Improving Breastfeeding Practices: The Role of Community Breastfeeding Guardians (BFGs) in Lagos State

Abstract

Abstract Objectives Research by the Alive & Thrive Program (A&T) in Nigeria to demonstrate that repeated exposures of pregnant women and mothers of infants to Breastfeeding Guardian (BFG) services - including counseling, home visits and problem solving – led to improvements in breastfeeding (BF) practices in intervention communities. Methods BFGs comprise community influencers such as teachers, religious leaders, and community health workers. BFGs were engaged, trained and equipped by A&T to support pregnant women and lactating mothers with key messages at critical decision-making points about: ANC, breastfeeding management, early initiation of BF in the first hour of birth (6 contacts in 3rd trimester); and exclusive BF (EBF) including problem-solving (6 contacts in first six months). The intervention lasted 12 months and included counseling of pregnant women and home visit support for newly delivered mothers. Assessments of EI and EBF rates were conducted in 40 health facilities (HF) using Alive & Thrive routine project data comparing rates pre and post BFG deployment. Key Informant Interviews (KII) were also conducted with pregnant women in their 3rd trimester and post-delivery with the same cohort targeting women with infants 4–8 months. Results EI rates improved from 72% to 93% while EBF rates improved from 67% to 84% across the 40 health facilities. Findings from KIIs indicated that support mothers received through the BFGs, such as home visits, were perceived to be helpful in preparing women for breastfeeding exclusively and managing challenges associated with feeding newborns. Fifty-three of 60 mothers interviewed said they were able to exclusively breastfeed for 6 months, and their infants had no cause to visit the clinic for treatment of any illnesses. Conclusions Repeated contacts by BFGs to support pregnant women and breastfeeding mothers at the community level could be effective in improving breastfeeding practices. It can also serve as a viable way of bridging the skilled health attendant gap in underserved communities. It would be interesting to observe how beneficial the BFGs innovation would be on a larger scale and longer term. Funding Sources The Bill and Melinda Gates Foundation.