Despite improvements in antenatal and postnatal care (ANC and PNC), exclusive breastfeeding (EBF) and early initiation of breastfeeding (within the first hour of birth) remain sub optimal in Nepal (57% and 49%). This study aims to evaluate the effectiveness of a USAID-funded large-scale integrated nutrition program, Suaahara, in improving knowledge and practices relating to early and exclusive breastfeeding.
A cross-sectional survey was conducted among pregnant women and mothers of children <2y (n=480) in 4 intervention and 4 matched districts. Descriptive analysis was conducted to compare intervention and comparison areas.
ANC in Suaahara districts was more likely to include counseling on early initiation (86% vs. 57%; p<0.001) and EBF (91% vs. 55%; p<0.001). Among mothers who received PNC, those in Suaahara areas were more likely to have received breastfeeding counseling (81% vs. 60%; p<0.0.001) and assistance with positioning (66% vs. 29%; p<0.001) and attachment (60% vs. 22%; p<0.001). More Suaahara women knew breastfeeding should be initiated in the first hour (91% vs. 73%; p<0.05) and the correct definition of EBF (68% vs. 16%; p<0.001). They were more likely to feed colostrum (94% vs. 75%; p<0.01) and practice EBF (77% vs. 51%; p<0.05).
Accelerating adoption of early and exclusive breastfeeding is feasible and ensuring that community health workers have adequate skills, not just knowledge, is important. As was evidenced through the Suaahara intervention, improvements in the quality of ANC and PNC may help to improve early and exclusive breastfeeding knowledge and practices critical for preventing malnutrition in children