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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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Health Goal	Improve maternal and child survival
Accelerator Behavior	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? Request and allow newborn to be placed on chest and breast immediately (within first hour) after birth Allow newborn to suckle immediately even if milk does not appear to be presenting 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: Institutionalize baby-friendly hospital initiatives within the health system Policymakers: Pass and enforce the international code preventing marketing of the Breast Milk Substitutes (BMS) Providers: Train mothers on techniques of early initiation and the need to avoid any other prelacteal feeding Providers: Support the need to keep mother and baby together immediately after birth Providers: Counsel on early initiation of breastfeeding during antenatal care visits 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

Behavior Analysis

Strategy

STEPS

What steps are needed to practice this behavior?

Request and allow newborn to be placed on chest and breast immediately (within first hour) after birth
Allow newborn to suckle immediately even if milk does not appear to be presenting
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: Institutionalize baby-friendly hospital initiatives within the health system

Policymakers: Pass and enforce the international code preventing marketing of the Breast Milk Substitutes (BMS)

Providers: Train mothers on techniques of early initiation and the need to avoid any other prelacteal feeding

Providers: Support the need to keep mother and baby together immediately after birth

Providers: Counsel on early initiation of breastfeeding during antenatal care visits

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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Early Initiation of Breastfeeding

Key Points from Global Research