Examining the Role of Health Facilities in Supporting Early Breastfeeding

Optimal breastfeeding is crucial for child growth, health, and development, and can prevent over 800,000 deaths of children under five each year. Health facilities provide essential pregnancy and maternal and newborn care services and support for early breastfeeding, making health systems interventions highly effective in promoting early initiation of breastfeeding. The study used data from the Demographic and Health Surveys (DHS) and Service Provision Assessment (SPA) surveys in Haiti and Malawi. The DHS provided data on women's early initiation of breastfeeding, while the SPA provided data on the health service environment (HSE) for breastfeeding. Three indicators of the HSE were created: the proportion of health facilities reporting routine counseling on breastfeeding in ANC services, the proportion of health workers providing ANC services who had recently received training in breastfeeding or Infant and Young Child Feeding (IYCF), and the proportion of ANC clients who were observed and who reported receiving counseling on breastfeeding during ANC. The study found that while almost all health facilities in Haiti and Malawi reported routine breastfeeding counseling during ANC, less than 3 in 10 (Haiti) and 4 in 10 (Malawi) ANC providers had recently received training in breastfeeding or IYCF, and only 4% to 10% of clients received counseling on breastfeeding during ANC. In Haiti, clients were significantly more likely to receive breastfeeding counseling if their provider had recently been trained in IYCF or any breastfeeding/IYCF topic. In urban areas of both Haiti and Malawi, having more providers recently trained on breastfeeding was associated with an increased likelihood of early initiation of breastfeeding. The results of this analysis suggest that provider training, which translates into greater counseling, can promote breastfeeding outcomes. In urban Malawi, women living in clusters with higher levels of breastfeeding counseling during ANC were more likely to initiate breastfeeding early than those in clusters with less counseling. The study highlights a substantial gap between facility reports of breastfeeding counseling, provider training in this area, and clients' actual receipt of this counseling. The findings of this study have significant implications for improving breastfeeding outcomes in Haiti and Malawi, and can inform strategies to strengthen the health service environment for breastfeeding.