Nutrition

Early Initiation of Breastfeeding

Mothers initiate breastfeeding within one hour after delivery

Initiation of breastfeeding within the first 1 hour of life can prevent up to 22% of newborn mortality.1Impact of early initiation of exclusive breastfeeding on newborn deaths
A&T Technical Brief
January 2010  This is a one-time behavior that requires a baby be immediately placed on a new mother’s chest after birth.

Key Points from Global Research

  • Addressing cultural as well as institutional practices that separate mother and infant after birth can encourage early initiation of breastfeeding and foster the practice of exclusive and continued breastfeeding.
  • Helping mothers and families understand the importance of immediate suckling, even without milk, can facilitate exclusive breastfeeding.

Behavior Profile Sample: Early Initiation of Breastfeeding

A Behavior Profile is a summary analysis of each behavior. This sample draws from global evidence and illustrates the result of using the Create Behavior Profiles Tool to analyze factors, supporting actors and strategies and to ensure logical pathways exist between strategies proposed and factors related to the practice of the behavior. This sample may be used as a starting point or reference for creating Behavior Profiles. 

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Improve maternal and child survival
Mothers initiate breastfeeding within one hour after delivery
Indicator: Among last-born children born in the two years preceding the survey the percentage who started breastfeeding within 1 hour of birth

Behavior Analysis

Strategy

STEPS

What steps are needed to practice this behavior?
  1. Request and allow newborn to be placed on chest and breast immediately (within first hour) after birth
  2. Allow newborn to suckle immediately even if milk does not appear to be presenting
  3. Refrain from offering pre-lacteal feeding

Click on any box
        to see the pathwaysA pathway illustrates how elements in the Behavior Profile are linked. When read from right to left, a pathway highlights how strategies are expected to address the factors to enable adoption of the Accelerator Behavior.  
        of the behavior.

FACTORS

What factors may prevent or support practice of this behavior? These should be analyzed for each country context.
Structural
Accessibility: Mothers do not initiate breastfeeding immediately after birth because of a lack of enforcement or existence of policies banning distribution of breast milk substitutes (BMS) in health facilities
Accessibility: Mothers use breast milk substitutes to feed the newborn immediately after birth instead of breastmilk because the environment is crowded with the promotion and presence of these substitutes
Service Provider Competencies: Mothers do not initiate breastfeeding immediately after birth because providers lack skills required to counsel on the importance of or techniques for early initiation from providers
Service Provider Competencies: Mothers do not initiate breastfeeding immediately after birth because the newborns are taken to be cleaned or wrapped and are often kept apart
Social
Family and Community Support: Mothers do not initiate breastfeeding immediately after birth because family members do not support it, especially if the baby is born at home
Norms: Mothers refrain from pre-lacteal feeding because babies are often immediately given other fluid, food, or substance based on cultural practices
Internal
Attitudes and Beliefs: Mothers do not initiate breastfeeding immediately after birth because many mothers do not understand the benefit of early breastfeeding and colostrum
Self-Efficacy: Mothers do not breastfeed immediately after birth because they feel they might not have enough or any milk

SUPPORTING ACTORS AND ACTIONS

Who must support the practice of this behavior?
Institutional
Policymakers: Pass and enforce the international code preventing marketing of the Breast Milk Substitutes (BMS)
Policymakers: Institutionalize baby-friendly hospital initiatives within the health system
Providers: Counsel on early initiation of breastfeeding during antenatal care visits
Providers: Support the need to keep mother and baby together immediately after birth
Providers: Train mothers on techniques of early initiation and the need to avoid any other prelacteal feeding
Household
Family Members: Support and assist with early initiation

POSSIBLE PROGRAM STRATEGIES

How might we focus our efforts based on this analysis?
Enabling Environment
Policies and Governance: Create structured policy frameworks (e.g. Baby Friendly Hospitals) that keep mother and baby together
Policies and Governance: Enact regulations to ensure adherence to BMS Code
Systems, Products and Services
Quality Improvement: Ensure health facilities have a provider trained in lactation
Demand and Use
Communication: Add early initiation to the full range of counseling materials used during antenatal care visits and pregnancy support groups and organize community dialogues and home visits before pregnancy to discuss and prepare with family members
Skills Building: Work with traditional birth attendants on the importance of supporting women with immediate breastfeeding
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Global Status of Accelerator Behavior

Indicator: Among last-born children born in the two years preceding the survey the percentage who started breastfeeding within 1 hour of birth

The DHS Program Indicator Data API, The Demographic and Health Surveys (DHS) Program