Sociocultural and structural influences on infant and young child feeding in pastoralist communities of Afar, Ethiopia: a qualitative phenomenological study

Abstract

Background

Infant and young child feeding (IYCF) practices are critical for child growth and survival, yet they are strongly shaped by sociocultural and livelihood contexts. In pastoralist settings, feeding practices are influenced by traditional beliefs, mobility, environmental constraints and access to health services. However, limited evidence exists on how community norms and social structures influence IYCF in remote pastoralist communities of Ethiopia.

Objective

This study aimed to explore maternal and community perspectives on IYCF practices in the pastoralist communities of Afar Region, Ethiopia.

Design

Qualitative observational study using a phenomenological approach.

Setting

Pastoralist communities in the Afar Region, Ethiopia.

Participants

16 mothers of children aged 6–23 months participated in in-depth interviews, and 20 community members (religious leaders, elders and clan leaders) participated in three focus group discussions.

Methods

Participants were purposively selected. Data were collected using semi-structured interviews and focus group guides, audio-recorded, transcribed verbatim and translated into English. Data were analysed using an inductive thematic analysis approach.

Results

Four interrelated themes shaped IYCF practices. Cultural rituals and elder authority influenced breastfeeding initiation, particularly following home births, where pre-lacteal feeding linked to the Onor/Onqor ritual was described as delaying initiation. Although awareness of exclusive breastfeeding was commonly reported among participants, seasonal water supplementation and maternal workload limited consistent adherence. Complementary feeding was generally introduced at 6 months; however, dietary diversity was constrained by pastoral livelihood instability, drought, market inaccessibility and rising food prices. Gendered household dynamics shaped resource control and caregiving responsibilities, with women bearing primary responsibility for childcare, feeding and hygiene. Clan-based social networks provided support during hardship but also reinforced some traditional feeding practices.

Conclusions

IYCF practices in pastoralist Afar are shaped by cultural norms, gender relations and structural constraints, including livelihood insecurity and limited service access. Interventions should integrate culturally responsive community engagement with gender-sensitive and livelihood-informed nutrition strategies.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• This qualitative study provides in-depth insights into infant and young child feeding practices in remote pastoralist communities of Afar, Ethiopia, a population under-represented in nutrition research.

• Inclusion of both mothers and influential community members enabled exploration of household and community-level sociocultural influences on feeding practices.

• The qualitative design allowed detailed understanding of how cultural norms, gender relations and pastoral livelihoods shape infant feeding behaviours.

• Findings are context-specific to pastoralist communities and may not be transferable to other geographic or livelihood settings.

• As with most qualitative studies, findings are based on self-reported experiences and may be influenced by social desirability bias; causal relationships cannot be inferred.

Introduction

Infant and young child undernutrition remains a major public health challenge, particularly during the first 1000 days of life, a critical period for growth and brain development.¹,⁵ Sub-Saharan Africa bears the highest burden of under-five mortality globally, with an estimated 69 deaths per 1000 live births.⁶ In Ethiopia, inappropriate infant and young child feeding (IYCF) practices are substantial contributors to child morbidity and mortality.^{7 8} Although national indicators for stunting, underweight and wasting have improved over the past two decades,^{9 10} these gains mask marked regional inequities.

Pastoralist regions experience disproportionately poor nutritional outcomes compared with national averages. In the Afar Region, stunting affects approximately 42% of children and wasting 26%, among the highest rates in the country.¹¹ These disparities reflect structural vulnerabilities, including food insecurity, limited access to health services, environmental shocks and geographic isolation.

The WHO recommends early initiation of breastfeeding, exclusive breastfeeding for 6 months, timely introduction of nutritionally adequate complementary foods at 6 months and continued breastfeeding up to 2 years or beyond.¹²,¹⁶ Despite their proven effectiveness in reducing child mortality and improving cognitive outcomes,¹⁷,¹⁹ global and national adherence to recommended IYCF practices remains suboptimal.²⁰,²³ In Ethiopia, only 8% of children aged 6–23 months achieve minimum dietary diversity, and in Afar this figure is as low as 2%.²³ Complementary feeding in pastoralist areas is often constrained by reliance on livestock products, limited market access and seasonal food shortages.¹¹²⁴,²⁶

Feeding practices in pastoralist communities are shaped not only by economic and environmental constraints but also by gender relations, household decision-making patterns and deeply embedded cultural norms.²⁷,²⁹ Seasonal mobility, recurrent drought and dispersed settlements further challenge consistent health service delivery and maternal caregiving capacity.³⁰,³² While quantitative surveys have documented low coverage of recommended IYCF practices in pastoralist regions, there remains limited qualitative evidence on how community beliefs, social structures and livelihood realities interact to influence feeding behaviours in these contexts.²⁷,³⁵

Understanding these contextual dynamics is essential for designing culturally responsive and equity-oriented nutrition interventions. Therefore, this study explores the perceptions, lived experiences and community perspectives on IYCF practices in pastoralist communities of the Afar Region, Ethiopia.

Methods

Study design and reporting

A qualitative observational study using a phenomenological approach was conducted to explore lived experiences and community perceptions of IYCF practices. The study is reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) (online supplemental file 1).

Study setting

The study was conducted between January and February 2025 in pastoralist communities of the Awsi Rasu Zone, Afar Region, northeastern Ethiopia. The zone has an estimated population of 703 531, including 80 203 children under 5 years and 26 313 children under 2 years.³⁶ Health infrastructure includes 3 hospitals, 26 health centres and 108 health posts.³⁷ The region is characterised by pastoralist livelihoods, seasonal mobility and recurrent drought.

Research team and reflexivity

In-depth interviews (IDIs) were conducted by the male first author, a Master of Public Health nutritionist with prior experience in qualitative research in pastoralist communities. Focus group discussions (FGDs) were facilitated by a trained moderator, assistant facilitator and note-taker. None of the research team members were residents of the study communities. Participants were informed that the interviewers were public health researchers interested in understanding IYCF practices, and the study objectives were explained before obtaining consent. To reduce potential bias related to externality, local facilitators supported community entry but were not present during interviews. The research team attended refresher training in qualitative methods prior to data collection, and reflexive journaling was maintained throughout data collection and analysis.

Sampling and recruitment

Purposive sampling was used to ensure variation in age, sex and community roles. Mothers or primary caregivers of children aged 6–23 months who had resided in the area for at least 6 months participated in IDIs. Religious leaders, elderly women and clan (Dala) leaders participated in FGDs. Recruitment was facilitated by health extension workers, who introduced the study but were not involved in interviews. Participation was voluntary, and no eligible individuals declined.

Data collection continued until thematic saturation was reached, defined as the point at which no new codes or themes emerged from successive interviews. A total of 16 IDIs and 3 FGDs involving 20 participants were conducted.

Data collection

Semi-structured interview guides were developed based on study objectives and relevant literature and piloted in Mille district to ensure clarity and cultural appropriateness (see online supplemental file 2) and online supplemental file 3). Topics included breastfeeding practices, complementary feeding, hygiene behaviours, gender norms and perceived barriers and facilitators.

Interviews lasted 45–60 min and focus groups 90–120 min. All sessions were conducted in local languages (Afar’af) in convenient places, audio-recorded with consent and supplemented by field notes.

Data analysis

Audio recordings were transcribed verbatim and translated into English. An inductive thematic analysis approach was used. The first and third authors independently coded transcripts line by line, followed by development of a coding framework through iterative discussion. Codes were grouped into categories and overarching themes using constant comparison. Discrepancies were resolved by consensus. Atlas.ti V.7 was used for data management.

As this study employed a qualitative phenomenological approach, findings are reported using thematic descriptions rather than quantitative estimates. To enhance clarity and analytical rigour, consistent qualitative descriptors such as ‘commonly reported’, ‘frequently described’ and ‘consistently observed across participants’ were used to indicate the relative prominence of themes. These descriptors do not imply statistical generalisation but reflect patterns identified across interviews and FGDs, in line with qualitative reporting standards (COREQ). Representative verbatim quotations are provided to support each theme and ensure transparency of interpretation.

Trustworthiness

Credibility was enhanced through triangulation of IDIs and FGDs, peer debriefing and member checking. Dependability was supported through an audit trail. Transferability was addressed through detailed contextual description. Confirmability was strengthened through reflexive documentation and independent coding.

Patient and public involvement

Community members were not involved in the study design. However, preliminary findings were shared with selected community representatives to validate interpretations and inform dissemination planning.

Results

Study participant characteristics

A total of 36 participants were included: 16 mothers or primary caregivers participated in IDIs and 20 community members participated in three FGDs. All IDI participants were women, while FGD participants were evenly distributed by sex. Mothers were predominantly aged 25–34 years, whereas FGD participants were older (45–74 years) and included religious leaders, elderly women and clan (Dala) leaders. Educational status was generally low; more than half of IDI participants and most FGD participants reported no formal education. Unemployment was common across both groups (table 1). Participants represented diverse social roles within pastoralist communities, allowing exploration of both household-level practices and broader normative influences.

Table 1. Socio-demographic characteristics of participants (n=36), January–February 2025, Awsi Rasu Zone, Afar Region.

Characteristic	IDI participants (n=16), n (%)	FGD participants (n=20), n (%)
Sex
Female	16 (100)	10 (50)
Male	0 (0)	10 (50)
Age (years)
18–24	3 (19)	–
25–34	11 (69)	–
35–49	2 (13)	–
30–44	–	3 (15)
45–54	–	6 (30)
55–64	–	4 (20)
65–74	–	5 (25)
75+	–	2 (10)
Educational Status
No formal education	9 (56)	16 (69)
Primary and above	7 (44)	4 (31)
Occupation
Unemployed	12 (75)	17 (85)
Employed	4 (25)	3 (15)

FGD, focus group discussion; IDI, in-depth interview.

Overview of themes

Inductive thematic analysis identified four overarching themes, each encompassing multiple subthemes that shaped IYCF practices in pastoralist communities (table 2). These themes were not independent; rather, they intersected to influence caregivers’ capacity to implement recommended IYCF practices.

Table 2. Summary of themes and subthemes influencing infant and young child feeding in pastoralist communities, Afar Region, Ethiopia.

Theme	Sub-themes
Theme 1: Cultural and health service use influences on feeding practices	Place of delivery and breastfeeding initiation Colostrum feeding knowledge and practices Exclusive breastfeeding knowledge and early water supplementation Complementary feeding initiation and food types Breastfeeding duration and early cessation
Theme 2: Livelihood insecurity and dietary constraints	Pastoralism as resource and vulnerability Economic constraints and rising food prices Market access and geographic isolation Food beliefs influencing dietary diversity
Theme 3: Gendered power relations and caregiving burden	Male resource control and decision-making authority Intra-household food allocation patterns Women’s workload and lack of time Clan (Dala/Fiqma) support systems
Theme 4: Hygiene practices within structural water scarcity	Hand washing practices under water scarcity Utensil sharing and soap availability Gendered roles in hygiene maintenance

Theme 1: Cultural and health service use influences on feeding practices

Place of delivery and breastfeeding initiation

Place of delivery was described as strongly influencing the timing of breastfeeding initiation. Mothers who delivered in health facilities commonly reported initiating breastfeeding immediately after birth, often following counselling and assistance from healthcare providers. Facility-based delivery was frequently described as being associated with earlier breastfeeding initiation and greater adherence to recommended newborn feeding practices.

I gave birth in the hospital and immediately started breastfeeding my baby, as advised by the healthcare professionals (Mother in her early 20s, IDI).

In contrast, home deliveries were commonly described as being associated with delayed initiation of breastfeeding due to the culturally embedded Onor/Onqor ritual, during which respected elders were reported to administer pre-lacteal feed such as sugar water, milk or dates before breastfeeding begins.

Breast milk is not started for the baby without Onor rituals (FGD participant).

These practices were described as socially important and sometimes prioritised over health worker advice.

My family was looking for someone who could feed him water with sugar… Our family doesn’t hear health extension workers’ advice. (Mother in her mid-20s, IDI)

These findings highlight how institutional health guidance and traditional authority structures coexist in shaping early infant feeding practices.

Colostrum feeding knowledge and practices

Participants commonly described the benefits of colostrum feeding, particularly among those with exposure to health facility counselling. Many described colostrum as beneficial for newborn health and strength.

Colostrum is indeed beneficial, and I ensured my child received it. Health professionals informed us about its importance. (Mother in her mid-30s, IDI)

Despite this growing awareness, some mothers reported earlier experiences in which colostrum was not immediately given following home births assisted by traditional birth attendants.

With my first child, who was born at home with the help of a traditional birth attendant, I did not give colostrum immediately. (Mother in her early 30s, IDI)

These accounts suggest that community perceptions regarding colostrum feeding are gradually shifting but may still vary depending on place of delivery.

Exclusive breastfeeding knowledge and early water supplementation

Knowledge regarding exclusive breastfeeding for the first 6 months was commonly reported across participants. Mothers were generally aware of recommendations to provide only breast milk during this period, reflecting exposure to health extension worker counselling. Some mothers reported successfully following this guidance:

Currently, my child is eight months old and he was exclusively breastfed for six months without adding any water or other liquids. (Mother in her early 20s, IDI)

One FGD participant explained:

For the next six months, only breast milk is consumed; nothing else is added. (FGD participant)

However, reported practices often differed from these recommendations. Early water supplementation was frequently described, particularly during periods of high temperature, as caregivers believed infants required additional fluids to quench thirst.

Although it varies depending on the temperature… after a month it will be hot so we will give him water. (FGD participant)

These findings indicate that knowledge of exclusive breastfeeding coexists with culturally embedded interpretations of infant physiological needs, particularly in hot pastoralist environments.

Complementary feeding initiation and food types

Complementary feeding was commonly introduced around 6 months of age. Initial complementary foods typically consisted of traditional cereal-based porridges, ‘sabta’, prepared with locally available ingredients such as maize, sorghum or milk products.

We start milk at six months. After six months, we give them a food called sabta, corn porridge made with yoghurt and butter. (FGD participant)

Mothers also reported introducing additional foods such as grains and vegetables as children grew older.

Alongside breastfeeding, I introduced additional food to my child when he turned six months old. Now he eats rice, pasta, cow’s milk, porridge and injera with cabbage. (Mother in her mid-20s, IDI)

Nevertheless, dietary diversity was often limited by food availability and cultural beliefs regarding appropriate foods for young children. Some caregivers reported restricting certain foods, such as meat, due to perceptions that infants could not digest them easily.

Most of the time we forbid children from eating meat because their intestines cannot handle it. (FGD participant)

Similarly, some mothers confirmed avoiding fatty foods, noting,

If we prepare meat at home, we do not provide meat for the children. Their stomachs may not tolerate fatty foods well (Mother in her early 20s, IDI).

Breastfeeding duration and early cessation

Breastfeeding was commonly described as a socially expected practice, with a culturally recognised duration referred to locally as ‘moola’. Participants described this duration as a socially accepted norm within the community.

When the child turns two years old, he stops breastfeeding. This is called moola. (FGD participant)

Mothers similarly described plans to continue breastfeeding for 2 years.

Breastfeeding should be stopped after two years. My child will breastfeed until two years, and after that he will be completely shifted to food. (Mother in her mid-30s, IDI)

However, some participants reported that breastfeeding could end earlier due to subsequent pregnancy or competing livelihood responsibilities.

Some stop at one year, some after a year and a half, and some after two and a half years… However, if pregnancy occurs, they might stop earlier (FGD participant).

Theme 2: Livelihood insecurity and dietary constraints

Pastoralism as both resource and vulnerability

Participants described pastoralism as central to household food systems and child nutrition. Livestock products, particularly milk, were considered important sources of nutrition for infants and young children, especially during the early stages of complementary feeding. Participants frequently referred to milk as a primary food available within pastoralist households.

We are pastoralists and have animal source foods that we feed our children, especially milk from our animals. (Mother in her early 30s, IDI)

However, pastoral livelihoods were also characterised by significant vulnerability. Participants reported that drought, livestock disease and seasonal mobility frequently reduced the availability of animal-source foods, limiting children’s diets during periods of hardship.

When drought happens, our animals become weak and produce little milk. During those times, it becomes difficult to feed children with animal products. (FGD participant)

These accounts illustrate the dual role of pastoralism as both a nutritional resource and a source of instability in food availability.

Economic constraints and rising food prices

Economic barriers were commonly reported across participants as major constraints to providing diverse foods for young children. Rapid increases in food prices were frequently described as limiting households’ ability to purchase staple foods such as rice, wheat flour and other market-based products.

Rice costs 25 kg for two thousand birr… children are deprived of such food because we are unable to purchase it. (FGD participant)

Several caregivers explained that income from livestock sales often did not keep pace with rising market costs, making it difficult to regularly provide nutritionally diverse foods for children.

One goat can only buy 25 kg of wheat flour… transportation costs are high and prices increase every week. (Mother in her early 30s, IDI)

These findings indicate that broader economic pressures significantly affect the ability of pastoralist households to maintain adequate complementary feeding.

Market access and geographic isolation

Limited access to markets further constrained household food options. Participants reported that many communities were located far from major market centres, requiring long travel distances to purchase food.

Market unavailability in our village is the major challenge. There is no shop in our surrounding to buy food for our children except Dubti town which is 15 km away (Mother in her mid-30s, IDI).

Transportation costs and poor road infrastructure were described as additional barriers that increased the price of goods and reduced the frequency with which households could access markets.

We have to spend the night travelling to get food from the market because flooding destroys our road. It exposes children to misery in the midst of this (FGD participant).

These geographic barriers contributed to reliance on locally available foods and limited the variety of foods accessible to young children.

Food beliefs influencing dietary diversity

Beyond structural constraints, participants also described cultural beliefs that influenced which foods were considered appropriate for young children. Certain nutrient-rich foods, particularly meat, were sometimes avoided due to concerns about children’s ability to digest them.

Most of the time we forbid children from eating meat. We do this because children’s intestines can’t handle it, so eating meat and other food can hurt them. After they drink milk, we also forbid them from eating anything else (FGD participant).

Such beliefs contributed to restrictions in dietary diversity, even when some food items were available within the household.

Theme 3: Gendered power relations and caregiving burden

Male resource control and decision-making authority

Participants frequently described household decision-making structures in which men held primary authority over financial resources and major household decisions. This control often influenced the types of foods purchased and how resources were allocated within the household. Mothers reported that although they were primarily responsible for childcare and feeding, their ability to provide diverse foods for children was sometimes constrained by limited control over household income.

My husband is the one who decides about money and what we buy from the market. (Mother in her late 20s, IDI)

These accounts highlight how gendered power dynamics within households shape the resources available for IYCF.

Intra-household food allocation patterns

Participants also described established norms regarding the order in which family members receive food. In several explanations, husbands were prioritised during meal distribution, followed by children and mothers. Such practices reflected culturally embedded expectations regarding gender roles and respect within households.

First and foremost, I prepare food for my husband. After he has eaten, my child and I eat. (Mother in her mid-30s, IDI)

These patterns of food allocation may influence the quantity and quality of foods available to mothers and children, particularly in situations of food scarcity.

Women’s workload and lack of time

Women’s multiple responsibilities within pastoralist households were frequently cited as barriers to optimal childcare and feeding practices. Participants described daily tasks including livestock management, water collection, firewood gathering and household food preparation. These activities often required long distances and substantial time, reducing the time available for child feeding and supervision.

Afar women travel long distances to gather wood for food preparation, and their children do not receive food and care in a timely manner. (Mother in her late 30s, IDI)

Such workload demands illustrate how gendered labour roles contribute to caregiving constraints in pastoralist settings.

Clan (Dala/Fiqma) support systems

Despite these challenges, participants emphasised the importance of traditional clan-based support systems, including Dala and Fiqma, which function as social safety networks within the community. These systems provide assistance during illness, economic hardship and other crises through financial contributions, social solidarity and collective decision-making.

If the illness requires treatment, we first help as friends; if it is higher, we help as neighbours; if it gets worse, we help as Dalas; and if it gets worse, we help as a tribe (FGD participant)

These structures were described as important sources of community resilience, helping families cope with challenges that may affect child care and nutrition.

Theme 4: Hygiene practices within structural water scarcity

Hand washing practices under water scarcity

The importance of hand washing during child feeding and food preparation was commonly reported across participants. Hand washing before preparing food or feeding children was frequently described as an important hygiene practice that helps prevent illness.

Yes, it is a common practice for me to always wash my hands before and after preparing food. (Mother in her early 20s, IDI)

However, participants also reported that limited water availability frequently constrained consistent implementation of recommended hygiene practices.

Utensil sharing and soap availability

In many households, utensils used for feeding young children were shared among family members due to limited household resources. Participants indicated that although cleaning utensils was considered important, the availability of soap and water sometimes limited the ability to maintain optimal hygiene.

Sometimes we wash the feeding utensils only with water because soap is not always available. (FGD participant)

These constraints highlight the practical challenges families face in maintaining recommended hygiene standards in resource-limited settings.

Gendered roles in hygiene maintenance

Women were primarily responsible for maintaining hygiene within the household, including washing utensils, cleaning the household environment and ensuring safe food preparation for children. Participants described these responsibilities as part of broader caregiving roles traditionally assigned to women.

Mothers are the ones who make sure the utensils are clean and the children are fed properly. (FGD participant)

These findings illustrate how gendered divisions of labour influence hygiene practices related to IYCF.

Cross-theme synthesis

IYCF practices in pastoralist communities are shaped by interacting cultural, structural and environmental factors. While participants were aware of recommended practices, longstanding cultural traditions and birth rituals often influenced breastfeeding and complementary feeding. Pastoralist livelihoods, fluctuating food availability and rising market prices limited dietary diversity, while gendered household dynamics placed primary caregiving responsibility on women with limited control over resources. Water scarcity and restricted access to hygiene facilities further constrained safe feeding practices. Overall, these findings highlight that feeding behaviours are shaped not only by individual knowledge but also by socio-cultural norms, gender roles, livelihood systems and environmental constraints.

Discussion

This study found that IYCF practices in pastoralist communities are influenced by a complex interplay of cultural norms, livelihood conditions, gender relations and environmental constraints. Although many mothers were aware of recommended feeding practices, implementation was often affected by community beliefs, limited resources and the realities of pastoralist life. Similar patterns have been observed in other resource-constrained settings, where knowledge alone is insufficient to ensure optimal feeding practices.

Breastfeeding initiation was shaped by both health service use and cultural practices. Mothers who delivered in health facilities consistently reported initiating breastfeeding immediately after birth, often following counselling from healthcare providers. In contrast, home deliveries were frequently described as being associated with delayed initiation due to culturally embedded Onor/Onqor rituals and the use of pre-lacteal feeds.

These findings are consistent with previous studies in pastoralist areas, where cultural birth rituals and elder influence shape early infant feeding behaviours.^{38 39} National evidence also indicates that health facility delivery is associated with earlier breastfeeding initiation in Ethiopia.^{38 39} Although awareness of colostrum feeding and exclusive breastfeeding is increasing, some mothers reported the belief that infants require water during extremely hot weather, a perception documented in other Ethiopian studies.⁴⁰,⁴⁵ Women’s decision-making power has been shown to influence adherence to recommended feeding practices.⁴³

Complementary feeding practices were influenced by livelihood conditions. While complementary foods were generally introduced around 6 months, children’s diets were often limited in diversity, typically consisting of cereal-based porridge sometimes supplemented with livestock milk. Environmental shocks, including drought, livestock disease and seasonal mobility, reduced milk availability during hardship periods. Similar challenges have been reported in other Ethiopian regions, where household food security, agricultural production and market access affect complementary feeding and dietary diversity.³⁸⁴⁶,⁵² Rising food prices and long distances to markets further constrained households’ ability to provide diverse foods.

Gender dynamics within households also shaped feeding practices. Men were primarily responsible for controlling livestock and financial resources, while women managed childcare, food preparation and household hygiene. Women’s limited control over income sometimes restricted access to diverse foods for children. Mothers also reported heavy workloads related to pastoralist livelihoods, including water collection, livestock management and domestic tasks, which reduced time available for breastfeeding and child feeding. These findings align with other rural Ethiopian studies where gendered labour roles influence maternal caregiving capacity and child nutrition.³⁸⁴⁶,⁴⁹

Community support systems were important coping mechanisms. Traditional clan-based structures such as Dala and Fiqma provided assistance during illness, food shortages and economic hardship. These informal safety nets help households manage environmental and economic shocks. Previous research has highlighted the importance of clan networks and customary institutions in strengthening resilience and supporting maternal and child well-being in pastoralist communities.^{53 54}

Environmental constraints further influenced hygiene practices. Although participants recognised the importance of hand washing and food preparation cleanliness, water scarcity and limited access to soap were common barriers. In pastoralist settings, households often prioritise water for drinking and livestock over hygiene purposes. Similar constraints have been reported in other rural and pastoralist contexts where limited access to water and sanitation facilities affects adoption of recommended hygiene practices.^{55 56}

Limitations of this study are that findings are context-specific to pastoralist communities and may not be transferable to other geographic or livelihood settings. As with most qualitative research, results are based on self-reported experiences and may be influenced by social desirability bias, and causal relationships cannot be inferred. Despite these limitations, the study provides valuable contextual insights to inform culturally appropriate interventions and policy.

Conclusion

IYCF in pastoralist communities is influenced by cultural traditions, livelihood conditions, gender roles and environmental constraints. Although awareness is high, structural barriers and community norms often limit optimal practices. Clan-based social networks may provide support, while water scarcity remains a major challenge. Multi-level interventions that combine behaviour change, community engagement, women’s empowerment and integration with maternal health, food security and Water, Sanitation and Hygiene (WASH) programmes are likely most effective. Future research should evaluate these interventions and include quantitative measures of child nutrition outcomes to inform policy and programming.

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.