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URC Recognizes World Breastfeeding Week
URC is pleased to recognize World Breastfeeding Week, held globally in the first week of August to promote the importance of breastfeeding for infant nutrition and health. The theme this year is "Breastfeeding Support: Close to Mothers." The World Health Organization (WHO) notes that good nutrition, which starts with breastfeeding, "is essential for survival, physical growth, mental development, performance, productivity, health and well-being." WHO adds that if every child were breastfed within an hour of birth, given only breast milk for the first six months of life, and continued breastfeeding up to the age of 2, about 220,000 would be saved annually.
Globally, less than 40% of infants under 6 months are exclusively breastfed (meaning infants receive only breast milk and are not given other liquids or solids). The global health organization recommends breastfeeding counseling and support for mothers and families to help them practice breastfeeding well. The following summarizes URC's work to ensure that WHO recommendations are embraced by both health care systems and families and that mothers are supported in their efforts to breastfeed.
Guatemala: Examining Barriers to Exclusive Breastfeeding
URC's Nutri-Salud Project, in Guatemala's highlands, is adapting its model for primary-level care (including community care) and working with a second URC project, Translating Research into Action (TRAction), to ensure that "baby and breastfeeding friendly" is part of the package of essential maternal and newborn care at all levels of service, from health centers to high-level hospitals. Nutri-Salud works in five "departments" (administrative areas) whose average rate of exclusive breastfeeding has been reported at only slightly over 50%. The project undertook a study to uncover the barriers to exclusive breastfeeding. It found, for instance, that mothers-in-law and traditional birth attendants were recommending to new mothers that they also give babies tea or sugar water to supplement breastfeeding and provide more nutrition. The study also found that few mothers understood the terms "exclusive breastfeeding" and "malnutrition," rendering messages with those terms ineffective. Such findings enable URC staff to craft behavior change messages that will resonate with new mothers.
Tanzania: Quality Improvement Teams Drive Impressive Outcomes
In Tanzania, the USAID Applying Science to Strengthen and Improve Systems (ASSIST) project is providing technical support to the Ministry of Health and Social Welfare and the Partnership for HIV Free Survival to eliminate mother-to-child transmission of HIV (MTCT) by strengthening postnatal nutrition programs. Working in 10 sites in the Iringa region, reproductive and child health facility-based quality improvement teams are implementing changes to increase exclusive breastfeeding among HIV-positive mothers with infants aged 0 to 6 months. Changes implemented from January 2010 to May 2013 included holding group and individual talks with expectant and new mothers on the importance of exclusive breastfeeding to prevent HIV transmission and talking to mothers individually before their discharge from the labor ward. These efforts contributed to a near doubling in the percentage of mothers who reported exclusive breastfeeding: from 41% to 78%.
This graph documents the data collected by health care providers and quality improvement teams from January 2010 to May 2013.
Iraq: Developing Evidence-based Guidelines and Promotional Materials on Breastfeeding
The USAID Primary Health Care Project in Iraq supports Iraqi Ministry of Health (MoH) efforts to improve maternal and child health outcomes and develop supportive services for mothers and children. The project worked with the MoH to develop evidence-based clinical care guidelines on antenatal care, nutrition for mothers and children, integrated management of child illnesses, and emergency obstetric and neonatal care. The last includes a focus on counseling and education for breastfeeding. The project trained health providers from 360 primary health care clinics countrywide about these guidelines and developed health education materials on breastfeeding for mothers and families. In coordination with community leaders, the project also spreads messages on breastfeeding through behavior change communication and community outreach activities.
Cambodia: A Multi-pronged Approach
The Better Health Services project (BHS) stresses both public education and provider training in its efforts to ensure that all babies and young children in Cambodia are optimally breastfed with three key practices: 1) initiation of breastfeeding within the first hour post-delivery, 2) exclusive breastfeeding for the first 6 months, and 3) continued breastfeeding until at least 2. The first two of these have improved greatly in Cambodia in the last 10 years, but the third has declined. BHS worked with a steering committee and the National Nutrition Program to develop and broadcast a series of radio and TV spots to encourage breastfeeding until at least age 2. Aired on three television channels and three radio channels last year, the series achieved nationwide coverage. UNICEF and the Ministry of Health continue the spots' airing.
The project supports providers in many areas of their capacity development to ensure those key practices. To inform system leaders and planners of the quality of maternal/ newborn care in the public health system, the project annually examines care in 31 hospitals. The examination includes systematically observing delivery room practices, where support for breastfeeding initiation and exclusive breastfeeding begin. Survey results are fed back to the leaders/ planners, building their support for high-quality care for mothers and newborns. In addition, quarterly midwifery meetings include a half-day of team-based learning sessions, one of which focuses on optimal breastfeeding behaviors and breastfeeding support. The effort now reaches all health center midwives in about 10 operational districts; participants receive a locally produced, project-developed DVD. Other trainings include a 25-minute film, also developed by the project, on safe delivery that also covers how to provide breastfeeding support.
Other efforts include clinical skills practices for about 350 hospital midwives and doctors; the sessions emphasize initiation of breastfeeding immediately after delivery and exclusive breastfeeding in maternity wards. Trainings and coaching are also held at health centers, reaching more rural providers, both midwives and nurses, and including support for all three key practices. Working with the leadership of the National Pediatric Hospital and the Ministry's National Nutrition Program, BHS supported the development of Cambodia's first clinical practice guidelines on the treatment of severe acute malnutrition; the guidelines have a strong breastfeeding support component. The project also helped develop and distribute a curriculum, job aids, training, and coaching to introduce the guidelines.
*URC staff contributors: Nancy Newton, Senior Advisor, Behavior Change & Communication; Katherine Fatta, QI Specialist for Knowledge Management and Communication; Hala Jassim AlMossawi, Senior Associate, Project Support Team; and the Better Health Services Team: Jerker Liljestrand, Program Leader, Maternal and Newborn Health and Family Planning; Katherine Krasovec, Technical Advisor for Nutrition, Child Health, and Safe Motherhood; and Savy Bou, BCC Team Leader, BHS.