A program in Dhaka, Bangladesh, in which pregnant and postpartum women receive home visits from specially trained peer breastfeeding counselors has been highly effective in encouraging women to feed their infants only breast milk for the first five months, in accordance with national health policy recommendations.1In a case-control study assessing the program's effectiveness, counseled women began breastfeeding sooner than similar women who did not receive counseling, and a higher proportion of them exclusively breastfed throughout the first five months of their infant's life. At five months, 70% of counseled women, compared with 6% of controls, were feeding their infants only breast milk.
The peer counseling intervention was designed to promote breastfeeding among women who give birth at home and thus may not otherwise receive correct information about breastfeeding. Counselors were local women with at least four years of schooling who had breastfed their own children. Once trained, they made a total of 15 visits to each woman in the program: two in the last trimester of pregnancy, three during the first two weeks postpartum and then one every two weeks until the infant was five months old. During the prenatal visits, counselors explained the benefits of exclusive breastfeeding, encouraged women to hold their infants soon after delivery and to begin breastfeeding within an hour, and advised women about their own dietary needs. In subsequent visits, they addressed any problems the women were having with breastfeeding and continued to encourage exclusive breastfeeding.
Study participants were identified through a house-to-house survey conducted in 1996. Women were eligible if they were 16-35 years old, were in their last trimester of pregnancy, and had no more than three living children or had had no more than five births. In all, 726 women enrolled; half were assigned to receive the intervention, and the other half were designated as controls. Participants completed seven semistructured interviews exploring their breastfeeding status; additional interviews and focus groups were conducted with women in the counseling group to assess their views of the program.
Most women in both the counseling and the control groups were housewives, had had five or fewer years of schooling and had given birth before; on average, they were about 23 years old. Roughly four in 10 had received no prenatal care, and about two in 10 had made only one prenatal visit. While familiarity with breastfeeding was common, few women knew what "exclusive breastfeeding" means. All of the women intended to nurse.
Women in the counseling group held their infants sooner after delivering than did controls (one hour vs. two hours); they also began to breastfeed sooner (one hour vs. nine hours) and were more likely to start nursing in the first hour (64% vs. 15%). Only 31% of mothers who had received counseling gave their infants any food or fluids before feeding them colostrum (a breast secretion with high concentrations of proteins and antibodies that is produced shortly after childbirth), compared with 89% of controls. During the first four days after giving birth, a significantly higher proportion of women in the counseling group than of controls fed their infants only breast milk (56% vs. 3%); on the fourth day, a significantly higher proportion were exclusively breastfeeding (84% vs. 30%).
The proportion of women exclusively breastfeeding in each of the first five months after delivery was considerably higher among those who had received counseling than among controls; at the end of five months, 70% and 6%, respectively, were giving their infants only breast milk. Half of babies whose mothers received counseling were exclusively breastfed throughout their first five months.
During their final interview, 95% of women from the counseling group said that they had found the peer counselors' visits beneficial. While they considered the visits soon after delivery (which provided necessary practical help) the most useful, they stressed that all of the visits were important. The mothers valued not only the information they received from the counselors but also the encouragement and support.
Discussing their findings, the investigators note that although the study was conducted in an urban area with relatively good hospital and maternity services, 78% of women delivered at home. Therefore, they conclude that the program's demonstrated effectiveness in promoting breastfeeding "confirms the need for community-based breastfeeding promotion strategies in Bangladesh."--D. Hollander
1. Haider R et al., Effect of community-based peer counsellors on exclusive breastfeeding practices in Dhaka, Bangladesh: a randomised controlled trial, Lancet, 2000, 356(9242):1643-1647.