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The breast and beyond: Improving feeding practices in Kenya

August 2, 2016 by PATH

Members of a mother-to-mother support group in Kenya. Photo: George Ndagu.

Members of a mother-to-mother support group in Kenya. Photo: George Ndagu.

Kenya is working to ensure children are exclusively breastfed. Next up: improving infant and young child feeding practices.

Several woman look forward while another woman looks down and smiles at a small child she is holding.

Editor’s note: This post originally published on the Maternal and Child Survival Program (MCSP) blog and was coauthored by Brenda Ahoya, nutrition advisor, and Justine Kavle, interim nutrition team leader for PATH’s work with MCSP.

In Kenya, this year’s World Breastfeeding Week theme is intimately understood: “Breastfeeding—a key to sustainable development.”

Sixty-one percent of Kenyan children less than six months of age are exclusively breastfed. And while many families have received the message that breastfeeding—if done within the first hour of life, exclusively for the first six months, and until age two—has the greatest potential impact on child survival of all preventive health interventions, there is still work to be done.

To help address this, USAID’s flagship Maternal and Child Survival Program (MCSP) is working with the Ministry of Health in Kenya to scale up the Baby-Friendly Community Initiative (BFCI). The initiative is based on expansion of the tenth step of the 10 Steps of Successful Breastfeeding of the Baby-Friendly Hospital Initiative, which encourages establishment of and referral to breastfeeding support groups.

Since 2010, we’ve provided comprehensive support to mothers at the community level to improve maternal, infant, and young child health and nutrition (MIYCN)—with an emphasis on initiation and exclusive breastfeeding in the first six months, and improving timely and optimal complementary feeding from 6 to 23 months.

A woman and a man smile at a young child who is craddled in the lap of another woman.

Mothers and a community health worker at a breastfeeding support group in Migori, Kenya. Photo: MCSP/Allan Gichigi.

BFCI is part of Kenya government policy, with a mandate to scale up.

Listen to Ms. Gladys Mugambi of the Ministry Of Health’s Nutrition and Dietetics Unit as she discusses the importance of BFCI and how it began in Kenya.

MCSP works closely with communities to understand and respond to their needs in supporting timely initiation of breastfeeding and ensuring that women breastfeed for the full duration of six months. We involve key community influencers—fathers, grandmothers, mothers-in-law, and local leaders—in this process, while building the capacity of health care workers and community health volunteers to deliver services at the health facility and community levels.

The integration of MIYCN into other health services is key to maximizing opportunities for nutrition services. Moreover, integration of BFCI with other health services increases coverage and uptake of all health indicators, such as immunization and antenatal care. Involving men, grandmothers, and mothers-in-law in supporting pregnant mothers and those with children younger than five years old also greatly improves uptake.

A woman holds a child who is breastfeeding.

A mother-to-mother support group member who overcame a breastfeeding problem thanks to the group’s help. Photo: George Ndagu.

MCSP has implemented BFCI in Migori County and helped form 13 mother-to-mother support groups. Comprised of pregnant or lactating mothers, these groups meet regularly to support each other’s MIYCN efforts. Members are also encouraged to have income-generating activities, such as kitchen gardens and savings schemes, to help sustain the groups.

Susan Makuri, a BFCI mother-to-mother support group member, explained her experience this way: “The community health volunteer had come to visit me. My child was crying a lot. She asked me what was wrong and I told her that my breasts were painful and the child could not breastfeed. She taught me how to express in a cup. I expressed and fed my child the expressed breast milk. I continued expressing until I got relief, then I put my child back on the breast and she is still breastfeeding.”

Find out how human milk banks are saving lives through low-cost interventions such as donated human milk and breastfeeding support.

To help shape the implementation and scale-up of BFCI in-country, on August 3, the Kenya Ministry of Health is launching the BFCI Implementation Guidelines, External Assessment Protocol, and MIYCN counseling cards. The development of this package was spearheaded by the Ministry of Health and UNICEF, and supported by MCSP with engagement with nongovernmental organizations and other partners.

A small group of women sit together while one woman breastfeeds a child.

Mothers in Migori, Kenya, are reminded of the importance of breastfeeding at a weekly meeting. Photo: MCSP/Allan Gichigi.

The next step is to continue the scale-up of BFCI to other counties, to assess and certify communities as baby friendly, and to engage other countries in learning about BFCI. In Malawi, for instance, MCSP is working with the Ministry of Health, the World Health Organization, and UNICEF to revitalize the Baby-Friendly Hospital Initiative in 15 districts. Malawi plans to adapt the Kenya BFCI experience to the country context, as expansion to the community level begins in the coming year.