Earlier this week, I was fortunate to attend the launch of a report by Save the Children on the state of malnutrition globally. Their report, entitled “A Life Free from Hunger” rightly draws global attention on one the most important, yet perhaps most neglected causes of child mortality and ill health – malnutrition. According to their estimates, malnutrition is an underlying cause in 2.6 million child deaths every year. And of course mortality is only the most extreme manifestation of this problem, it leaves children less able to learn and to grow into productive members of society.

What I disagree with is the message among advocates of child health that the we already know what works and that “simple” interventions simply need to be implemented. If the solutions are so simple, why are they not adopted or implemented?

The report states:

Simple solutions delivered to children who are at risk of malnutrition and their families are well known and well supported by nutrition experts. In 2008 the Lancet medical journal identified a package of 13 direct interventions – such as vitamin A and zinc supplements, iodized salt, and the promotion of healthy behavior, including hand washing, exclusive breastfeeding, and complementary feeding practices – that were proven to have an impact on the nutrition and health of children and mothers.

[Emphasis mine]

I agree, many of these interventions are relatively inexpensive and straightforward, but in particular with regards to the behavior change components, I don’t think the solutions are so simple. I believe that we have not even begun to understand why these practices are so hard to put into practice. One prime example of this is breastfeeding.

Honestly, if I hear another public health official (frequently male) allude to the fact that breastfeeding is among the simplest interventions available I think I am going to lose it. I can tell you from first hand experience, breastfeeding was among the most physically and emotionally challenging aspects of raising my own son.

My son was born a week early by cesarean section due to the fact that he was breeched. This delivery likely delayed my own milk production and I spent four very distressed and agonizing days watching my son shrivel up because I was so hell bent on making breastfeeding work. The simple solution would have beee to supplement his feeding. The advice and support I received from the breastfeeding experts usually took the form of one counsellor telling me to only do Y and whatever I do don’t do X only to be followed up by another counsellor telling me to only to X and never to do Y. Oh, and I did I mention how painful it was? Picture cracked, bleeding and infected nipples and a whirlwind of hormones. Yeah.

Most public health experts recommend mothers to “exclusively” breastfeed their children for 6 months. But that means that the mother can never very far from their baby this entire time. The fact that this might negatively impact a mother’s labor force participation or productivity seems completely ignored in these cost-effectiveness calculations. Simple in this case is leaving a bottle so that fathers, grandparents, and other care givers can share in the feeding of children.

This of course is just one of these interventions, and this is just my own personal reflections on the process – many women love and adore breastfeeding – I even started to enjoy it after a month or two and before my son decided he had enough and decided to communicate this to me by biting during feeding sessions – but it points to what I believe is a very important and overlooked issue in global health, that of why some healthy behaviors and technologies are adopted while others are not. That is not so simple and we have only begun to scratch the surface being able to influence these behaviors through policy.

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57 Responses to “Stop saying the solutions are so simple”

  1. Karen Grepin says:

    Stop saying the solutions are so simple http://t.co/11IiBPPH

    • Raveesha says:

      I agree with karen, The solutions which look simple or simpler in terms of technicality and without the specialized process may not universally followed are or able follow.

      I also urge to stop saying that,if the

      problems with the simple known solutions are better implemented.Eg.Sanitation,

  2. Amen. RT @KarenGrepin Stop saying the solutions are so simple http://t.co/W5N2fhen

  3. Laura Seay says:

    Amen. RT @KarenGrepin Stop saying the solutions are so simple http://t.co/W5N2fhen

  4. Alex B. Hill says:

    Amen. RT @KarenGrepin Stop saying the solutions are so simple http://t.co/W5N2fhen

  5. James Cohen says:

    Foriegn aid takes quite a pot of thought and time: 'Stop saying the solutions are so simple' http://t.co/czvLoIsC

  6. RT @KarenGrepin Stop saying the solutions are so simple http://t.co/DHj9gPea <<<dishonest & counter-productive to say breastfeeding 'simple'

  7. Ryan Briggs says:

    Amen. RT @KarenGrepin Stop saying the solutions are so simple http://t.co/W5N2fhen

  8. April says:

    I couldn’t agree more Karen. The child health advocacy community is rarely able to leave behind their marketing framing of their issues (we have all the answers, just give us money to do all this good stuff) – to dig into the evidence on the range of strategies that may and may not work to increase uptake and use of all those great “interventions”. And it has been my experience, that they are quite unhappy when anyone wants to discuss these issues – because it requires actually taking a critical look at successful and UNSUCCESSFUL child health initiatives. It is quite disheartening.

  9. Laura Seay says:

    Stop saying the solutions are so simple – @karengrepin on "simple" health solutions http://t.co/Mkved1H6

  10. RT @ithorpe: Stop saying the solutions are so simple – @karengrepin on "simple" health solutions http://t.co/0ACVmOjS

  11. RT @ithorpe: Stop saying the solutions are so simple – @karengrepin on "simple" health solutions http://t.co/0ACVmOjS

  12. AGREED. Aid is complex work & we devalue it by saying it's simple RT @ithorpe @karengrepin on "simple" health solutions http://t.co/wOXBNVog

  13. Stop saying the solutions are so simple http://t.co/11IiBPPH

  14. RT @KarenGrepin: Stop saying the solutions are so simple. http://t.co/JljWlA8O

  15. Stop saying the solutions are so simple – @karengrepin on "simple" health solutions http://t.co/Mkved1H6

  16. Robin Rogers says:

    Stop saying the solutions are so simple http://t.co/11IiBPPH

  17. Robin Rogers says:

    “@KarenGrepin: Stop saying the solutions are so simple http://t.co/9LEq5ifP” Amen. And buy that woman lunch! #philanthropy

  18. Might undermine their aid market-share @KarenGrepin asks child health advocates to "stop saying the solution is simple" http://t.co/kgZxZgU0

  19. Might undermine their aid market-share @KarenGrepin asks child health advocates to "stop saying the solution is simple" http://t.co/kgZxZgU0

  20. Stop saying the solutions for child health and malnutrition are so simple. Karen Grepin on "A Life Free from Hunger" http://t.co/pyppnDkG

  21. Nina Killen says:

    Sorry your breastfeeding journey was so difficult. Do you think this may have been because your baby was born a week early by C-section because he was breech? Babies born before they are ready can have difficulties breastfeeding because they shouldn’t have been born yet! And the hormones involved in birth and breastfeeding are interfered with because the baby is born via surgery – thus negatively affecting breastfeeding. Breastfeeding is simple if you let your baby and your body do the work.

  22. Oh dear. So, because your own breastfeeding experience was full of pain and ignorance and you didn't get the… http://t.co/vfcxjanF

  23. Mars Lord says:

    Oh dear. So, because your own breastfeeding experience was full of pain and ignorance and you didn't get the… http://t.co/vfcxjanF

  24. Oh dear. So, because your own breastfeeding experience was full of pain and ignorance and you didn't get the… http://t.co/vfcxjanF

  25. April Harding says:

    With respect to one of the most important “simple” child health interventions – vaccination:

    Amanda Glassman & Victoria Fan at CGD explain very clearly how “unsimple” it is to overcome the persistent service quality problems that discourage caregivers to take children for vaccination.
    http://blogs.cgdev.org/globalhealth/2012/01/why-are-people-hesitating-to-get-vaccinated-distinguishing-context-vs-individuals.php

  26. Regina Keith says:

    Dear Karen, I usually try not to let blogs get to me, it is a complex world and some communications are not always as we would like them to be. As a midwife, a mother and a global health advocate I too know that our simple solutions are not always easy to implement. However it does not make them less simple. Immediate and exclusive breastfeeding can reduce under five deaths by 12.5% yet the more developed a nation becomes the less breastfeeding occurs. The reasons are complex, breastfeeding is not easy it needs trained community support workers like grandmothers who can be with mothers and support proper fixing of the baby, this requires time and patience not always in abundance. The managment of engorged breasts on day three is also poorly managed. However most women can breastfeed, it helps the mother as well as the baby by helping to prevent maternal death through post natal haemorrahge (the most common cause of materal death). Rather than looking at wording in such advocacy documents we need to be looking at where aid money is going, are women being trained to support others to breastfed, are national employement policies allowing women to have time and flexibility to breastfeed and have maternity leave?

    ORS is another simple solution not being implemented when given with zinc it can not only prevent a childs death but reduce futher diarrohea episodes yet this intervention is also reducing in coverage in some countries. While other countries still have not added zinc onto their essential drug lists. The interventions themselves are simple however addressing the supply and demand side barriers of these simple interventions is where aid often falters as it tends to focus on disease specific interventions and Behaviour change rather than on building robust health systems. There also needs to be more engagement between the population and the health service to ensure that demand side barriers and blockages to simple interventions are addressed professionally. To do this we need more health workers and a change in mindset around interventions such as breastmilk and ORS. We need to work together to change this present reality urgently.

  27. Great post Karen, thanks a lot!

  28. Tom Murphy says:

    Stop saying the solutions are so simple says @KarenGrepin in response to the recent Save the Children Report http://t.co/KvAHA7Y2

  29. How Matters says:

    RT @viewfromthecave: Stop saying solutions are simple says @KarenGrepin in response to recent Save the Children Report http://t.co/obG9ELc6

  30. Arjen Mulder says:

    Stop saying the solutions are so simple http://t.co/11IiBPPH

  31. Stop saying the solutions are so simple says @KarenGrepin in response to the recent Save the Children Report http://t.co/KvAHA7Y2

  32. Stop saying the solutions are so simple says @KarenGrepin in response to the recent Save the Children Report http://t.co/KvAHA7Y2

  33. RT @KarenGrepin: Stop saying the solutions are so simple http://t.co/fOgpLMTv #maternalhealth #publichealth

  34. RT @KarenGrepin: Stop saying the solutions are so simple http://t.co/8Pdnrq2A

  35. I really appreciate @KarenGrepin and her taking a stance and asking folks to stop saying ‘the solutions are so simple.’ I appreciate the fact that she’s bringing her own experience as a mother to the discussion as I think women advocates can be more powerful in all areas of reproductive health and child health.

    Acknowledging the difficulties in breastfeeding is not the same thing as saying one isn’t behind breastfeeding 100% as an intervention. It’s just that it’s not simple. Breastfeeding is not a ‘pill’ that you give someone once a day. As new mothers know, it is a round the clock complete lifestyle. If you live in poverty, if you are malnourished, if you are anemic, if you have 4-5 other children, if you have to work near a smoky fire and fetch heavy water–these are all extremely important adjuncts to consider.

    I have never seen a single anthropological study of breastfeeding in the developing world and a set of suggestions for how to encourage breastfeeding based on these studies. We’d love to know more.

    The reason I started Maternova was based on a similar reaction. In maternal and newborn health, the standard phrase is ‘the interventions are simple, we just need to scale them up.’ ‘We know what to do.’ Well, like Karen, I disagree. I’m not sure we do know what to do–at scale. I’m not so sure we have all the answers. There is something missing in the communication and advocacy and length of attention span that has meant that SEEMINGLY simple techniques like:

    -handwashing
    -breastfeeding
    -kangaroo mother care
    -micronutrient supplementation

    are not universally adopted. What is it?

  36. Meghan Reidy says:

    Thank you! One of my biggest GH pet peeves RT @KarenGrepin: Stop saying the solutions are so simple http://t.co/RnmV9dzQ

  37. Maternova says:

    Thank you! One of my biggest GH pet peeves RT @KarenGrepin: Stop saying the solutions are so simple http://t.co/pooUTzQr

  38. […] Karen had a nice post this week about how we talk about ‘simple’ solutions to global health problems, here. […]

  39. Karen Grepin says:

    Thanks 4 the comment RT @maternova: Thank you! 1 of my biggest GH pet peeves RT Stop saying the solutions are so simple http://t.co/0uF9znkp

  40. Peter Singer says:

    Thanks 4 the comment RT @maternova: Thank you! 1 of my biggest GH pet peeves RT Stop saying the solutions are so simple http://t.co/0uF9znkp

  41. Based on personal experience that men simply do not have. RT @KarenGrepin: Stop saying the solutions are so simple http://t.co/nmj2xWNw

  42. Sophie says:

    Stop saying the solutions are so simple http://t.co/11IiBPPH

  43. […] Stop saying the solutions are so simple – Karen Grepin’s Global Health Blog […]

  44. Lola Taiwo says:

    Stop saying the solutions are so simple http://t.co/CRlWwIZJ

  45. Jon Scherdin says:

    Stop saying the solutions are so simple http://t.co/vs3EbBiE

  46. […] micronutrient deficiency appears to be a health issue that should be easily addressed. However, as Karen Grepin points out, there’s really no such thing as a simple solution. As she argues, there are […]

  47. Great article: Stop saying the solutions are so simple http://t.co/78au9ki2

  48. "Stop saying the solutions are so simple" http://t.co/Y7s85d5V by @karengrepin Worth a re-read. Patient Optimists unite http://t.co/MFEE2Yyk

  49. "Stop saying the solutions are so simple" http://t.co/0Szv5neq by @karengrepin Worth a re-read. Patient Optimists unite http://t.co/TG9aLXBD

  50. […] attending a report launch on child health, Grepin writes on her blog: What I disagree with is the message among advocates of child health that the we already know what […]

  51. Andoy Castro says:

    Malnutrition: RT @KarenGrepin: Stop saying the solutions are so simple http://t.co/xUprzeI5

  52. […] In the end it is complicated. Breastfeeding is time intensive and can be painful for some mothers. Dr. Karen Grepin, a NYU health researcher, refuted the idea that breastfeeding is a simple solution in a blog post last year. […]

  53. […] Stop saying the solutions are so simple – Karen Grepin’s Global Health Blog […]

  54. […] It is a similar idea that NYU global health researcher Karen Grepin pushed back against in a 2012 blog post. […]

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