A multipronged approach to supporting healthy breastfeeding among new mothers was effective when implemented at the population level, according to research published in PLOS Medicine. In cluster-randomized evaluations of two programs in Viet Nam and Bangladesh, Purnima Menon of the International Food Policy Research Institute in Washington, DC, and colleagues compared the effect of a program combining intensive interpersonal counseling (IPC), mass media (MM), and community mobilization (CM) to encourage breastfeeding (intensive group) to that of standard nutrition counseling and less intensive MM and CM (non-intensive group). In Bangladesh IPC was delivered through a large non-governmental health program, while in Viet Nam it was integrated into government health facilities.
The researchers compared surveyed breastfeeding practices in households with children less than 6 months old before the interventions started and again four years later. They found positive population-level impacts on breastfeeding practices, including higher rates of early initiation of breastfeeding and exclusive breastfeeding, and lower use of prelacteal feeding and bottle feeding, in areas that received the intensive package compared to areas that received the non-intensive program. In Bangladesh, the percentage of mothers reporting exclusive breastfeeding rose from 48.5% to 87.6% in areas receiving the intensive program, and in Viet Nam the EBF prevalence rose from 18.9% to 57.8%. This is compared to much smaller changes in the areas with the non-intensive program (51.2% to 53.5% in Bangladesh and 17.8% to 28.4% in Viet Nam).
The authors note that the findings are reliant on self-reporting of the mothers, who may have felt pressure to report "desirable" behavior, and the surveys only asked the mothers to report their behavior from the previous day, and thus would not capture day-to-day fluctuations in breastfeeding practices. However, they note that this study "shows that comprehensive behavior change strategies implemented at scale, under real-life conditions, and delivered through outreach-based (Bangladesh) and facility-based (Viet Nam) platforms have strong and significant impacts on breastfeeding practices."
Funding for this evaluation and the implementation of the interventions was provided by the Bill & Melinda Gates Foundation, through Alive & Thrive, managed by FHI360; additional financial support to the evaluation study was provided by the CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), led by the International Food Policy Research Institute (IFPRI). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
JB, TS, NH, SA, KA and RH are part of the implementation team who delivered the interventions described in this paper. They helped conceive and design the study, but played no role in research data collection or data analysis. Their contributions to this manuscript included written inputs to sections on intervention design, critical in-person discussions regarding interpretation of results, and written review of manuscript drafts. Final decisions about results to include, interpretation and conclusions rested with authors from the evaluation team (PM, RR, EAF, MR, PN, KKS, AKh, AKn, LTM).
Menon P, Nguyen PH, Saha KK, Khaled A, Kennedy A, Tran LM, et al. (2016) Impacts on Breastfeeding Practices of At-Scale Strategies That Combine Intensive Interpersonal Counseling, Mass Media, and Community Mobilization: Results of Cluster-Randomized Program Evaluations in Bangladesh and Viet Nam. PLoS Med 13(10): e1002159. doi:10.1371/journal.pmed.1002159
Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, United States of America
Alive & Thrive, FHI360, Washington, District of Columbia, United States of America
Save the Children, Washington, District of Columbia, United States of America
BRAC, Dhaka, Bangladesh
University of South Carolina, Columbia, South Carolina, United States of America
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