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.Child care. ,Nutrition Ghana. ,

Arimond, Mary

Armar-Klemesu, Margaret

Ruel, Marie T.

English

Research Papers in Economics

 
Discussion Paper 116 
A Multiple-Method Approach to Studying Childcare in an 
Urban Environment: The Case of Accra, Ghana 
Marie T. Ruel, Margaret Armar-Klemesu, and Mary Arimond 
 
here are increasing concerns about the impact 
of rapid urbanization and the growth of urban 
poverty on access to adequate food and nutri-
tion by the urban poor. The high dependence on cash 
income, the exposure to high levels of air, food and 
water contamination, and the increasing necessity of 
women to participate in income-generating activities 
are examples of some of the constraints faced by the 
urban poor. 
  The Accra Urban Food and Nutrition Study 
(AUFNS) was conducted to understand the nature of 
urban poverty and the interrelationships between 
urban poverty, food insecurity, and malnutrition in a 
major urban African center (Accra). The ultimate 
goal was to provide high-quality information to 
policymakers and to promote appropriate policies 
and programs for intervention in urban poverty, food 
security, and malnutrition. The AUFNS consisted of 
three types of data collection: A participatory rapid 
appraisal (PRA), a representative quantitative survey 
of Accra, and a small observational study. 
 
Purpose of This Paper 
This paper focuses on one of the sub-themes 
addressed by the AUFNS: the role of care as an 
input into child nutrition and the relative 
contribution of a number of maternal and household 
resources to the provision of care. The main goal 
was to integrate the findings from the three primary 
data sources and to specifically 
address the following questions: 
(1) Is care an important input 
into child nutrition in Accra? 
(2)  Which care practices are 
most crucial for child nutrition? 
(3)  Which maternal and house-
hold resources contribute the 
most to enhancing care in Accra? (4) What are the 
program and policy responses to promote optimal 
childcare practices in this urban context? and 
(5)  How do the three research approaches used to 
measure childcare complement each other? 
Methodology 
The research was carried out in three stages, and was 
preceded by an initial roundtable seminar convened 
in Accra to elicit the views of key stakeholders. The 
first stage involved a series of qualitative data 
collection activities to identify key issues to be 
followed up in the quantitative phase, to guide the 
design of a survey questionnaire, and to build up an 
understanding of the Accra urban context from the 
point of view of the poor. The second phase was a 
representative quantitative survey of 556 house-
holds, and the final stage was an observational study 
of a small subsample of households. The main 
purpose of this last component was to gain a more 
in-depth understanding of aspects of childcare that 
could not be explored through recall techniques, 
such as intrahousehold processes involving food and 
nutrient distribution, maternal time and child 
feeding, and care practices. 
 
Is Care an Important Input into Child Nutrition 
in Accra? 
The Accra study provides unequivocal evidence of 
the crucial role of childcare practices as a key input 
into children’s nutritional status. Children whose 
mothers had poor childcare practices were up to 
three times more likely to be stunted compared to 
those whose mothers had good care practices. Care 
was more critical for children whose mothers had 
less than secondary 
schooling, and house-
holds of lower socioeco-
nomic status. Good care 
practices appeared to 
mitigate the negative 
effects of low maternal 
education and poverty. 
 
Which Care Practices Are Most Crucial for 
Child Nutrition? 
Findings from the observational study confirmed 
the suggestions   from   the   quantitative  survey that  
T 
 
Discussion Paper BRIEFS 
Food Consumption and Nutrition Division of the International Food Policy Research Institute 
“The Accra study provides 
unequivocal evidence of the crucial 
role of childcare practices as a key 
input into children’s nutritional 
status.”  
optimal feeding practices during the first 6 months 
of life contribute to the prevention of growth 
faltering among young infants in Accra and that the 
benefits may linger beyond the first year of live. 
 
Which Maternal and Household Resources 
Contribute the Most to Enhancing Care in Accra? 
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. There was 
no evidence that poor feeding practices resulted 
from severe poverty, food insecurity, or economic 
constraints. These socioeconomic factors, however, 
did affect hygiene practices, confirming the well-
documented fact that good personal household, 
environmental hygiene are particularly difficult to 
maintain in the absence of a minimum level of 
services and resources. 
 
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 interventions can simulate some of 
the benefits of formal education. In Accra, 
promotion of exclusive breastfeeding, particularly 
among women with little or no education, could 
have major payoffs. 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 for the 
Measurement of Childcare Complement Each 
Other? 
Each method provided unique information but also 
enriched and informed interpretation of other study 
components. This “triangulation” of findings also 
helped generate additional hypotheses that could be 
tested using an iterative process of analysis. This 
allowed obtaining a richer and more complete 
picture of the role of care as an input into child 
nutrition in Accra. 
 
Keywords: urban food security, childhood 
malnutrition, childcare practices, qualitative 
methods, quantitative methods, urban policies 
 
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The full text of this document and other FCND Discussion Papers are available on our Website 
(www.ifpri.org/divs/fcnd/dp.htm) or via B.McClafferty@cgiar.org 
 
 
 
FCND BRIEFS 
 
International 
Food 
Policy 
Research 
Institute 
 
 
2033 K Street, N.W. 
Washington, D.C. 20006 U.S.A. 
 
“The Accra study provides unequivocal evidence of the 
crucial role of childcare practices as a key input into 
children’s nutritional status.”—DP116 

A multiple-method approach to studying childcare in an urban environment

http://www.ifpri.org/sites/default/files/publications/fcnbr116.pdf

A multiple-method approach to studying childcare in an urban environment

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