Presented at the National
Breastfeeding Consultative Meeting
22-23 August 2011
by Lynn Moeng
Contextual factors
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Individual Level- Personal factors
Household Level- family influences and
perceptions
Community Level- attitudes and support
Cultural practices and taboos
Knowledge related aspects
Generally, women and caregivers believe that
breastfeeding is the best way to feed babies and
many do choose breastfeeding as the first
feeding option
The questions is why are breastfeeding
practices so poor?
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Not enough milk - Preventable
Breast problems - Preventable
Baby or Mother too ill - Can be managed
Baby crying often
Child refuses to breastfeed – many preventable
reasons for this.
Fear of HIV transmitting through breastfeeding
Young women believe it is difficult and painful
Going back to work/school - Mothers believe
that children should be introduced to other
milks and foods before 6 months, in
preparation for separation.
Reason for stopping breastfeeding
Chose to formula feed
Mother working
Child refused breast
Nipple/breast problem
Mother ill/weak
0
5
10
15
Percentages
20
25
30
Where can one go for support on breastfeeding
Friend
Grand mother
Mother
CHW
Health worker
0
10
20
30
40
Percentages
50
60
70
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Family history and traditions- how other children were fed.
Storing expressed milk at home is a taboo in our culture.
Men not given an opportunity to make decisions on infant
feeding. The best they can contribute is purchasing formula.
Influence from grannies
The pressure for young girls who have just delivered babies
to go back to school immediately. – the effect of this on the
health and survival of these children needs to be
investigated.
Preparation for a newborn often includes formula,
bottle,teat and self medication eg. Druppels, gripewater and
many others.
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Link between community structures and the
health facility is weak.
Knowledge and skills of community health
workers.
Availability and sustainability of support
groups
Acceptability of mixed feeding- regarded as
the norm.
There are conflicts between cultural norms and
information provided by health workers.
Limited utilization of NGO’s to support infant
feeding.
Where can one go for information on breastfeeding
Support group
Friend
Grand mother
Mother
TV
Radio
CHW
Health worker
0
10
20
30
40
50
Percentages
60
70
80
90
100
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Where should women breastfeed- in some
environments, restrooms are designated as
breastfeeding places- breastfeeding is feeding.
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Public places are not breastfeeding friendly
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Households are not breastfeeding friendly
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Strengthen referral systems from PHC to existing
community structures.
Follow-up support just after discharge ( within
three days).
How are the postnatal visits used to support
breastfeeding.
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Breastfeeding management challenges
◦ Supply and demand
◦ Positioning and attachment
◦ Assisting mothers with problems such as flat
nipples
Growth spurts ( critical points when frequency of
breastfeeding should be increased.
Rates of HIV transmission not well understood
Feasibility of exclusive breastfeeding for six months
Effects of the use of self medication on breastfeeding
including drupples that pored in bath water.
Tested strategies that can
improve breastfeeding practices
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Partner involvement
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Promoting the
culture of cup VS
bottle feeding
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Assist mothers to
position
Ensuring them that is
important to
breastfeed twins.
Supporting a mother to
80%
70%
70%
Percentage
60%
50%
Exclusively
breastfeeding 5
month old infants
40%
30%
20%
6%
10%
0%
Project Area
Control
Adapted from: Haider R, Kabir I, Huttly S, Ashworth A. Training peer counselors to promote and
support exclusive breastfeeding in Bangladesh. J Hum Lact, 2002;18(1):7-12.
Slide 4.10.5
Step 2: Breastfeeding counselling
increases exclusive breastfeeding
Age:
3 months
4 months
Exclusive breastfeeding (%)
100
80
2 weeks after
diarrhoea treatment
75
72
56.8
60
58.7
Control
Counselled
40
20
12.7
6
0
Brazil '98
Sri Lanka '99
Bangladesh '96
(Albernaz)
(Jayathilaka)
(Haider)
All differences between intervention and control groups are significant at p<0.001.
From: CAH/WHO based on studies by Albernaz, Jayathilaka and Haider.
Slide 4.2.5
Median duration of
exclusive
breastfeeding = 159
days
% exclusively breastfeeding
100
80
81.90%
72.5%
60
66.7%
45%
5 mths
6 mths
40
20
0
6 weeks
3 mths
Age
Coovadia et al., Lancet 2007
Exclusive reastfeeding
(%)
90%
80%
80%
70%
60%
Six-visit group
Three-visit group
Control group
67%
62%
50%
50%
40%
24%
30%
20%
12%
10%
0%
2 weeks
3 months
Infant's age
From: Morrow A, Guerrereo ML, Shultis J, et al. Efficacy of home-based peer counselling to
promote exclusive breastfeeding: a randomised controlled trial. Lancet, 1999, 353:1226-31
Slide 4.10.6
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Capacity building of CHW
Improve prenatal and post natal education
Involvement of all role players in promoting
Breastfeeding
Investment in marketing
Social mobilisation of community
Creating conducive environments for mothers
to breastfeed
Thank you