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Discovering gender-related uncommon practices for 
improved nutrition of mothers and children through the 
Positive Deviance approach in rural Madhya Pradesh, India
FROM RESEARCH TO IMPACT: Towards just and resilient agri-food systems
Presenter: Nadine Bader  Date: 11th October 2023
1. Background: Positive Deviance
What is the Positive Deviance Approach?
Observation that in every community, there are a few 
individuals or groups whose uncommon but successful 
practices have enabled them to find better solutions 
to  problems than their peers who face the same 
challenges and have similar socio-economic 
circumstances. 
Albanna/Heeks 2018
Positive Deviance Initiative 2010: PD Facilitator guide
Pascale et al. 2010
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1. Background: Positive Deviance
Shift in perspective – Positive Deviance Approach
Needs-based approach Assets-based approach 
• Expertise from outside to • Assumption that all communities possess 
determine what a community solutions that are untapped and can be 
needs and how those needs can Positive leveraged for the development of the 
be met Deviance entire community
• Perspective: What is missing? • Perspective: What are available solutions 
• Good to address specific technical within the community? How to build on 
challenges but less useful for them?
behavioural change
Act your way into a new way of thinking, 
than to think your way into a new of acting
Albanna/Heeks 2018, Kadetz 2014, Tufts University 2010, Pascale et al. 2010
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2. Objective of the Study
Overview: Thematic Areas 
Objective of the Qualitative of the Study Tools
Research Study • Nutrition Practices
To discover uncommon practices among • Childcare & Health-seeking Practices for 
families with well-nourished mothers and Mother and Child
young children living in similar low • Roles & Responsibilities among Household 
socio-economic circumstances as their Members 
peers and that lead to their better nutrition • Gender roles
situation. • Psychological Resilience & Stress Coping 
Strategies of Mother
• Support Groups & Social Networks in the 
Village & Sources of Nutrition-relevant 
Focus of this presentation Information
• Hygiene Practices
Discovered uncommon practices related to • Food Production & Purchase
gender dynamics favouring a good nutrition • Livestock Keep and Use
situation of mother and young child. • Any Other Topics / Observations
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3. Context of the Study
Nutrition Situation in 
Rural Madhya Pradesh, India
Nutrition status of children under 5 years of age:
• 18.7 % wasted (low weight-for-height)
• 37.3 % stunted (low height-for-age)
Nutrition-relevant gender gaps:
• Unequal access to food, consumption, and production
• Family and marriage often benefit males in various 
dimensions including nutritional security 
• Women are perceived to be responsible for household 
chores & childcare, men to financially provide
• Literacy, schooling, employment, decision-making at 
household level
Population size of Madhya 
IIPS/MHFW 2022, Verma/Milcher 2022, Das/Mishra 2021, Nguyen et al. 2021 Pradesh: 86.5 million
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4. Methodology
Positive Deviance Inquiry 
• Determination of Positive Deviant families (N=23) 
through a) baseline data or b) growth monitoring data 
of children controlled by socio-economic situation
• Focus group discussions with community 5 Steps of Positive Deviance Inquiry
representatives per village (N=7)
• Semi-structured interviews with mothers, fathers, 
grandparents, and participatory observations
• Shortlisting successful uncommon practices and 
reflection with nutrition experts & researchers 
• Group discussions to validate shortlisted practices 
to be uncommon (N=7) and upon their feasibility 
(N=2) with mothers, fathers, grandparents, adolescent 
girls & boys, and frontline workers (data collection 
ongoing)
Sarnkhaowkhom et al. 2022; Jain et al. 2019; Steinke et al. 2019; Albanna/Heeks 2018 ; 
Tufts University 2010
Group discussion with adolescent girls for validation of uncommon 
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5. Findings
Gender-related 
uncommon 
practices for 
improved 
nutrition of 
mothers and 
children
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10/11/2023 Nadine Bader
5. Findings
Characteristics of Positive Deviant Parents
• Eating together (mother is not eating last) 
• Joint decision-making, e.g. in family planning 
• Managing workloads jointly
• Marriage age higher compared to others
• Girl and boy child treated equally, 2-3 children per 
family, however, wish for a boy when there are only girls
Uncommon practices of mothers related to gender
• Discuss issues with neighbourhood friends or parents
• One mother was part of a women group where she receives training on 
financial management and how to open a small business
• One mother attends multiple community meetings
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5. Findings
Father´s supportive uncommon practices
• Conscious financial planning to ensure good nutrition for mother and child 
• Attaining knowledge about good nutrition 
     If mother eats well, child also gets good nutrition through her breastmilk
• Not consuming alcohol 
• Feeding the child before or after returning from work 
• Active engagement and interaction with the small child
Uncommon practices of grandparents 
• Not sending their daughter-in-law to farm work before and after delivery 
despite the loss of income 
• Grandfathers look after their grandchildren, e.g. ensuring their nutrition, 
cleaning them, putting them to sleep, pacify them when they cry etc.
• In-laws and parents discuss jointly decisions to make
• Let mother rest post delivery for 1 month (one family)
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5. Findings
Controversial Findings to Critically Reflect Upon
My wife is at home and that's why the child is Favourable for the child´s nutrition 
well. Otherwise, if she pays more attention to but what about mother´s agency?
her work, the child would become weak.
PD families in sample with unequal gender Other identified uncommon practices explain 
roles but well-nourished mothers and it: e.g. child regularly attends childcare centre, 
young children “collective care”, frequent feeding throughout 
the day, uncultivated foods, hygiene practices
No consumption of alcohol was perceived Community members find this practice difficult 
as an effective driver to address malnutrition
- Woman would get tubectomy done, not father 
Joint decision about family planning “good” vasectomy (no discussion about this)
step and requires counselling of young - (female) frontline workers play important role 
couples but often feel not confident to talk to men
Motivation of fathers to invest in childcare was in two cases based on earlier 
malnutrition-related child loss in the (extended) family
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Conclusions
• Women´s empowerment: expected more 
uncommon practices, e.g. being part of 
women´s groups / social networks
• Promising positive uncommon practices of 
young fathers and grandfathers identified
• Dialogues with young fathers have 
potential to enhance their engagement 
*Involvement of men and boys in 
transforming gender norms and 
empowerment of women
• Many non-gender related uncommon 
practices were identified in the research
Group discussion with young fathers for validation of uncommon practices
*Bapolisi et al. 2020, Kagesten/Chandra-Mouli 2020, Kinati et al. 2023
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Outlook
• Positive Deviance approach can 
be a useful tool to identify and 
promote (gender-related) 
positive uncommon practices
- successful scaling 
strategies need to be identified
• Develop Positive Deviance 
tool for frontline workers & 
adolescent girls to leverage 
local solutions 
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Thanks for 
your attention!
Contact:
nadine.bader@giz.de
nadine.bader@wur.nl 
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Deutsche Gesellschaft für
Internationale Zusammenarbeit (GIZ) GmbH
Registered offices
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E  info@giz.de
I    www.giz.de
The PD Concept
1. Solutions / good practices to complex 
problems ALREADY exist.
2. They have been devised by a few of its 
members.
3. These individual or group “outliers” have 
prevented or solved the problem 
without  special resources and under 
the  same or worse circumstances as 
their peers.
15
Determine Positive Deviants through Baseline survey & Community
• Added questions for control variables in the baseline standard questionnaire to 
identify Positive Deviants (PD, 2021)
• 370 rural mother-child pairs in 2 districts
• 2 performance indicators: mother’s dietary diversity (WDDS)
child’s diet (MAD)
• 11 control variables (assets, education, region, market access etc.)
• Identified 29 Positive Deviants from Baseline in the 2 districts
Community identified Positive Deviants:
• Child below 2 years with “green” category in child growth monitor scores 
• from a low-income family, e.g. no land ownership or only rainfed land, no / 
hardly livestock, BPL, family members go out for migration labour etc. 
(as per community definition)
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Definitions of Positive Deviants
Baseline identified Positive Deviants:
• Mother-child pair with optimal performance in WDDS 
and child´s MAD 
• Controlled for following variables: 
1. Caste How can communities without 
2. Market orientation external support / surveys identify 
3. Education level of mother PDs and their uncommon practices?
4. Education level of head female in the household
5. Migration of household members to other areas to Community identified Positive Deviants:
do labour work
6. Sex of the household head • Child below 2 years of age with “green” 
7. People who lived permanently in households for category in child growth monitor scores 
the last 3 months • and from a low-income family, 
8. Main material of the roof of your house e.g. no land ownership or only rainfed 
9. Fuel mainly used by the household for cooking land, no / hardly livestock, BPL, family 
10. Use of any land for agriculture (owned, rented, …) members go out for migration labour etc. 
during the last 12 months (as per community definition)
11. Use of any livestock herds or farm animals or 
poultry
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Overview Qualitative PD Inquiry at Household Level
Khandwa (Nov 2022) Barwani (Jan 2023)
4 villages visited 4 villages visited
• 3 Community meetings • 4 Community meetings
• 1 girl adolescent group meeting • 5 Baseline and 6 Community 
• 1 group interview with AWW identified PD Household visits
• 1 interview with school principle • 1 girl adolescent group for 
• 8 Baseline and 3 Community participatory sketching
identified PD Household visits • 2 households with participatory 
• 1 interview with Non-PD mother sketching of children (& 
• 1 women group with small mothers)
children
• 2 households with participatory 
sketching of children
• 1 pilot validation workshop with 
Non-PD families & AWW 
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