Scientific Evaluation of the Psychosocial Impacts of Baby Friendly Spaces in Low-Resource Humanitarian Settings


Recognizing the critical role of maternal mental health in addressing the health and development of children in emergencies, Action Contre La Faim/Action Against Hunger (ACF) developed the Baby Friendly Spaces (BFS) program. BFS is a holistic psychosocial support (PSS) program implemented as a part of child malnutrition prevention services that aims to enhance mothers’ wellbeing, internal resources, and child care practices skills in order to create a buffer against the deleterious health and developmental impacts of humanitarian crisis on mothers and children. This study evaluated the effectiveness of BFS for improving conflict-affected Rohingya mothers’ psychosocial well-being, and secondarily, for supporting the growth of their young children experiencing acute malnutrition while living in refugee camps in Cox’s Bazar, Bangladesh.

Study Design

Cluster randomized controlled trial


Refugee mothers and their acute malnourished infants and young children (<2 years of age)


Refugee camps in Cox’s Bazaar, Bangladesh

Baby Friendly Spaces is a holistic psychosocial program designed to enhance mothers’ wellbeing in order to buffer against the deleterious health and developmental impacts of conflict and disaster on children and on maternal mental health. To advance their goal of preventing child malnutrition, ACF began implementing BFS for Rohingya pregnant and lactating mothers of children under age two in Cox’s Bazar refugee camps in 2017. BFS is designed to be flexible to meet the unique needs of conflict-affected populations in a community-based approach, but always focuses on two domains: psychosocial support that targets maternal wellbeing and childcare practices that target caregiver functioning and behaviors and child’s health in order to support mother-child relationship. In so doing, BFS strengthens mothers’ internal resources and skills in caring for their children to positively impact the wellbeing of their children during humanitarian emergencies.

In those BFS programmes, the following activities are delivered by trained psychosocial workers and psychologists: 

  • counseling on infant and young child breastfeeding and feeding practices
  • attachment and communication between the mothers and their children;
  • group discussions on child care practices;
  • psychosocial stimulation activities(including play and massage) that provide physical and neurocognitive stimulation essential for children at risk of, or experiencing, malnutrition;
  • and provision of maternal psychosocial support(i.e. psychoeducation, stress management, individual conselling).


These activities support mothers’ ability to provide essential care practices both in quantity (time spent caring for the child) and quality (responsiveness, continuity of attention and affection and the encouragement of autonomy and exploration) in order to protect and promote child wellbeing, health and development.

Operationally, BFS programs are linked to ACF’s Integrated Nutrition Centers which serve undernourished children. In the current study, we will evaluate BFS as implemented within Integrated Nutrition Centers. Women receive an initial assessment and one-on-one admissions session with a psychosocial worker during which standardized instruments are administered to identify their specific psychosocial and care practice needs. Based on this initial assessment, the psychosocial worker refers the women to scheduled BFS activities and/or arranges home visits from community outreach or psychosocial workers as needed for monitoring and follow-up (this has been put on hold due to the Covid-19 pandemic restrictions). Women can drop in and attend BFS activities as they desire and for as long as they desire, but are encouraged to attend at least weekly for a period of two months. BFS also serve as point of contact for referrals to other services (e.g. higher-level mental health care, gender-based violence resources, etc.). BFS are integrated in the existing care pathways and run as one of the services delivered to undernourished children and their mothers together.

"Talking about mental health is not easy but well-being is inherent to any human being, one should care about it and try to maintain it, overcoming the shyness and barriers.”
Program Psychologist

Sarah Murray, PhD
Assistant Professor
Johns Hopkins University Bloomberg School of Public Health

Karine Le Roch, PhD
MHPSS Research Project Advisor
Action contre la Faim

Kh. Shafiur Rahaman, MPH
Research Project Manager
Action contre la Faim

Amanda Nguyen, PhD
Assistant Professor
University of  Virginia School of Education and Human Development

Laetitia Clouin
MHPSS Regional Technical Advisor for Asia
Action contre la Faim

Matthew Schojan
Research Association
Johns Hopkins University Bloomberg School of Public Health

Molly Lasater, PhD
Johns Hopkins University Bloomberg School of Public Health

Anvita Bhardwaj, MSPH
Research Assistant
Johns Hopkins University Bloomberg School of Public Health

Catherine Lee, PhD
Johns Hopkins University Bloomberg School of Public Health

Brigitte Tonon, MPH
Nutrition and Health Regional Technical Advisor for Asia
Action contre la Faim


Most Significant Change Workshop Report

Study Brief: Being a Rohingya Mother with a Malnourished Child Living in Cox’s Bazar, Bangladesh

Study Brief: Conducting Interviews with Rohingya Refugee Mothers Living in Cox’s Bazar, Bangladesh

Measuring the psychosocial wellbeing of Rohingya mothers in Cox’s Bazar, Bangladesh: Psychometric properties of an MHPSS assessment battery

Formative and Supportive Supervision: Brief Note for ACF MHPSS Team