Breastfeeding in Haiti: Beliefs, attitudes and

behaviors

Mohamed Ag Ayoya

UNICEF and UPenn – Social Norms and Social Changes Course

July 12, 2012

Background

One of poorest

countries in LAC region

- independence in 1804.

10 million inhabitants

Under 5 mortality high

(80 per 1000 live births)

35% of under 5 deaths attributable to malnutrition

Major cause of child malnutrition: inappropriate infant and

young child feeding (IYCF) practices.

Recommended IYCF practices (UNICEF and WHO)

Empirical evidence shows that appropriate IYCF practices prevent

19% of all deaths of under 5s in the developing world (Lancet 2008).

Early initiation of breastfeeding (breast milk within the

1st hour of life).

In Haiti, only 44% of mothers initiate breastfeeding within 1 hr

Exclusive breastfeeding for 6 months (no liquid or solid

foods given to the child except medicines).

In Haiti, only 41% of children < 6 months are exclusively breastfed

Introduction of energy and nutrient dense age

appropriate complementary foods at 6 months and

continued breastfeeding up to 24 months and beyond.

Factual beliefs hindering optimal IYCF practicesFirst milk is dirty and should be discarded.

Sweet tisanes or a mixture of oils and different leave extracts (locally called “lok”) given after birth open up child’s intestine and help eliminate the meconium.

The child cannot survive without water, especially during hot seasons.

Mother’s milk alone is not enough for the child in the first 6 months of life.

Bad news and strong emotions spoil mother’s milk.

If mother spends time under the sun, she can’t breastfeed; her milk becomes hot and can cause diarrhea to the child.

Child should not eat eggs; he will become a thief.

Mothers-in-law and grandmothers have power and know best how to feed a child; thus must be obeyed to.

There is a network of beliefs, which support the custom, and norms (obedience

to elders) that all contribute to the inadequate IYCF practices in Haiti.

Previous solutions (What has been done till now? )

Baby Friendly Hospital Initiative.

7 hospitals certified in 1996 - increase in exclusive BF but not

sustained

Networks (youths, religious leaders, scouts, women’s groups etc...) to

promote breastfeeding.

BCC campaigns (mass media, community-based, inter-personal

through positive deviants and medical professionals).

High level advocacy to influence policies.

Baby tents after the earthquake (January 2010)

Exclusive BF increased from 24.6% in 2010 to 56.9% in 2012 in one

of the areas where evaluation was conducted.

Reasons for successes and failures Better understanding of breastfeeding’s health and

economic benefits.

Linking breastfeeding with beautiful and healthy babies.

Agressive promotion of breastmilk substitutes by

industry through health networks and mass media.

Persistent beliefs (core) and attitudes.

Lack of family support (husbands, mothers-in law etc.)

Ignorance of bottle feeding dangers.

Ineffective communication strategy (proposed solutions often

far from people and social norms).

Strategies to introduce changes Diagnostic study and a detailed analysis of the

community dynamics and the networks. Understand better the factual beliefs, attitudes and

practices that hinder appropriate breastfeeding practices

More importantly what is supporting themo Why is first milk considered dirty?o Why is water necessary for a child under 6 months?o Why breastmilk alone is not enough for such child?o Where did you learn these information?o What a mother thinks is good for her baby and why?o What a mother thinks other mothers think is good for their

babies and why?o How strong does a mother feel about following or not following

what her mother-in-law says she should or should not do? o How does a mother-in-law perceive her daughter in law who

doesn’t obey to her? And what are the sanctions?

Strategies to introduce changes Diagnostic study and a detailed analysis of the

community dynamics and the networks.o What are the most important people for the mothers and why?o What are the attitudes of these important people?o Who talks to whom in a typical community?

Broader discussion and an open dialogue with communities based on the results of the study

o Trigger argumentation and engagemento make them feel that they are co-responsible and part of the

solution of the problem.

Strategies to introduce changes Comprehensive long term communication IYCF

strategyo Culturally acceptableo Fits into the context (urban, rural, poor, rich etc..)o Creative (showing clearly that breastmilk contains water)o Addresses rationale of existing wrong factual beliefso Includes all reference group members (Networking)o Messages delivered by trustworthy sources and trained

facilitatorso Offers alternative to wrong factual beliefso Highly visible and publicized

Incentives (Collectives not individuals)o Moral and image (Awards, certificates)o Financial (through conditional cash transfers)

Advocate or ambassador (preeminent figure)o First Lady of Haiti

Existing strategies to strengthen Baby Friendly Hospital Initiative

o Train health professionals on the 10 steps for a hospital to become baby friendly

o Monitor the implementation of the 10 stepso Work with Ministry of Health to provide certification to hospitals

implementing effectively the 10 steps

Law on breast milk substituteso Provide technical and financial support to the Ministry of

Commerce and Industry and the Ministry of Health to enforce the law

Women’s groups and community-based organizationso Support existing groups and creation of new oneso Build more upon the positive deviants

Mass media campaignso Support widely use of radios and TVs to support community-

based communication for development (C4D) activities.

---- THANK YOU ----