Abstract
BackgroundIn Bangladesh, many programs and projects have been promoting breastfeeding since the late 1980 s. Breastfeeding practices, however, have not improved accordingly.MethodsFor identifying program-relevant issues to improve breastfeeding in infancy, quantitative data were collected through visits to households (n = 356) in rural Chittagong and urban slums in Dhaka, and qualitative data from sub-samples by applying semi-structured in-depth interviews (n = 42), focus group discussions (n = 28), and opportunistic observations (n = 21). Trials of Improved Practices (TIPs) (n = 26) were conducted in the above sites and rural Sylhet to determine how best to design further interventions. Our analysis focused on five breastfeeding practices recommended by the World Health Organization: putting baby to the breast within the first hour of birth, feeding colostrum and not giving fluids, food or other substances in the first days of life, breastfeeding on demand, not feeding anything by bottle, and exclusive breastfeeding for the first six months.ResultsThe biggest gaps were found to be in putting baby to the breast within the first hour of birth (76% gap), feeding colostrum and not giving other fluids, foods or substances within the first three days (54% gap), and exclusive breastfeeding from birth through 180 days (90% gap). Lack of knowledge about dangers of delaying initiation beyond the first hour and giving other fluids, foods or substances, and the common perception of "insufficient milk" were main reasons given by mothers for these practices. Health workers had talked to only 8% of mothers about infant feeding during antenatal and immunization visits, and to 34% of mothers during sick child visits. The major providers of infant feeding information were grandmothers (28%).ConclusionsThe findings showed that huge gaps continue to exist in breastfeeding behaviors, mostly due to lack of awareness as to why the recommended breastfeeding practices are beneficial, the risks of not practicing them, as well as how to practice them. Health workers' interactions for promoting and supporting optimal breastfeeding are extremely low. Counseling techniques should be used to reinforce specific, priority messages by health facility staff and community-based workers at all contact points with mothers of young infants.
Highlights
In Bangladesh, many programs and projects have been promoting breastfeeding since the late 1980 s
Based on 24-hour recall reported in the national Bangladesh Demographic and Health surveys (BDHS) 1999, 2004, and 2007 [10,11,12], the prevalence of exclusive breastfeeding (EBF) among infants below six months of age has not increased in the past twelve years
As with other DHS and MICS household surveys, the BDHS data is based on 24-hour recall, which tends to overstate the rate of EBF because it is not measured from birth
Summary
In Bangladesh, many programs and projects have been promoting breastfeeding since the late 1980 s. While there is considerable evidence that exclusive breastfeeding contributes to child survival and that efforts to increase exclusive breastfeeding (EBF) have been effective [1,2,3], new evidence for the benefits of optimal early infant feeding practices continue to be documented. Based on 24-hour recall reported in the national Bangladesh Demographic and Health surveys (BDHS) 1999, 2004, and 2007 [10,11,12], the prevalence of EBF (defined as giving only breast milk, not even water) among infants below six months of age has not increased in the past twelve years. Initiation of breastfeeding within one hour of birth, is reported to have increased from 24% in 2004 to 43% in 2007. As with other DHS and MICS household surveys, the BDHS data is based on 24-hour recall, which tends to overstate the rate of EBF because it is not measured from birth
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