Improving breastfeeding behaviors through Traditional Birth Attendants support: A Case Study of Alive and Thrive, Nigeria

Summary

In Kaduna and Lagos Nigeria, 21% of pregnant women and mothers of children under 2 access services at health facilities while 39% seek care from traditional birth attendants (TBA).1 The preference for the less skilled TBAs is attributed to patient-centered care and inexpensive option as they often accept payment in kind.2 Rates of early initiation (EI) and exclusive breastfeeding (EBF) have been persistently low at 32.8% and 29% (NDHS, 2018) which are attributed in large part to adequate knowledge of and lack of family support for breastfeeding. In Nigeria, inadequate breastfeeding contributes to over 100,000 child mortalities a year2. Alive & Thrive seeks to improve quality and use of nutrition services through capacity building of TBAs. They receive training on Infant and Young Child Feeding (IYCF) and weekly coaching sessions by a coach who observes their interactions with clients during ante-natal services (ANC), identifies gaps, then provides advice to improve the quality of services. Program monitoring data shows an increase from 0%-95% (Kaduna) and 0%-96% (Lagos) in EI rates; and 0% to 59% in Kaduna and 0% to 77% in Lagos in EBF rates.

Background/Objectives

In Nigeria, malnutrition threatens the survival, growth and development of children and is it a major contributing factor to the high childhood mortality rate, these deaths are linked to poor breastfeeding knowledge and behaviors and low attendance at ANC and delivery services (UNICEF, 2019)3. Alive & Thrive Project baseline showed that 39% of Pregnant and Lactating Women (PLW) seek care from traditional birth attendants (TBA) as against the 21% who seek services from health facilities. The preference for services of the less skilled TBAs makes them crucial to the effort in getting PLWs to adopt optimal breastfeeding behaviors.

Description Of Intervention And/or Methods/Design

A&T is funded by the Bill and Melinda Gates Foundation, managed by FHI360 and implemented by Save the Children and Wellbeing Foundation. A&T strives to create an enabling environment to build knowledge and capacity for excellence in social behaviour change, policy advocacy, delivery of quality nutrition services, and strategic use of data. Local authorities selected 1554 influential TBAs from 339 wards in 26 LGAs across Lagos and Kaduna to participate in A&T. They received training and coaching on appropriate IYCF practices, Interpersonal Communication for effective counseling of pregnant women during ANC/PNC and home visits, as well as hands-on support for EI and EBF. A focus of the training was the benefits of early initiation of breastfeeding in the first hour of birth for both mother and baby and supporting women directly in labor to start breastfeeding immediately upon delivery by placing baby to breast and assisting with positioning.

Results/Lessons Learned

Through A&T 1,554 TBA were trained and 460,290 PLW were counselled. A&T routine data from TBA facilities in 2018 and 2019 showed that the rate of early initiation of breastfeeding were higher than the national rate of 32.8%. In Lagos, of the 6,355 newborns delivered with the support of A&T trained TBAs, 6,110 (96%) were put to breast within one hour of delivery while in Kaduna the result was 28,398 of 30,045 newborns (95%). Anecdotal evidence recorded by TBAs during routine coaching, supervision visits and refresher trainings, noted how they would always promote EI with their patients as it resulted in good outcomes for the baby and better outcomes for them as practitioners. They observed that routinely putting baby to breast immediately after birth helped the motherду»s uterus contraction, faster dispel of placenta with lesser incidence of hemorrhage. This was good for their patients and good for their reputation.

Discussion/Implications For The Field

TBAs are a significant source of human resource for women during childbirth as well as key behaviour change agent. Changing their behaviour to promote optimal IYCF practices is a critical path to changing the behaviour of pregnant and lactating mothers. They have influence through interpersonal communication to promote and support good breastfeeding practices and are inclined to do so when they see tangible positive results. Hence, they can and should be leveraged wherever they act as frontline practitioners through capacity building approach, and supportive supervision to help drive the demand for optimal IYCF services among pregnant and lactating mothers.

Abstract submitted by:

Carolyn O'Donnell Save the Children

Afolabi Lukman Save the Children

Awotunde Williams Save the Children

Adaeze  Oramalu Save the Children

Oluwatoyin  Oyekenu Save the Children