Nutrition

Exclusive Breastfeeding

Mothers breastfeed exclusively for six months after birth

Optimal breastfeeding of infants under two years of age has the potential to prevent over 800,000 deaths, 13% of all deaths in children under five in the developing world.1Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect
The Lancet, Volume 387, Issue 10017, 475 490
Victora, Cesar G et al. This is a home-based, daily behavior that needs to be practiced on demand, 8-12 times through the day and night.

Key Points from Global Research

  • A supportive family and a positive social environment are critical to initiating and continuing exclusive breastfeeding for the full 6 months.
  • A woman's success with exclusive breastfeeding can be determined by her belief that she is capable of fulfilling her child's needs by breastfeeding only and her knowledge of or ability to get assistance with important breastfeeding skills to avoid problems.

Behavior Profile Sample: Exclusive 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. 

Create Behavior Profiles

Improve maternal and child survival
Mothers breastfeed exclusively for six months after birth
Indicator: Percentage of youngest children under two years of age living with the mother who are exclusively breastfed from age 0-5 months

Behavior Analysis

Strategy

STEPS

What steps are needed to practice this behavior?
  1. Decide to exclusively breastfeed
  2. Plan with family members and other supporting actors for ways to work through breastfeeding concerns and challenges (i.e. feed the baby breastmilk if away from the baby)
  3. Do not give any other substance before initiating breastfeeding wthin the first hour
  4. Make sure baby attaches properly to the breast
  5. Feed only breastmilk day and night when baby is hungry or when it is time (8-12 times per 24 hour period)
  6. Do not give or allow others to give baby water other liquids, substances, or foods
  7. Allow time to feed, feeding until the first breast offered feels soft, and then offering the second breast
  8. Seek care for breast or breastfeeding problems

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: Women often have to return to school or work before the baby is 6 months old, leaving the baby during the day usually without breast milk
Accessibility: Environment is crowded with promotion and presence of breast milk substitutes
Accessibility:  Women lack access to assistance on the proper techniques to breastfeed or how to resolve problems when they occur
Social
Family and Community Support: Family members do not support exclusive breastfeeding due to time, value, worry of illness or appropriateness
Norms: Completely exclusive breastfeeding until 6 months is not always common
Internal
Attitudes and Beliefs: Most women believe that breastfeeding is good for their children
Self-Efficacy: Women are not confident that they have sufficient milk supply or quality

SUPPORTING ACTORS AND ACTIONS

Who must support the practice of this behavior?
Institutional
Policymakers: Enact and enforce Baby-Friendly standards in hospitals, maternity homes, and health centers
Policymakers: Update maternity leave policies
Policymakers: Pass and enforce the Code to the Marketing of Breast Milk Substitutes (BMS)
Providers: Counsel mothers on ease and benefits of exclusive breastfeeding first, then on how to succeed at exclusive breastfeeding (breastfeeding techniques)
Employers: Offer breastfeeding areas or pumping breaks at work, if it is feasible for women to bring their infants to work
Household
Family Members: Especially fathers and grandmothers, encourage and support mothers to exclusively breastfeed (do not offer the infant water or foods, help with chores as needed and ensure a nutritious diet for the mother)

POSSIBLE PROGRAM STRATEGIES

How might we focus our efforts based on this analysis?
Enabling Environment
Partnerships and Networks: Make alliances with pediatric associations, social welfare, and environmental groups to promote exclusive breastfeeding
Policies and Governance: Create structured policy framework supportive of exclusive breastfeeding Baby-Friendly hospitals, maternity leave regulations, and the enactment and enforcement of the BMS Code
Systems, Products and Services
Quality Improvement: Train clinic or community-based providers in lactation management
Demand and Use
Communication: As part of new mother support groups, offer proactive tips for successful breastfeeding and discuss importance of exclusivity until age 6 months, similar to the La Leche League in the US
Collective Engagement: Identify ways to engage men and extended family members in supporting women to exclusively breastfeed
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Global Status of Accelerator Behavior

Indicator: Percentage of youngest children under two years of age living with the mother who are exclusively breastfed from age 0-5 months

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