Breastfeeding can significantly improve a baby's chance of survival. But hospital-based breastfeeding promotion has limited impact in Bangladesh, where 95 percent of mothers give birth at home. How can mothers be advised and supported effectively in exclusive breastfeeding during the first five months after birth?

Researchers from the International Centre for Diarrhoeal Disease Research, Bangladesh, and the London School of Hygiene and Tropical Medicine designed and implemented an alternative strategy using home-based peer counselling in Dhaka, Bangladesh. Will this approach increase breastfeeding rates?

The researchers randomly allocated 726 new mothers into either the 'intervention' or 'control' group. Peer counsellors made up to 15 visits to each woman in the intervention group, twice before the birth, then continuing until the baby reached five months old. Peer counsellors were local mothers who had at least four years of schooling. They received two weeks of training and a small payment. During their visits, the counsellors answered the mothers' questions. They offered advice on the position of the baby during feeds and on nutrition and rest for the mothers. They encouraged exclusive breastfeeding, often countering family pressure to introduce early supplementary feeding.

Analysis of the project showed that:

• Peer counselling significantly improves breastfeeding practices: 70 percent of mothers in the intervention group were exclusively breastfeeding at five months, compared to six percent in the control group.
• Visits before and soon after childbirth are the most useful for mothers.
• Mothers who receive peer counselling initiate breastfeeding earlier than those who do not.

The researchers offer the following recommendations for health policy in relation to breastfeeding promotion:

• Peer counselling is highly effective and should be incorporated into mother and child health programmes in developing countries.
• Where resources are limited, group counselling could be considered from two months after the birth.
• Peer counsellors must be selected with great care to ensure that they have credibility and will gain the respect of the mothers they visit.

Source(s):
'Effect of community-based peer counsellors on exclusive breastfeeding practices in Dhaka, Bangladesh: a randomised controlled trial' by R. Haider, A. Ashworth, I. Kabir and S. Huttly, The Lancet 356 (2000)

Funded by: Swiss Agency for Development and Cooperation

id21 Research Highlight: 1 June 2001

Further Information:
Rukhsana Haider
Urban Family Health Partnership and John Snow Inc
Level 2 Progress Tower
Road 23, Gulshan
Dhaka 1212
Bangladesh

Contact the contributor: rhaider@ufhp.bdmail.net

John Snow International

Ann Ashworth
London School of Hygiene and Tropical Medicine
Keppel Street
London WC1E 7HT
UK

Tel: +44 (0)20 7299 4700
Fax: +44 (0)20 7299 4666
Contact the contributor: ann.hill@lshtm.ac.uk

Sharon Huttly
London School of Hygiene and Tropical Medicine
Keppel Street
London WC1E 7HT
UK

Tel: +44 (0)20 7299 4674
Fax: +44 (0)20 7299 466325
Contact the contributor: sharon.huttly@lshtm.ac.uk

Other related links:
Linkages Project works worldwide to support breastfeeding.

UNICEF also has programmes focusing on breastfeeding.