Community level factors enabling breast feeding in

South Africa

Presented at the National Breastfeeding Consultative Meeting

22-23 August 2011by Lynn Moeng

Contextual factors

Individual Level- Personal factors Household Level- family influences and

perceptions Community Level- attitudes and support Cultural practices and taboos Knowledge related aspects

Presentation outline

Individual level

Household level

Community level

Macro environment level

Contextual factors that influence breastfeeding promotion in South Africa

Generally, women and caregivers believe that breastfeeding is the best way to feed babies and many do choose breastfeeding as the first feeding option

The questions is why are breastfeeding practices so poor?

Perceptions of caregivers and women about breastfeeding

Not enough milk - Preventable Breast problems - Preventable Baby or Mother too ill - Can be managed Baby crying often Child refuses to breastfeed – many

preventable reasons for this. Fear of HIV transmitting through

breastfeeding Young women believe it is difficult and

painful Going back to work/school - Mothers believe

that children should be introduced to other milks and foods before 6 months, in preparation for separation.

INDIVIDUAL FACTORS

Mother ill/weak

Nipple/breast problem

Child refused breast

Mother working

Chose to formula feed

0 5 10 15 20 25 30

Reason for stopping breastfeeding

Percentages

The need to identify sources of information

Health worker

CHW

Mother

Grand mother

Friend

0 10 20 30 40 50 60 70

Where can one go for support on breastfeeding

Percentages

Family history and traditions- how other children were fed. Storing expressed milk at home is a taboo in our culture. Men not given an opportunity to make decisions on infant

feeding. The best they can contribute is purchasing formula. Influence from grannies The pressure for young girls who have just delivered babies

to go back to school immediately. – the effect of this on the health and survival of these children needs to be investigated.

Preparation for a newborn often includes formula, bottle,teat and self medication eg. Druppels, gripewater and many others.

Family and Household related factors

Link between community structures and the health facility is weak.

Knowledge and skills of community health workers.

Availability and sustainability of support groups

Acceptability of mixed feeding- regarded as the norm.

There are conflicts between cultural norms and information provided by health workers.

Limited utilization of NGO’s to support infant feeding.

Community related factors

Health worker

CHW

Radio

TV

Mother

Grand mother

Friend

Support group

0 10 20 30 40 50 60 70 80 90 100

Where can one go for information on breastfeed-ing

Percentages

Where should women breastfeed- in some environments, restrooms are designated as breastfeeding places- breastfeeding is feeding.

Public places are not breastfeeding friendly

Households are not breastfeeding friendly

Attitudes of the public

Strengthen referral systems from PHC to existing community structures.

Follow-up support just after discharge ( within three days).

How are the postnatal visits used to support breastfeeding.

Role of PHC services

Breastfeeding management challenges◦ Supply and demand◦ Positioning and attachment◦ Assisting mothers with problems such as flat

nipples Growth spurts ( critical points when frequency of

breastfeeding should be increased. Rates of HIV transmission not well understood Feasibility of exclusive breastfeeding for six months Effects of the use of self medication on

breastfeeding including drupples that pored in bath water.

Knowledge: Critical points

Tested strategies that can improve breastfeeding

practices

Partner involvement

Promoting the culture of cup VS bottle feeding

Strategies that can be employed

Improving the knowledge of health workers

Assist mothers to position

Ensuring them that is important to breastfeed twins.

Supporting a mother to

Step 10: Effect of trained peer counsellors on the duration of exclusive breastfeeding

70%

6%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Project Area Control

Per

cent

age

Exclusivelybreastfeeding 5month old infants

Adapted from: Haider R, Kabir I, Huttly S, Ashworth A. Training peer counselors to promote and support exclusive breastfeeding in Bangladesh. J Hum Lact, 2002;18(1):7-12.

Slide 4.10.5

Slide 4.2.5

12.7

58.7

6

56.8

72 75

0

20

40

60

80

100

Brazil '98 Sri Lanka '99 Bangladesh '96

Exc

lusi

ve b

reas

tfee

din

g (%

)

Control

Counselled

Step 2: Breastfeeding counselling increases exclusive breastfeeding

All differences between intervention and control groups are significant at p<0.001.From: CAH/WHO based on studies by Albernaz, Jayathilaka and Haider.

Age:

(Albernaz) (Jayathilaka) (Haider)

2 weeks after diarrhoea treatment

4 months3 months

Exclusive breastfeeding for 6 months is possible if we have health care workers who support mothers

45% 72.5%

66.7%

81.90%

0

20

40

60

80

100

6 weeks 3 mths 5 mths 6 mthsAge

% e

xclu

sive

ly b

reas

tfee

ding

Median duration of exclusive

breastfeeding = 159 days

Coovadia et al., Lancet 2007

Home visits improve exclusive breastfeeding

80%

67%62%

50%

24%

12%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

2 weeks 3 months

Infant's age

Exc

lusi

ve

reas

tfee

din

g

(%)

Six-visit group

Three-visit group

Control group

From: Morrow A, Guerrereo ML, Shultis J, et al. Efficacy of home-based peer counselling to promote exclusive breastfeeding: a randomised controlled trial. Lancet, 1999, 353:1226-31

Slide 4.10.6

Capacity building of CHW Improve prenatal and post natal education Involvement of all role players in promoting

Breastfeeding Investment in marketing Social mobilisation of community Creating conducive environments for

mothers to breastfeed

What needs to be done

Thank you