Breastfeeding rates and practices: Monitoring, evaluation and research gaps

Review of breastfeeding indicators Indicators that are used: WHO: Division of Child Health and Development Australian Institute of Health and Welfare Indicators for assessing infant and young child feeding practices: Consensus meeting Nov 2007, Washington DHS Indicators similar – look at breastfeeding rates at different ages, exclusive and predominant feeding, complementary feeding

Linkages Project in Madagascar Aimed to ensure behaviour change at all levels to support breastfeeding (very successful in increasing breastfeeding) Three strategies: partnerships, advocacy, BCC tools – M&E: to monitoring of workplan – To report annual progress – To report final impact – Have data to share with partners and stakeholders

M&E system Methods: baseline and endline surveys (looking at impact) Annual Rapid Assessment Survey (tracked process and impact indicators using quantitative and qualitative data) Ongoing monitoring of process indicators Special study of program intervention

Lessons learnt General Co-ordination mechanisms were important Field partnerships allowed rapid scale-up M&E system Systems need to be in place at the beginning of the project and embedded in annual workplan (must include process and impact indicators) Process evaluation and rapid assessment need to be used to provide feedback to stake-holders and partners Ensuring compatibility of systems is important Building capacity of existing M&E networks and groups is important.

Issues The M&E system and indicators need to reflect objectives of a breastfeeding strategy. Most indicators presented focus on practice – but behaviour change model suggests that we also need to looking at knowledge and attitudes Need to have population-based data – DHS last done in 2003 – population data are now being collected through surveys (HSRC health survey, SANHANES) DHIS – already has too many indicators (Currently no specific breastfeeding indicators in NIDs, but some data elements on infant feeding included in ART database) ? Should some specific issues on BF be added.

Need to have a simple system with a clear set of minimum indicators (should this be collected at facility level or community level?) Should as far as possible use existing data sources. Establishment of (or use of existing ) sentinel sites - allow for more detailed data collection and learning whilst the minimum set for routine collection remains simple. Importance of integrating data and indicators between programmes, rather than each programme adding its own indicators – also use data to feedback to staff to improve the quality and use of data

Technical issues: Inclusion of specific indicators, limitations of using 24 hour recall to calculate exclusive BF rates (debates for tomorrow).

WHO indicators Exclusive breastfeeding rate Predominant breastfeeding rate Timely complementary breastfeeding rate Continued breastfeeding rate

Australian Institute of Health and Welfare Proportion of children ever breastfed Proportion of children breastfed at each month end Proportion of children exclusively breastfed to each month of age, 0-6 months Proportion of children predominantly breastfed to each month of age, 0-6 months Proportion of children receiving soft/solid food at each month of age, 0-12 months Proportion of children receiving non-human milk or formula at each month of age, 0-12 months

Consensus on IF indicators Early initiation of breastfeeding Exclusive breastfeeding at 6 months Continued breastfeeding at 2 years Duration of breastfeeding Bottle-feeding Milk feeding frequency

SADHS Children ever breastfed Initial breastfeeding Breastfeeding by status Bottle feeding