Lactation Management in Nepal, a Scalable Model for Increasing Early and Exclusive Breastfeeding

Presentation at the Global Maternal Newborn Health Conference, October 19, 2015

Background: Despite improvements in the last two decades in ANC and PNC, the rate of exclusive breastfeeding (EBF) in Nepal has declined since 1996 (from 74% to 70%). Other optimal breastfeeding behaviors, such as initiation within the first hour after birth, have improved, but remain suboptimal (41% in 2011 NDHS).

Methodology: The USAID-funded Suaahara project, provided skills-based training in lactation management to health workers and community-based health volunteers across 20 districts in Nepal. Training focused on the skills to support recently delivered mothers with positioning and attachment. A behavior change campaign also promoted early and exclusive breastfeeding. A survey of 238 mothers of children under two in 4 Suaahara and 4 matched comparison districts was conducted 23 months after implementation.

Results: The content of ANC in Suaahara districts, as reported by the women, was more likely to include counseling on early initiation (86% vs. 57%; p<0.001) and EBF (91% vs. 55%; p<0.001). Of those who received PNC, mothers in Suaahara districts were more likely to report having received assistance with positioning (66% vs. 29%; p<0.001) and attachment (60% vs. 22%; p<0.001). These mothers were more likely to know about initiating in the first hour (91% vs. 73%; p<0.05) and the correct definition of EBF (68% vs. 16%; p<0.001). They were also more likely to practice these behaviors. Almost all women in intervention areas reported feeding colostrum (94% vs. 75%; p<0.01) and EBF, defined as not having introduced water, other fluids, formula, porridge or soft and semi-solid foods, reached very high levels as well (68% vs. 16%; p<0.05).

Conclusion: Accelerating adoption of early and exclusive breastfeeding is feasible in very low resource settings. Focusing on skills, not just knowledge, to help newborns attach to the breast and support mothers to initiate early is key to longer term EBF success.