Scaling Up of Breastfeeding Promotion Programs in Low- and Middle-Income Countries: the “Breastfeeding Gear” Model

Pérez‐Escamilla, Rafael; Curry, Leslie; Minhas, Dilpreet; Taylor, Lauren A.; Bradley, Elizabeth H.

doi:10.3945/an.112.002873

Cited by 193 publications

(293 citation statements)

References 17 publications

Supporting

Mentioning

263

Contrasting

Unclassified

Order By: Relevance

“…These factors must be considered when planning integral interventions to promote, support and protect breast-feeding in this population. Promotion of breast-feeding must be comprehensive, combining education by medical practitioners sensitive to women's cultural and social background, and support by the family, peers and the community (65) . Breast-feeding in public makes people uncomfortable.…”

Section: Resultsmentioning

confidence: 99%

‘Life does not make it easy to breast-feed’: using the socio-ecological framework to determine social breast-feeding obstacles in a low-income population in Tijuana, Mexico

Bueno-Gutierrez

Chantry

2015

Public Health Nutr.

View full text Add to dashboard Cite

Objective: Breast-feeding rates reflect sociodemographic discrepancies. In Mexico, exclusive breast-feeding under 6 months of age has deteriorated among the poor, rural and indigenous populations from 1999 to 2012. Our objective of the present study was to identify the main social obstacles to breast-feeding in a low-income population in Tijuana, Mexico. Design: Qualitative study using a socio-ecological framework for data collection. Setting: Low-income communities in Tijuana, Mexico. Subjects: Mothers (n 66), fathers (n 11), grandparents (n 27) and key informants (n 25). Results: One hundred and twenty-nine individuals participated in the study: six focus groups (n 53) and fifty-one interviews among mothers, fathers and grandparents; and twenty-five interviews among key informants. Seven social themes were identified: (i) embarrassment to breast-feed in public; (ii) migrant experience; (iii) women's role in society; (iv) association of formula with higher social status; (v) marketing by the infant food industry; (vi) perception of a nonbreast-feeding culture; and (vii) lack of breast-feeding social programmes. Conclusions: Socio-structural factors influence infant feeding practices in lowincome communities in Tijuana. We hypothesize that messages emphasizing Mexican traditions along with modern healthy practices could help to re-establish and normalize a breast-feeding culture in this population. The target audience for these messages should not be limited to mothers but also include family, healthcare providers, the work environment and society as a whole. Keywords Breast-feedingObstacles Low income Socio-ecological framework Breast-feeding practices have improved in the last decades in most of Latin America (1)(2)(3) . Exclusive breast-feeding (EBF) under 6 months of age has increased greatly in Brazil, Colombia and Peru. However in other countries, such as Mexico and the Dominican Republic, prevalence of EBF under 6 months of age has decreased (3,4) . Despite improvements, only in five of nineteen Latin American countries with nationally representative data on trends in EBF over a 10-20 year period do >50 % of mothers exclusively breast-fed babies under 6 months of age (1) . Table 1 depicts rates of EBF under 6 months from Latin America including Tijuana.In the last decades, changes in breast-feeding prevalence in Latin America have shown less improvement in population subgroups whose children are most at risk for mortality and increased morbidity from not being breast-fed, such as poorly educated women with little access to health care (5,6) . In Mexico, EBF under 6 months deteriorated among the poor (33·5 % to 16·6 %), rural (32·7 % to 18·5 %) and indigenous (46 % to 27·5 %) populations from 1999 to 2012 (7,8) . Breast-feeding rates in Mexico are one of the lowest of Latin America with 14·4 % of EBF under 6 months of age (1) . Particularly in North Mexico, there is a lower prevalence of EBF under 6 months of age (10·6 %) than the national average in 2012 (4,9) . There are no data with EBF rates in...

show abstract

Section: Resultsmentioning

confidence: 99%

‘Life does not make it easy to breast-feed’: using the socio-ecological framework to determine social breast-feeding obstacles in a low-income population in Tijuana, Mexico

Bueno-Gutierrez

Chantry

2015

Public Health Nutr.

View full text Add to dashboard Cite

show abstract

“…115,116 Much implementation research is from small-scale interventions, as opposed to large-scale programmes or interventions, for which the challenges to ensurance of quality, intensity, equity, and coverage are diff erent and need various factors to operate in concert. [117][118][119][120][121][122] Analyses of scaled-up programmes or of scale-up of small area or pilot interventions raise several challenges-eg, establishing of counterfactuals, assurance that real-time process documentation captures nuances of organisational changes that facilitated or hampered scale-up, and that research generated is of a publishable quality.…”

Section: Implementation Research: What Work Why and How?mentioning

confidence: 99%

The politics of reducing malnutrition: building commitment and accelerating progress

et al. 2013

View full text Add to dashboard Cite

In the past 5 years, political discourse about the challenge of undernutrition has increased substantially at national and international levels and has led to stated commitments from many national governments, international organisations, and donors. The Scaling Up Nutrition movement has both driven, and been driven by, this developing momentum. Harmonisation has increased among stakeholders, with regard to their understanding of the main causes of malnutrition and to the various options for addressing it. The main challenges are to enhance and expand the quality and coverage of nutrition-specifi c interventions, and to maximise the nutrition sensitivity of more distal interventions, such as agriculture, social protection, and water and sanitation. But a crucial third level of action exists, which relates to the environments and processes that underpin and shape political and policy processes. We focus on this neglected level. We address several fundamental questions: how can enabling environments and processes be cultivated, sustained, and ultimately translated into results on the ground? How has high-level political momentum been generated? What needs to happen to turn this momentum into results? How can we ensure that high-quality, well-resourced interventions for nutrition are available to those who need them, and that agriculture, social protection, and water and sanitation systems and programmes are proactively reoriented to support nutrition goals? We use a six-cell framework to discuss the ways in which three domains (knowledge and evidence, politics and governance, and capacity and resources) are pivotal to create and sustain political momentum, and to translate momentum into results in high-burden countries.

show abstract

“…Chief executives and senior management claim to be fully dedicated to nutrition promotion 42 and to be unaware of Code violations, 43 while their lower management maintains strong pressure on their staff to increase sales. 7,10 Code violations by formula companies are not "innocent mistakes" and should not be excused, as was done in India recently.…”

Section: Lessons From the Formula Industrymentioning

confidence: 99%

Enforcing the International Code of Marketing of Breast-milk Substitutes for Better Promotion of Exclusive Breastfeeding

Hubert

Slesak²,

Goyet

et al. 2015

J Hum Lact

View full text Add to dashboard Cite

Exclusive breastfeeding, one of the best natural resources, needs protection and promotion. The International Code of Marketing of Breast-milk Substitutes (the Code), which aims to prevent the undermining of breastfeeding by formula advertising, faces implementation challenges. We reviewed frequently overlooked challenges and obstacles that the Code is facing worldwide, but particularly in Southeast Asia. Drawing lessons from various countries where we work, and following the example of successful public health interventions, we discussed legislation, enforcement, and experiences that are needed to successfully implement the Code. Successful holistic approaches that have strengthened the Code need to be scaled up. Community-based actions and peer-to-peer promotions have proved successful. Legislation without stringent enforcement and sufficient penalties is ineffective. The public needs education about the benefits and ways and means to support breastfeeding. It is crucial to combine strong political commitment and leadership with strict national regulations, definitions, and enforcement. National breastfeeding committees, with the authority to improve regulations, investigate violations, and enforce the laws, must be established. Systematic monitoring and reporting are needed to identify companies, individuals, intermediaries, and practices that infringe on the Code. Penalizing violators is crucial. Managers of multinational companies must be held accountable for international violations, and international legislative enforcement needs to be established. Further measures should include improved regulations to protect the breastfeeding mother: large-scale education campaigns; strong penalties for Code violators; exclusion of the formula industry from nutrition, education, and policy roles; supportive legal networks; and independent research of interventions supporting breastfeeding.

show abstract

Scaling Up of Breastfeeding Promotion Programs in Low- and Middle-Income Countries: the “Breastfeeding Gear” Model

Cited by 193 publications

References 17 publications

‘Life does not make it easy to breast-feed’: using the socio-ecological framework to determine social breast-feeding obstacles in a low-income population in Tijuana, Mexico

‘Life does not make it easy to breast-feed’: using the socio-ecological framework to determine social breast-feeding obstacles in a low-income population in Tijuana, Mexico

The politics of reducing malnutrition: building commitment and accelerating progress

Enforcing the International Code of Marketing of Breast-milk Substitutes for Better Promotion of Exclusive Breastfeeding

Contact Info

Product

Resources

About