Abstract
BackgroundLay support has been associated with improved breastfeeding practices, but studies of programs that engage men in breastfeeding support have shown mixed results and most are from high-income countries. The purpose of our research is to review strategies to engage men in exclusive breastfeeding (EBF) promotion or support in 28 project areas across 20 low- and middle-income countries. This information may be used to inform program implementers and policymakers seeking to increase EBF.MethodsWe tested the difference between baseline and final EBF proportions using Pearson’s chi-square (a = 0.05) and identified project areas with a significant increase. We categorized male engagement strategies as low- and high-intensity, using information from project reports. We looked for patterns by intensity and geography and described strategies used to engage men in different places.ResultsTwenty-eight projects were reviewed; 21 (75%) were in areas where a statistically significant increase in EBF was observed between the beginning and end of the project. A variety of high- and low-intensity male engagement strategies was used in areas with an increase in EBF prevalence and in all geographic regions. High-intensity strategies engaged men directly during home or health visits by forming men’s groups and by working with male community leaders or members to promote EBF. Low-intensity strategies included large community meetings that included men, and radio messages, and other behavior change materials directed towards men.ConclusionMale engagement strategies took many forms in these project areas. We did not find consistent associations between the intensities or types of male engagement strategies and increases in EBF proportions. There is a gap in understanding how gender norms might impact male involvement in women’s health behaviors. This review does not support the broad application of male engagement to improve EBF practices, and we recommend considering local gender norms when designing programs to support women to EBF.
Highlights
Lay support has been associated with improved breastfeeding practices, but studies of programs that engage men in breastfeeding support have shown mixed results and most are from high-income countries
Fifteen projects were implemented in sub-Saharan AKF Aga Khan Foundation (Africa), eight in South or Central CHS Center for Human Services (Asia), four in the Latin America/Caribbean region, and one in Southeast Asia
Twenty-one project areas (75%) had significant increases in exclusive breastfeeding (EBF) prevalence at the end of project implementation (Table 1; Fig. 2)
Summary
Lay support has been associated with improved breastfeeding practices, but studies of programs that engage men in breastfeeding support have shown mixed results and most are from high-income countries. The purpose of our research is to review strategies to engage men in exclusive breastfeeding (EBF) promotion or support in 28 project areas across 20 low- and middle-income countries This information may be used to inform program implementers and policymakers seeking to increase EBF. Exclusive breastfeeding (EBF) has been shown to provide immediate and longterm benefits for both mothers and children [3,4,5,6,7] Both skilled and lay (e.g., peer) support have been shown to reduce the risk of suboptimal breastfeeding practices [8, 9] with face-to-face support being the most effective for EBF [8], but effective approaches and strategies to support in different geographic, cultural, and income contexts are still being studied. Many of the studies about engaging men in EBF promotion and support were in higher-income countries and are of unknown relevance to LMIC (e.g., [15,16,17,18,19,20])
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