Effectiveness of programmes and interventions to support optimal breastfeeding among children 0–23 months, South Asia: A scoping review

Abstract

Most children in South Asia are breastfed at some point in their lives; however, many are not breastfed optimally, including the early initiation of breastfeeding (EIBF) within 1 hr of birth, avoidance of prelacteal feeds (APF), exclusive breastfeeding (EBF) for 6 months, and continued breastfeeding (CBF) up to 2 years of age or beyond. This review identifies and collates evidence on the effectiveness of interventions to support optimal breastfeeding in five countries in South Asia: Afghanistan, Bangladesh, India, Nepal, and Pakistan. A scoping review was conducted of peer‐reviewed and grey literature. The 31 eligible studies included randomized trials and quasi‐experimental designs that were conducted between 1990 and 2015. Data were collated regarding intervention design, characteristics, and effectiveness to support EIBF, APF, EBF, and CBF. Most studies reported a positive impact on breastfeeding outcomes, including 21/25 studies that examined EIBF, 15/19 studies that examined EBF, and 10/10 studies that examined APF. The only study that examined CBF reported no effect. Education, counselling, and maternal, newborn, and child health initiatives were common intervention types with positive effects on breastfeeding outcomes. Interventions were delivered in health facility, community, and home/family environments. Programmes and interventions that reached women and their families with repeated exposure and beginning during pregnancy were more likely to improve EIBF and EBF outcomes. Interventions with no impact on breastfeeding were characterized by short duration, irregular frequency, inappropriate timing, poor coverage, and targeting.

Trends and predictors of optimal breastfeeding among children 0–23 months, South Asia: Analysis of national survey data

“…Our findings indicate that interventions should be based on a local understanding of social–cultural barriers, including potentially harmful traditional practices and the low autonomy of women. Interventions delivered by health workers and community‐based workers to inform, educate, and counsel on breastfeeding in the home/family, community, and health facility environments all demonstrate effectiveness, highlighting the impact of multiple supportive environments (Benedict, Craig, Torlesse, & Stoltzfus, ). A breastfeeding supportive environment should include not only the immediate family and health system but also the broader community.…”

Aiming higher for maternal and child nutrition in South Asia

“…An understanding of what predicts suboptimal feeding and what works to improve breastfeeding practices can help to better target advocacy, policy, programme, and research efforts in the region. Two papers by Benedict et al () and Benedict, Craig, Torlesse, and Stoltzfus () examine these issues. Multivariate analysis of national survey datasets from South Asia's five largest countries (Afghanistan, Bangladesh, India, Nepal, and Pakistan) reveal that the initiation of breastfeeding is more likely to be delayed in infants who were born by caesarean section (Benedict et al, ).…”

Feeding of Infants and Young Children in South Asia

“…Caesarean delivery is a consistent determinant of delayed breastfeeding initiation in South Asia, as post-delivery practices often fail to support early initiation (Dibley et al 2010;Sharma and Byrne 2016;Kavle et al 2017;Benedict et al 2018a). Other barriers to early initiation include maternal or infant, sociocultural, and health system factors (Dibley et al 2010;Sharma and Byrne 2016;Kavle et al 2017;Benedict et al 2018).…”

“…Other barriers to early initiation include maternal or infant, sociocultural, and health system factors (Dibley et al 2010;Sharma and Byrne 2016;Kavle et al 2017;Benedict et al 2018). Delayed initiation is often more likely among women with no formal education, with low access to media, and with low decision-making autonomy (Dibley 2010;Sharma and Byrne 2016;Benedict et al 2018a). In Pakistan, early initiation is less likely among overweight women (Benedict et al 2018a)-a pattern that deserves greater attention given the rising prevalence of overnutrition among women in both Pakistan and across the region.…”

“…Delayed initiation is often more likely among women with no formal education, with low access to media, and with low decision-making autonomy (Dibley 2010;Sharma and Byrne 2016;Benedict et al 2018a). In Pakistan, early initiation is less likely among overweight women (Benedict et al 2018a)-a pattern that deserves greater attention given the rising prevalence of overnutrition among women in both Pakistan and across the region. Infants who are small at birth are less likely to breastfeed early, potentially reflecting suckling difficulties in premature or smallfor-gestational age newborn children (Benedict et al 2018a).…”