In celebration of World Breastfeeding Week, USAID Advancing Nutrition has compiled this set of resources that focuses on the importance of breastfeeding to improve the health of infants, children, their mothers, and the environment. This collection demonstrates the critical role breastfeeding plays in early childhood development, health and food systems, and nutrition in humanitarian contexts. Have a resource to share? Let us know ›

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Early Childhood
Development
Food Systems Knowledge Management Monitoring, Evaluation,
and Learning
Nutrition and
Health Systems
Nutrition in
Humanitarian Contexts
Social and
Behavior Change

August 2020

IconEarly Childhood Development

Research Articles

Baby Friendly Spaces: An Intervention for Pregnant and Lactating Women and Their Infants in Cameroon

Dozio, Elizabeth, K. Le Roch, C. Bizouerne. Intervention, 18:78-84, January 2020
  • Early Childhood Development
The Baby Friendly Spaces program provides workshops focusing on improving maternal mental health, infant and young child feeding practices, early child stimulation, and parenting skills in the context of complex humanitarian emergencies. Researchers found statistically significant changes in psychosocial suffering among pregnant and lactating women, perceived social support, breastfeeding practices, and mother-child relationships.

Experiences of Incorporating Support for Early Childhood Development into the Baby Friendly Community Initiative in Rural Kenya

Mwoma, Teresa, Patricia Kitsao-Wekulo, Emma Haycraft, et al. Journal of the British Academy, March 2020
  • Early Childhood Development
The Care for Child Development package trains community health volunteers to help caregivers provide nurturing care and develop stronger relationships with young children. Participating volunteers reported that training increased their skills and confidence, while caregivers reported learning about feeding practices and the importance of play. The authors conclude that there is political will in Kenya to support a care package to promote optimal early child development.

Reports and Tools

Birth & Beyond iOS App

Global Health Media, June 2020
  • Early Childhood Development
The Birth & Beyond app provides easy access to videos for mothers and other caregivers that focus on birth, breastfeeding, newborn care, small baby care, and complementary feeding. Videos are currently available in 21 languages and can be streamed or downloaded to an offline library.  The app is free for download, works with iPhones, and its Android version is in development.

IconFood Systems

Research Articles

COVID-19 Pandemic and Mitigation Strategies: Implications for Maternal and Child Health and Nutrition

Akseer, Nadia, Goutham Kandru, Emily C Keats, et al. The American Journal of Clinical Nutrition, June 2020
  • Food Systems
COVID-19 has created profound challenges for maternal and child nutrition. This review urges governments, donors, and others to rely on data for decision-making as they prioritize investments to strengthen food supply chains, respond to acute food shortages, improve access to health care, and provide social safety net programs for the most vulnerable.

IconKnowledge Management

Reports and Tools

The Business Case for Investment in Nutrition

Chatham House, July 2020
  • Knowledge Management
Authors discuss the impacts of malnutrition on companies’ bottom line, including loss of productivity due to underweight employees and lifelong cognitive impacts from childhood malnutrition. While corporate entities cannot address all factors driving malnutrition, providing workplace support for breastfeeding women is within businesses’ sphere of influence.

COVID-19 Videos

Partnership for Maternal, Newborn & Child Health, July 2020
  • Knowledge Management
These brief videos demonstrate how women with COVID-19 can safely breastfeed. Videos are available in Spanish, English, French, Russian, Chinese, and Arabic.

World Alliance for Breastfeeding Action (WABA) #WBW2020 Action Folder

World Alliance for Breastfeeding Action, May 2020
  • Knowledge Management
Protecting, promoting, and supporting breastfeeding requires coordinated actions to identify and address structural, setting, and individual-level determinants. Authors identify fundamental challenges and detail actions that governments, donors, and NGOs must take to create a more enabling environment and improve breastfeeding practices.

World Alliance for Breastfeeding Action (WABA) #WBW2020 Pledge Map

World Alliance for Breastfeeding Action, May 2020
  • Knowledge Management
The World Alliance for Breastfeeding Action has crowdsourced events and activities for Breastfeeding Week 2020 around the world. The interactive pledge map allows users to explore details of each event and activity categorized by country.

Events

Protecting, Promoting and Supporting Breastfeeding amid COVID-19

1,000 Days, May 2020
  • Knowledge Management
In this webinar, Dr. Larry Grummer-Strawn from the World Health Organization stresses that women with suspected COVID-19 symptoms can continue to breastfeed according to standard feeding guidelines but must practice proper respiratory and hand hygiene.

IconMonitoring, Evaluation, and Learning

Research Articles

Measuring Coverage of Infant and Young Child Feeding Counselling Interventions: A Framework and Empirical Considerations for Survey Question Design

Choufani, Jowel, Sunny S. Kim, Phuong Hong Nguyen, et al. Maternal & Child Nutrition, April 2020
  • Monitoring, Evaluation, and Learning
Infant and young child feeding counselling interventions are common, but data to track coverage of these activities is limited and inconsistent. Authors introduce a framework for designing surveys to measure counselling coverage and stress that surveys must include questions about timing, place, and frequency of contact, target behavior, message content, type of service provider, and mode of intervention. Triangulating data with local administrative data is also recommended.

Reports and Tools

Making a Difference: An Evaluation Report of the World Breastfeeding Trends Initiative (WBTi) in Mobilising National Actions on Breastfeeding and IYCF

World Breastfeeding Trends Initiative Global Secretariat, June 2020
  • Monitoring, Evaluation, and Learning
The WBTi has brought together diverse partners to advocate for breastfeeding and created national-level structures to benchmark breastfeeding and infant and young child feeding (IYCF) progress. Almost all countries that have conducted multiple WBTi assessments have seen improvements in breastfeeding and IYCF practices; have developed better policies, partnerships, and monitoring tools; and are better able to identify gaps.

Meeting Emerging Nutrition Data Needs in DHS-8 (Blog)

The DHS Program, December 2019
  • Monitoring, Evaluation, and Learning
To better understand the current state of nutrition and track nutrition interventions, the Woman’s Questionnaire asks 89 questions related to nutrition counseling, including questions on breastfeeding counseling. Questions also include anthropometry measurement, food and cash assistance, iron supplementation, minimum dietary diversity for women, unhealthy foods for children, growth monitoring, and the Food Insecurity Experience Scale. The Questionnaire will be ready for use in late 2020.

IconNutrition and Health Systems

Research Articles

The Cost of Not Breastfeeding: Global Results from a New Tool

Walters, Dylan D., Linh T. H. Phan, Roger Mathisen. Health Policy and Planning, June 2019
  • Nutrition and Health Systems
This tool aggregates data to estimate the human and economic costs of not breastfeeding. Data attributed to not breastfeeding include childhood deaths from diarrhea and pneumonia, childhood obesity, maternal breast and ovarian cancers, and type 2 diabetes. Researchers conservatively estimate total global economic losses to be US $341.3 billion (0.70% of global gross national income) per year due to cognitive losses, health system treatment costs, and future lost earnings.

Facility Readiness and Counseling during Antenatal Care and the Relationship with Early Breastfeeding in Haiti and Malawi

Mallick, Lindsay, Rukundo K. Benedict, Wenjuan Wang. BMC Pregnancy and Childbirth, May 2020
  • Nutrition and Health Systems
While almost all surveyed health facilities in Haiti and Malawi reported that they routinely provided breastfeeding counseling, fewer than 30% of providers reported having recently attended relevant training, and only 4% of patients were observed to have received counseling as part of antenatal care. Training providers on breastfeeding counseling was positively associated with early initiation of breastfeeding.

Scaling Up Breastfeeding Policy and Programs in Samoa: Application of the Becoming Breastfeeding Friendly Initiative

Soti-Ulberg, Christina, Amber Hromi-Fiedler, Nicola L Hawley, et al. International Breastfeeding Journal, January 2020
  • Nutrition and Health Systems
This evidence-informed initiative provides countries with a practical toolbox to assess and scale breastfeeding policies and programs. Work in Samoa yielded important policy recommendations, including the development and implementation of a National Breastfeeding Policy and Strategic Action Plan, identification of high-level advocates to serve as champions, and the creation of a national budget line for breastfeeding activities.

Reports and Tools

Breastfeeding and COVID-19

World Health Organization, June 2020
  • Nutrition and Health Systems
The World Health Organization recommends that mothers with suspected or confirmed COVID-19 be encouraged to practice skin-to-skin contact and initiate or continue breastfeeding while practicing infection prevention and control measures. Current data suggest that the health benefits of breastfeeding outweigh the risks of potential infant or child COVID-19 infection. Current data are insufficient to conclude vertical transmission of COVID-19 through breastfeeding.

Frequently Asked Questions: Breastfeeding and COVID-19 for Health Care Workers

World Health Organization, May 2020
  • Nutrition and Health Systems
In addition to answering common questions about COVID-19 transmission through breast milk and the risks of choosing not to breastfeed, a decision tree helps health care workers understand current guidelines and precautionary steps to support breastfeeding mothers with a suspected or confirmed COVID-19 diagnosis. The document is available in Arabic, English, French, Portuguese, Russian, and Spanish.

Infant and Young Child Feeding in the Context of COVID-19

UNICEF, Global Technical Assistance Mechanism for Nutrition (GTAM), and the Global Nutrition Cluster, March 2020
  • Nutrition and Health Systems
During COVID-19, UNICEF recommends that mothers follow hygiene precautions while continuing recommended feeding practices. It calls for coordinating nutrition, health, food security and livelihood, agriculture, WASH, social protection, and mental health support to reach infants and young children. It also highlights the need to prioritize preventive services to mitigate the impact of the pandemic on young children’s diets and wellbeing.

Initiation of Breastfeeding in Low- and Middle-Income Countries: A Time-to-Event Analysis

United States Agency for International Development, June 2020
  • Nutrition and Health Systems
Demographic and Health Survey data collected in 31 countries since 2015 show that women who deliver by cesarean section initiate breastfeeding later compared to those who give birth vaginally. Immediate skin-to-skin contact and higher parity were also significantly associated with shorter time to initiating breastfeeding.

The International Code of Marketing of Breastmilk Substitutes: Frequently Asked Questions on the Roles and Responsibilities of Health Workers

World Health Organization, May 2020
  • Nutrition and Health Systems
Authors discuss common tactics that companies use to encourage health care workers to over-promote breast milk substitutes and clarify health care workers’ role and responsibilities to protect, promote, and support breastfeeding.

Nutrition During Pregnancy and Lactation

The National Academies of Science, Engineering, and Medicine, June 2020
  • Nutrition and Health Systems
This brief summarizes new evidence related to nutrients, dietary patterns, and nutritional supplements, including improving the micronutrient composition of breastmilk. It identifies additional research needed to design effective interventions to improve maternal and infant nutrition.

Toolkit: Workplace Lactation Support Program

Alive & Thrive, April 2020
  • Nutrition and Health Systems
This toolkit provides practical advocacy, policy, technical, and financial guidance for employers, employees, governments, and donors working to support lactation in the workplace. It includes detailed case studies and is available in Vietnamese and English.

IconNutrition in Humanitarian Contexts

Research Articles

Greater Household Food Insecurity Is Associated With Lower Breast Milk Intake Among Infants In Western Kenya

Miller, Joshua D., Sera L. Young, Godfred O. Boateng, et al. Maternal & Child Nutrition, June 2019
  • Nutrition in Humanitarian Contexts
Researchers found a significant relationship between household food insecurity and decreased breast milk intake among HIV-uninfected infants in this cohort. They recommend screening for and integrating programs that reduce food insecurity to increase quantities of breast milk ingested.

Violent Conflict and Breastfeeding: The Case of Iraq

Diwakar, Vidya, Michael Malcolm, George Naufal. Conflict and Health, December 2019
  • Nutrition in Humanitarian Contexts
Findings from this study suggest that increases in conflict-related casualties reduce the probability of a child ever beginning and continuing breastfeeding, and that infant formula provided to offer temporary relief impact these trends. Adequate health care and breastfeeding support systems for women are critical in conflict zones.

Reports and Tools

Marketing of Breast Milk Substitutes: National Implementation of the International Code, Status Report 2020

World Health Organization, May 2020
  • Nutrition in Humanitarian Contexts
This report highlights progress to promote and protect breastfeeding and curb harmful marketing practices by manufacturers and distributors of breastmilk substitutes, which often are donated or offered in emergency settings. It provides recommendations for legislators and policy-makers to fulfill legal and human rights obligations, analyze and address weaknesses or gaps in their existing legislation, and act accordingly. The full report is available in English while the summary is available in Arabic, Chinese, French, Russian, and Spanish.

IconSocial and Behavior Change

Research Articles

Mixed-Methods Systematic Review of Behavioral Interventions in Low- and Middle-Income Countries to Increase Family Support for Maternal, Infant, and Young Child Nutrition during the First 1000 Days

Martin, Stephanie L., Juliet K McCann, Emily Gascoigne, et al. Current Developments in Nutrition, June 2020
  • Social and Behavior Change
Research that draws causal inference, estimates the magnitude of impact, and identifies scalable behavioral interventions that engage fathers, grandmothers, and other family members to support mothers of infants and young children is limited. This research design found quantitative and qualitative evidence of positive impacts on nutrition practices, including breastfeeding, family members’ knowledge and awareness of recommended practices, and provision of support to mothers.

Social Circumstances and Cultural Beliefs Influence Maternal Nutrition, Breastfeeding and Child Feeding Practices in South Africa

Chakona, Gamuchirai. Nutrition Journal, May 2020
  • Nutrition in Humanitarian Contexts
  • Social and Behavior Change
There is a gap between knowledge and practices related to maternal dietary diversity, breastfeeding, and infant and young child feeding. Lack of income, dependence on food purchasing, young mothers' feelings about breastfeeding, and cultural beliefs were drivers of this gap. Authors conclude that it is crucial to identify interventions to reduce breastfeeding burden and isolation, including paternal inclusion and the use of indigenous knowledge.

When Separation is Not the Answer: Breastfeeding Mothers and Infants Affected by COVID‐19

Tomori, Cecília, Karleen Gribble, Aunchalee E.L. Palmquist, et al. Maternal and Child Nutrition, May 2020
  • Social and Behavior Change
Although the World Health Organization has provided comprehensive guidance that promotes continued breastfeeding during COVID-19, this article argues countries that have imposed separation and discouraged or prohibited breastfeeding or provision of expressed breastmilk fail to acknowledge the health and psychological impacts of separation. This article argues that countries have unduly imposed separation between mothers and breastfeeding children, citing the discouragement of breastfeeding or the provision of expressed breastmilk as a failure to acknowledge the health and psychological impacts of separation.

Reports and Tools

Behavior Profile: Continued Breastfeeding

The Manoff Group, n.d.
  • Social and Behavior Change
This tool provides a framework for identifying individual, social, and structural factors that support or hinder continued breastfeeding through age two. Acknowledging the importance of external forces on continued breastfeeding, the tool guides the identification of supportive actions required by policymakers and others and facilitates thinking about possible program strategies.

Factors That Influence Multi-Sectoral Nutrition Behaviors

USAID Advancing Nutrition, March 2020
  • Nutrition in Humanitarian Contexts
Researchers and implementers can use this tool when designing formative research and social and behavior change activities to improve breastfeeding. Barriers and enablers at the structural, social, and internal level must be considered and addressed. This tool can also be used to identify factors to measure to ensure programs are making progress to improve breastfeeding.