Addressing Barriers to Exclusive Breastfeeding in Mozambique: Opportunities to Strengthen Provider Counseling and Use of a Job Aid (OR30-03-19)

Objectives The objectives of this implementation science study are to 1) identify problems and challenges with exclusive breastfeeding (EBF) experienced by mothers in Nampula, Mozambique, 2) gain an understanding of the quality and type of counseling on breastfeeding problems and challenges provided by facility and community-based health providers and 3) assess the use of a job aid to improve the identification of and counseling on barriers to EBF within existing health services. Methods In-depth interviews were carried out with mother-child pairs (n = 23) who ‘ever breastfed’ and had infants less than 6 months of age, as well as facility-based (n = 13), and community-based health providers (n = 10) who offered maternal, child health and/or nutrition services. Observations of breastfeeding counseling were also conducted with mothers. Following these interviews and observations, the research team and program implementers jointly developed provider job aids addressing breastfeeding challenges, which were used in training facility and community-based health providers in two districts, designated study areas. Following two months of implementation within routine health services, providers and mothers were interviewed regarding their experiences. A qualitative analysis was conducted. Results Difficulty latching, and engorgement were barriers to delayed initiation of breastfeeding, and perceptions of insufficient breastmilk and early return to fieldwork were challenges in maintaining EBF. Community providers referred women with breastfeeding problems to health facilities, yet lacked training and knowledge to provide basic breastfeeding support. Facility-based providers demonstrated some knowledge in identifying breastfeeding difficulties, yet often lacked the ability to counsel on common breastfeeding problems. The job aid was found to be useful for most providers. Conclusions This study revealed the need to strengthen counseling skills among health providers to address challenges experienced with EBF. Job aids, in tandem with adequate training and practical experience and/or case studies may equip providers to improve lactation support at the facility and community level in low and middle-income countries. Funding Sources United States Agency for International Development (USAID).