Academy for Educational Development

Exclusive Breastfeeding Shows Consistent Double-Digit Gains in Five Countries

Washington, D.C., June 2, 2006 — Washington, D.C., June 2, 2006 – An Academy for Educational Development project significantly improved child health in five countries, as measured by double-digit gains in key breastfeeding practices.

LINKAGES, a 10-year project to improve child health through breastfeeding and related complementary feeding and maternal dietary practices, led to improvements in two critical indicators: initiation of breastfeeding within one hour of delivery and exclusive breastfeeding for the first six months of life. LINKAGES is funded by the U.S. Agency for International Development.

Exclusive breastfeeding is the leading intervention to prevent malnutrition, which is an underlying cause of more than half of all child deaths in developing countries. It has the potential to reduce 13% of deaths among children under 5, or more than 1.3 million each year.

“USAID’s mandate for LINKAGES was to demonstrate that exclusive breastfeeding is an achievable goal and to improve breastfeeding practices in a large geographic area in five countries for public health impact,” said Margaret Burns Parlato, director of the AED Global Health, Population, and Nutrition Group. “These goals have been accomplished.”

Studies in five countries show consistent upward trends in breastfeeding as a result of comprehensive programs focusing on counseling with mothers, community education, training of health care providers and community health workers, and national policies.

In Madagascar, timely initiation rose from 32% in 2000 to 68% in 2005, while the rate of exclusive breastfeeding jumped from 42% to 70%. In Bolivia, breastfeeding initiation went from 56% in 2000 to 74% in 2003, and exclusive breastfeeding increased from 54% to 65%. In Zambia, initiation rose from 53% in 2000 to 70% in 2004, and exclusive breastfeeding increased from 57% to 74%. In Ghana and Jordan, the results were similar.

Over the past ten years, LINKAGES has worked in 30 countries worldwide.

“Belying the conventional wisdom, the LINKAGES project has shown that women will integrate new breastfeeding practices into their daily routines,” said Parlato. “While there are many factors in the success of this effort, one of the key things we learned is that actions need to be small and do-able. Improved breastfeeding practices are more likely to occur if a woman perceives them as beneficial, feasible, and socially acceptable.”

LINKAGES’ efforts to improve infant and young child feeding (IYCF) encompasses:

Areas of focus: breastfeeding, complementary feeding, maternal nutrition, lactational amenorrhea (contraceptive) method (LAM), HIV and infant feeding

Program components: multi-level partnerships, information and technical updates, training and skills development, community-based strategies, behavior change communication, policy analysis and advocacy, monitoring and evaluation

Large scale country projects: Bolivia, Ethiopia,* Ghana, Jordan, Madagascar, Zambia

Country coordinators and short-term project assistance: 24 countries

Policy guidelines: women’s nutrition (South Africa); HIV and infant feeding (Nigeria, Zambia); IYCF (Ethiopia, Nepal, Zambia); maternity protection (Zambia); Code of Marketing Breastmilk Substitutes (Ethiopia, Zambia); micronutrient protocols (Ethiopia, Madagascar); global guidelines on infant feeding in emergencies

Publications: Facts for Feeding series; Frequently Asked Questions series; Experience LINKAGES series on strategies, tools, and materials; World LINKAGES series on country results; technical reports; joint publications with WHO, UNICEF, PAHO, WABA, La Leche League, Wellstart, Helen Keller International, Emergency Nutrition Network, CORE Group; 25 peer-reviewed journal articles

Tools: national IYCF assessment tool; benefits of breastfeeding advocacy model; HIV and breastfeeding risk model; counseling cards and educational materials in nine countries; media spots in six countries; monitoring and evaluation instruments

Research studies: Impact of social marketing of a micronutrient dietary supplement to women of reproductive age (Bolivia); mother-to-mother support for breastfeeding (Guatemala), the “positive deviance approach” for improved IYCF (Vietnam); counseling on HIV and breastfeeding (Zimbabwe); and offering LAM as a modern contraceptive method (Jordan)

Cost-effectiveness studies: Ghana, Jordan, Madagascar, Zambia

For more information on LINKAGES and all country programs, visit www.linkagesproject.org.

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