Barriers and Facilitators to Facility-Based Feeding Support for Small and Sick Newborns in Ethiopia: A Qualitative Study of Clinicians’ Perspectives

Abstract

Breastfeeding is recognized as the optimal form of infant nutrition. The World Health Organization recommends initiation of breastfeeding within the first hour after birth and exclusive breastfeeding (EBF) for the first six months. However, facility based breastfeeding practices, especially for small and sick newborns (SSN), face numerous challenges. The Saving Little Lives (SLL) program in Ethiopia seeks to improve SSN survival by promoting comprehensive neonatal healthcare practices, including appropriate feeding. Despite these efforts, limited data exist on clinicians experiences and perspectives regarding SSN feeding support in healthcare facilities. This qualitative study explored the neonatal feeding experiences of clinicians in selected SLL facilities in the Amhara region, Ethiopia. Semi structured interviews revealed multilevel barriers influencing facility based SSN feeding practices. These barriers were categorized as: (1) facility factors including insufficient clinician training, staff shortages, and inadequate feeding tools; (2) neonatal/maternal factors such as health complications in newborns and mothers and maternal concerns about insufficient milk production; and (3) sociocultural factors including traditional practices like uvulectomy and prelacteal feeding. A key facilitator identified was the role of predominantly female clinicians with personal breastfeeding experience, which positively influenced feeding support efforts. The findings suggest that many barriers are modifiable through targeted interventions, including enhanced clinician training, integration of infant feeding counseling into prenatal and postnatal care, and improved access to feeding tools in healthcare facilities. These insights offer critical guidance for developing evidence based strategies to strengthen facility-based SSN feeding support, contributing to improved neonatal health outcomes in low resource settings.