mother-to-mother support group meeting in a barangay (village) in the Philippines, a trained health volunteer guides a discussion on exclusive breastfeeding and ways to get your baby to latch. One woman volunteers to demonstrate. She positions her baby, who is more than welcome to this meeting of moms, and starts breastfeeding in front of the other women while speaking about her personal experience. Partway through, the mom adapts her position as the workshop facilitator suggests a more comfortable way to hold her baby.

Angelita Sapitula-Evidente, Nutrition International’s Senior Program Officer, Infant and Young Child Nutrition in the Philippines, recalled this scene as an example of the type of impact the mother-to-mother support groups are having. “In that particular mother-to-mother support group, they were able to establish that rapport and the mother was confident in sharing her experience. At the same time, she was not ashamed of accepting whatever misconceptions or advice on improper technique.”

Prior to the program with Nutrition International, community health volunteers shared nutrition education tailored to pregnant and lactating women in villages in the Philippines through a classroom set-up. Information flowed from health volunteers to mothers, but not the other way around. The one-way communication didn’t encourage participation and lessened the likelihood of women changing behaviour based on the information shared.

Mother wearing a mask holds her baby

In 2018, Nutrition International, through its partnership with the Department of Health and Helen Keller International, started the mother-to-mother support groups to give moms the opportunity to engage meaningfully with their peers and discuss topics relevant to their own health and the health of their babies. The support groups are part of Nutrition International’s Barangay First 1,000-Day (BF1KD) program, which is focused on combating malnutrition in young children by supporting women from the time they get pregnant to their child’s second birthday. The groups meet to support pregnant women, lactating mothers and children up to two years by discussing topics such as exclusive breastfeeding, iron and folic acid (IFA) supplementation to prevent anaemia, and infant and young child feeding practices. The women choose the topics they want to discuss and the content is guided by evidence-informed resources and activities.

The facilitated dialogue, led by a trained volunteer who also lives in the village, encourages the women to share their lived experiences, learn from each other, and receive targeted advice from the facilitator in a supportive way.

The groups range in size from 10-50 participants and are active in more than 800 villages in four provinces across the Philippines.

Below, read first-hand accounts of workshop facilitators and participants; and watch these videos to see support groups in action.

A mother demonstrates different holds for breastfeeding during a peer support group in the Philippines

Name: Christina Alamis
Role: Workshop facilitator, volunteer health worker

Christina Alamis is a volunteer health worker in her village of Barangay Cubay North. She participated in a training run by Nutrition International in March 2018 and went on to start her village’s first mother-to-mother support group. Her sessions cover the 15 topics she was provided in training, but the most popular topics include the importance of daily IFA supplementation during pregnancy, positions for breastfeeding, complementary feeding and micronutrient powder supplements.

“A baby’s first 1,000 days are considered the most important part of their life,” she said, referring to the critical brain development that takes place during the time from conception to the baby’s second birthday. “As a facilitator, I feel I can be a change agent for mothers and caregivers.” She said she’s seen moms alter their nutrition and health behaviours because of the program. “It really helped parents and malnourished children. It made a difference to the mom’s attitudes. They now live their lives based on what they’ve learned.”

A mother holds her baby in her arms

Name: Camila Konia
Role: Program participant, first time mom

When Camila Konia became pregnant with her first child, she said she felt unprepared for the role of motherhood. She was particularly worried about how to hold her baby or a good position to breastfeed in. The local health worker introduced Konia to her local mother-to-mother support group and encouraged her to join. She did, and she hasn’t looked back.

By participating in the group, her knowledge and confidence has grown. “[The support group] was a great help to moms, especially to first time moms like me who don’t have any prior experience… I am very thankful because this program helped mothers like me that really needed support and guidance on taking care of their baby.”

Woman wears a mask outside and holds a booklet during a mother-to-mother support group session in the Philippines

Name: Melanie Sab
Role: Workshop facilitator, barangay nutrition scholar

Melanie Sab is a barangay nutrition scholar who participated in training to become a support group facilitator. Barangay nutrition scholars are the backbone of nutrition education and support at the community level in the Philippines. As nationally mandated positions, their roles existed prior to the implementation of mother-to-mother support groups. Nutrition International was able to leverage their position and expertise and integrate them into the fabric of the programs’ design, training more than 500 volunteers on 15 health and nutrition topic modules as well as effective workshop facilitation. Partnering with barangay nutrition scholars has been central to the program’s uptake and success.

“I noticed that many mothers don’t have enough knowledge when it comes to proper nutrition… mothers need help and guidance,” Sab said. She participated in the facilitator training with Nutrition International and started hosting a local support group. She’s seen a marked improvement in women taking IFA tablets daily during pregnancy – key for preventing maternal anaemia – after participating in sessions, as well as moms deciding to practice exclusive breastfeeding for the first six months. “This is important so more moms are given more information on proper nutrition and malnutrition here in our barangay.”

Mother kisses her child on the cheek while the child laughs.

Name: Lyn Atronomo
Role: Program participant, mother of three 

Lyn Atronomo started participating in a mother-to-mother support group when she was pregnant with her third child. This opened her eyes to the importance of the first 1000-day developmental window. “With my third child, I attended BF1KD and that’s when I realized there was a lot I didn’t know about nutrition… I joined so I would learn what proper nutrition for children and pregnant mothers is.”

She said she didn’t regularly attend prenatal check-ups or consistently take recommended micronutrient supplements with her prior pregnancies. One of the biggest takeaways for her was learning how beneficial exclusive breastfeeding can be. With her first two children, she started feeding them solid food at four months. After learning from the group, she decided to exclusively breastfeed her third child until six months. “I learned so much because of BF1KD… I am thankful for being part of the program. It really helped me a lot.”

Community health volunteers speaks to a mother outside and both are wearing masks.

Name: Rhea Debil
Role: Workshop facilitator, barangay nutrition scholar

Rhea Debil, a barangay nutrition scholar and workshop facilitator, participated in a follow-up training with Nutrition International in January 2021 tailored to the COVID-19 context. Pre-pandemic, support group meetings were held twice a month. Since COVID-19 hit, the groups have adapted to local health and safety protocols. Where able to do so, groups meet once a month at a reduced capacity to maintain social distancing. To ensure mothers are getting the support they need during this extra challenging time, Debil also makes socially-distanced house visits.

During the group meetings and house visits, women voice their concerns around pregnancy and delivery during the pandemic and ask about breastfeeding if COVID-19 positive. Debil takes the time to listen to women’s concerns and explains that babies born to mothers with COVID-19 should continue to breastfeed with appropriate infection prevention and control measures in place, such as wearing a mask and regular handwashing. Debil said she regularly consults the guidance put together by Nutrition International from the World Health Organization and local government to answer these pressing questions and supports mothers in her community to the best of her ability.

“The Barangay First 1,000-Day program really helped us a lot here in our barangay,” Debil said. “Mothers are now familiar with micronutrient powder and iron and folic acid supplements. It’s a relief to hear from the mothers how effective these commodities are to their pregnancy and infants.”

Debil has also noticed a change in herself through participating in the training to become a workshop facilitator. “As a health worker, BF1KD gave me additional knowledge and developed my self-confidence. I’m now able to speak in front of people without hesitation… It’s a good feeling to know they learn from me.”

A maternal health trainers speaks to a group outside under palm trees during a mother-to-mother support group in the Philippines

Local government units have reported lower malnutrition rates in communities where mother-to-mother support groups were started. Based on their success, the units have taken it upon themselves to start support groups in villages outside the original program scope. In addition, municipalities reported increasing their budgets for nutrition in relation to the potential return-on-investment from the program. Nutrition International continues to use its expertise to support the government in the Philippines to scale maternal and child health best practices in sustainable ways across the country.