Abstract
Reviews of programmes in Bangladesh, Benin, the Philippines, Sri Lanka, Uganda, and Uzbekistan sought to identify health policy and programmatic factors that influenced breastfeeding practices during a 10 to 15 year period. Exclusive breastfeeding rates and trends were analysed in six countries in general and from an equity perspective in two of them. Success factors and challenges were identified in countries with improved and stagnated rates respectively. The disaggregated data analysis showed that progress may be unequal in population subgroups, but if appropriately designed and implemented, a programme can become a “health equalizer” and eliminate discrepancies among different subgroups. Success requires commitment, supportive policies, and comprehensiveness of programmes for breastfeeding promotion, protection and support. Community-based promotion and support was identified as a particularly important component. Although health workers’ training on infant feeding support and counselling was prioritized, further improvement of interpersonal counselling and problem solving skills is needed. More attention is advised for pre-service education, including a stronger focus on clinical practice, to ensure knowledge and skills among all health workers. Large-scale communication activities played a significant role, but essential steps were often underemphasized, including identifying social norms and influencing factors, ensuring community participation, and testing of approaches and messages.
Highlights
Undernutrition, an important determinant of child health [1,2], is the underlying cause of 35% of the disease burden in children younger than 5 years [3]
Were selected for study based on a number of criteria, such as (i) wide range of programmatic and policy experiences; (ii) potential for significant cross-country learning from diverse demographic, health, nutrition, and development contexts (Table 1); (iii) geographic representation of different world regions; (iv) interest by international and national stakeholders involved in IYCF-related activities; and (v) availability of nationally representative breastfeeding data over the time period of interest
The national government through the MOH was the lead agency for programming in the reviewed countries, with a certain degree of involvement of other structures, except in Sri Lanka where the responsibilities for IYCF were mainly within the MOH units
Summary
Undernutrition, an important determinant of child health [1,2], is the underlying cause of 35% of the disease burden in children younger than 5 years [3]. Implementation of proven public health and nutrition interventions, including promotion of breastfeeding, has resulted in sizeable progress in improving child survival and health in many countries [4,5]. Optimal breastfeeding practices can help prevent undernutrition [6,7] during early childhood. 6 months of life and continued breastfeeding from 6 to 11 months is the preventative intervention with the highest potential among others to reduce under-5 deaths in the developing world [9]. Optimal breastfeeding contributes to young child growth [4,10] and development [11,12,13]
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