Suggested title: Responsive complementary feeding practices in rural Rwanda: Perspective from mothers.

Background: The feeding practices of the mothers, particularly responsive feeding, are critical determinants of acceptance of food, dietary intake as well as the growth of infants and young children (IYC). Responsive feeding refers to the interactions between mother and child that lead to a positive feeding experience, adequate dietary intake and enhanced developmental opportunities. Little is known about mothers responsive feeding practices in Rwanda. Therefore, this study sought to explore mothers’ responsive feeding practices as well as the factors that hinder the implementation of recommended practices among mothers from rural Muhanga District. Method: This qualitative, longitudinal study, recruited a purposive sample of 29 pregnant women attending prenatal consultations in two rural health centers. They were interviewed and mother-child interactions during mealtime were further observed during one lunch meal feeding episode at 6, 9 and 12 months postpartum. The interviews were recorded, transcribed and thematically analyzed using qualitative software, Atlas.ti. Frequency distribution was generated for each practice observed. Results: At 6 months, most mothers reported to verbally encourage their children to eat during feeding and the numbers increased over the age at 9 and 12 months respectively. Less than a half, at all 3 time points, reported to allow their child to self-feed, to smile and talking during feeding. During the observation, the practices were even less than the reported at all 3 time points of the observations. The burden of other responsibilities and poverty were perceived as the major barriers that made mother child- interactions during feeding difficult. Conclusion: Findings indicate that what mothers report may not always reflect the responsive feeding practices performed during feeding . Nutrition interventions in the study community should consider promoting responsive feeding practices as well as addressing the issue of poverty and the burden of other responsibilities that hinder mother-child interactions.