A Collective Responsibility
Tags: Global Health, Maternal Health, International Development, World Breastfeeding Week, Breastfeeding

A Collective Responsibility

How USAID inspires support for breastfeeding around the world USAID Follow Jul 28 · 6 min read

Community Health Worker Denise Ravaonasolo visits a household in Andasibe, Madagascar to support a mother who is having a hard time breastfeeding. / Karen Kasmauski, USAID Maternal and Child Survival Program

Breastfeeding has always been more than a one person job. Yet in many places around the world, mothers shoulder this responsibility alone or with very little support.

Recognizing that achieving optimal breastfeeding practices requires broad-based support, USAID promotes breastfeeding as a collective responsibility — one that families, communities, health systems, governments, and development partners must champion together.

For over 40 years, USAID has supported breastfeeding initiatives around the world to save lives, prevent malnutrition, support healthy birth spacing, and enhance the long-term health and prosperity of women and children.

Breast milk provides ideal nutrition for infants, supports optimal cognitive and physical development, and reduces the risk of disease. In fact, infants younger than 6 months old who are not breastfed are three to four times more likely to die, on average, compared to infants who have been breastfed. For nursing individuals, breastfeeding improves birth spacing, and reduces the risk of breast and ovarian cancers and chronic diseases, including type-2 diabetes and heart disease.

Supporting breastfeeding is more critical than ever as the COVID-19 pandemic has introduced new barriers to breastfeeding, including widespread misinformation and decreased access to skilled support. Despite these barriers, over the last several years USAID has intensified breastfeeding programming and found additional opportunities to engage communities, religious leaders, health systems, and families to support mothers on their breastfeeding journeys.

In Bangladesh, Rupna Das, a family welfare assistant, supports Azizun Tumpa to breastfeed her daughter while taking precautions to limit potential COVID-19 exposure. / Jamila Siddika, USAID Ujjiban

Counseling Helps Ensure Family Involvement

Skilled breastfeeding counselors play an important role in supporting mothers with breastfeeding challenges, encouraging them to adopt good breastfeeding practices — including the early initiation of breastfeeding and exclusive breastfeeding for the first six months — and engaging family members to support lactating mothers.

In Laos, breastfeeding counseling made all the difference for Done, a 31-year-old mother of four, who previously struggled with exclusive breastfeeding. Following the common practices of her village, she fed her first three infants rice, in addition to breast milk, worrying that they would not be full on breast milk alone. However, while she was pregnant with her fourth child, Done received counseling on the benefits of exclusive breastfeeding during a prenatal care visit at a nearby USAID-supported health facility.

In Kengly Village, Laos, Done’s husband and mother-in-law provided physical and emotional support while she was breastfeeding her youngest son, Phonethavy. / Keomany Phommahan, USAID Nurture

At the same time, her husband and mother-in-law were educated through project activities and events back in their village. As a result, they not only encouraged Done to continue exclusive breastfeeding, but also took on some of her household responsibilities so she could have more time to breastfeed.

Her youngest is now an energetic 2-year-old, who is healthy and growing well.

Susan Alaba breastfeeds her baby in the presence of her husband, who she says has been very supportive in helping her exclusively breastfeed their youngest child after he received messages on breastfeeding benefits from their local Village Health Teams. / Barbara Akite, USAID RHITES-N Lango

In Uganda, Susan Alabada shared a similar experience. She emphasized that with USAID-supported breastfeeding counseling from a local midwife and “the support of my husband, who took up the trainings from the Village Health Team, I am exclusively breastfeeding our daughter.” She added proudly that “as a result of this support, my 4-month-old baby Angela doesn’t get sick like my 3-year-old who wasn’t exclusively breastfed.”

Community Support Helps Navigate Myths and Misconceptions

Beyond family-level support, community and peer engagement can also play a critical role in promoting optimal breastfeeding practices and helping families navigate myths and misconceptions around breastfeeding.

Zulkumar Erkebaeva, a 27-year-old mother of three from the Kyrgyz Republic, thought her baby needed water during the first few months of life. But after a community activist invited her to a USAID-supported virtual education session, she learned about exclusive breastfeeding for the first time. “It never occurred to me that during the first six months my baby can get everything it needs out of breast milk,” she emphasized.

Ainura Yuldasheva, a project activist, provides breastfeeding counseling to Zulkumar Erkebaeva, in Kenchi Village, Kyrgyzstan. / USAID Advancing Nutrition

In Lesotho, Mareekelelitsoe Monne was devastated when she found out she had tested positive for HIV, worrying that she wouldn’t be able to breastfeed her child. After meeting with a USAID-supported peer counselor, or “mentor mother,” at her local health facility, she was surprised to learn that exclusive breastfeeding was actually recommended for mothers living with HIV to ensure that their children get the appropriate nutrients needed to grow and thrive.

Mareekelelitsoe emphasized that the support and encouragement she received from the mentor mothers enabled her to “make the very best decision to exclusively breastfeed my baby.” By taking antiretroviral medications, maintaining regular visits to the clinic, and ensuring her infant received daily preventative prophylaxis, she is also happy to report that her child remains HIV-free to this day.

Breastfeeding women receive education and breastfeeding support from Mentor Mothers at Mafeteng Hospital MCH in Lesotho. / M’me Limpho Nteko, Mothers2Mothers for USAID

USAID also engages with religious leaders to promote positive care seeking practices and breastfeeding in their communities.

After hearing his Imam talk about breastfeeding before a regular Friday-afternoon prayer in Bangladesh, Nasir Munshi quickly rushed home to share the messages with his wife, Ayesha. With the encouragement of his religious community, Nasir was motivated to support Ayesha and encouraged her to continue breastfeeding even after the first six months.

Ayesha Begum breastfeeds her five-month-old child in Pukurjana Sadar, Bangladesh. / Masuda Tajmim Mou, Feed the Future Bangladesh

Working with Healthcare Providers Helps to Initiate Early Breastfeeding

Health facilities are a critical entry point for promoting good breastfeeding practices, such as the early initiation of breastfeeding within an hour after birth. Recognizing this role, USAID is training primary health care workers in hard-to-reach communities in Nigeria to improve breastfeeding counseling and support for lactating individuals in order to influence positive infant feeding decisions at key moments before and after birth.

USAID also helped develop audio tools that health workers can access through their mobile phones. In rural communities, this supplements the clinical training and acts as a mobile reference library for health workers.

In Abakaliki Town in Ebonyi State Nigeria, Midwife Oko Constance helps nursing students learn how to teach mothers to express breast milk. / Karen Kasmauski, USAID Maternal and Child Survival Program

In Northern Uganda, Kevin Ajajura, a midwife at the Gulu Regional Referral Hospital, recalls how USAID helped the facility achieve Baby Friendly Hospital certification, allowing them to better support breastfeeding individuals. With some key transformations in the hospital’s policies and operating procedures, health workers are now champions for breastfeeding, helping families get off to the best start as they feed their newborns.

“Sometimes mothers stop me on the streets to show me their babies,” Kevin recalls. “I am happy when I see mothers like [that]. I know whatever information I gave the mother, she put it into practice to help protect breastfeeding.”

In Mirandrivazo, Madagascar, Midwife Haingomalala Roilande Richter is making her rounds in the maternity ward, helping mothers with breastfeeding. / Karen Kasmauski, USAID Maternal and Child Survival Program

Together with the global community, USAID is working to scale up optimal breastfeeding practices to near universal levels, to help save the lives of more than 800,000 children and 20,000 women each year.