Mainstreaming nutrition into maternal and child health programmes: scaling up of exclusive breastfeeding
Nita Bhandari1, A K M Iqbal Kabir, Mohammed Abdus Salam
1Society for Applied Studies, New Delhi, India. community.research@cih.uib.no
Insights
Promoting exclusive breastfeeding is crucial for preventing under-5 deaths. Successful scale-up requires evidence-based policies, strong advocacy, community engagement, and sustained national leadership.
Area of Science:
- Public Health
- Maternal and Child Health
- Global Health
Background:
- Exclusive breastfeeding is the most critical intervention to prevent under-5 mortality in developing nations, potentially averting 13% of deaths.
- Current global exclusive breastfeeding rates for infants under 4 months are low, with only 39% adherence according to WHO and UNICEF.
- Scaling up exclusive breastfeeding programs faces significant challenges within existing Maternal and Child Health frameworks.
Purpose of the Study:
- To review and analyze global program efforts aimed at scaling up exclusive breastfeeding.
- To identify key lessons, opportunities, and challenges associated with successful exclusive breastfeeding scale-up.
- To provide insights for optimizing exclusive breastfeeding interventions within Maternal and Child Health programs.
Main Methods:
- Systematic review of program efforts to scale up exclusive breastfeeding across various countries.
- Identification and analysis of critical success factors and implementation strategies.
- Examination of policy, advocacy, financial, and community-level engagement factors.
Main Results:
- Successful scale-up hinges on evidence-based policies, strong advocacy, enabling legislation, and community-level delivery.
- Key enablers include political will, sustained funding, clear stakeholder roles, and effective antenatal, birth, and postnatal care integration.
- Formative research, robust communication strategies, quality training, and adaptive monitoring and evaluation systems are vital for high coverage.
Conclusions:
- Achieving high exclusive breastfeeding rates requires a comprehensive strategy encompassing policy, community mobilization, and sustained national leadership.
- Legal frameworks supporting mothers to exclusively breastfeed for at least 4 months are essential.
- Continuous program adaptation, innovation, and strong leadership are critical for sustainable, high-coverage exclusive breastfeeding initiatives.
Abstract:
Interventions to promote exclusive breastfeeding have been estimated to have the potential to prevent 13% of all under-5 deaths in developing countries and are the single most important preventive intervention against child mortality. According to World Health Organization and United Nations Children Funds (UNICEF), only 39% infants are exclusively breastfed for less than 4 months. This review examines programme efforts to scale up exclusive breastfeeding in different countries and draws lesson for successful scale-up. Opportunities and challenges in scaling up of exclusive breastfeeding into Maternal and Child Health programmes are identified. The key processes required for exclusive breastfeeding scale-up are: (1) an evidence-based policy and science-driven technical guidelines; and (2) an implementation strategy and plan for achieving high exclusive breastfeeding rates in all strata of society, on a sustainable basis. Factors related to success include political will, strong advocacy, enabling policies, well-defined short- and long-term programme strategy, sustained financial support, clear definition of roles of multiple stakeholders and emphasis on delivery at the community level. Effective use of antenatal, birth and post-natal contacts at homes and through community mobilization efforts is emphasized. Formative research to ensure appropriate intervention design and delivery is critical particularly in areas with high HIV prevalence. Strong communication strategy and support, quality trainers and training contributed significantly to programme success. Monitoring and evaluation with feedback systems that allow for periodic programme corrections and continued innovation are central to very high coverage. Legal framework must make it possible for mothers to exclusively breastfeed for at least 4 months. Sustained programme efforts are critical to achieve high coverage and this requires strong national- and state-level leadership.
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