EBF - Exclusive breastfeeding: global rates, optimal duration, and a multi-country intervention

Human breastmilk is increasingly recognized as critical for immune system development in infancy, and can substantially reduce the incidence of infectious and non-infectious childhood diseases. The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months of life; however, the recommendation is based on a 20 year old review of mostly cross sectional data, and thus, does not reflect current evidence or health impacts. Further, true global, regional, and country-level estimates of compliance with the six-month exclusive breastfeeding recommendation remains elusive. Large publicly available datasets for low- and middle-income countries only provides an average of exclusive breastfeeding within the last 24-hours among children 0-5 months of age, leaving the final duration of exclusive breastfeeding unknown. Lastly, interventions based on educational campaigns have had limited efficacy for increasing exclusive breastfeeding rates, underscoring the need for innovative interventions. A social transfer program, defined as a cash or in-kind transfer, which recognizes the economic and financial constraints faced by breastfeeding mothers could increase exclusive breastfeeding.

The overall objectives of this project are to: 1) empirically re-assess the relationship between exclusive breastfeeding duration and child health and development; 2) create updated and comparable estimates for compliance with recommendations at national,
regional and global levels; and 3) implement an innovative intervention to optimize exclusive breastfeeding in two middle-income countries with low exclusive breastfeeding rates. We will accomplish these objectives by completing the following work packages (WP): 1) build a large, multi-country database pooling international birth cohort studies to identify the optimal duration of exclusive breastfeeding for child health and development, stratifying by country economic level; 2) create national, regional, and global estimates of compliance with current exclusive breastfeeding rates applying standardized estimation models to all publicly available Demographics and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) datasets; and 3) develop and validate a social transfer intervention for increasing exclusive breastfeeding rates in Brazil and Lao People’s Democratic Republic (Lao PDR).

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