Addressing Breastfeeding Difficulties

Women often do not breastfeed not because they are not aware of its importance but because they face problems that make breastfeeding difficult, such as sore nipples or a perception of not having enough breast milk. This indicator therefore assesses to what extent they are aware of how to address the most common breastfeeding difficulties.

Based on interviews and focus group discussions with local women, community health workers and health authorities, identify the main breastfeeding difficulties and appropriate solutions. Subsequently, conduct individual interviews with a representative sample of mothers with children aged 0-23 months, inquiring about each of the most common problems, assessing whether she can provide a correct answer on how to address it. 

EXAMPLE OF SURVEY QUESTION:

Q1: Can you please explain what a breastfeeding woman can do when her nipples are sore and breastfeeding hurts? How can she resolve such problem?

EXAMPLE OF ANSWERS:

A1: _

1) explanation was correct

2) explanation was not adequate

3) no explanation was provided

NOTE: Encourage the data collector to probe for further explanation if the initial response s/he receives is not adequate (for example, by asking: "Is there any other way how women can address the problem?").

To calculate the indicator's value, divide the number of respondents who knew how to effectively address the minimum number of common breastfeeding difficulties (for example, at least 4 out of 6) by the total number of female respondents. Multiply the result by 100 to convert it to a percentage. 

Disaggregate the data by age groups.

1) Since you already will have discussed the most common breastfeeding difficulties, you can add a question assessing whether the respondent ever faced such a problem (giving you an idea of how widespread such difficulties are). 

2) Data collectors need to be very well trained in understanding the most common breastfeeding difficulties and effective solutions. Identify them during focus group discussions with local women and key informant interviews, such as female health workers.

3) There needs to be a clear agreement on which answer counts as "correct" (i.e. the respondent knows how to effectively address the problem) and which are "inadequate" (i.e. the respondent was not able to explain an effective solution to the given breastfeeding difficulty). Make sure that this part of your questionnaire receives maximum attention during training and field-based piloting.

4) Male data collectors might be hesitant to ask women about their breastfeeding difficulties and women might be uncomfortable discussing this topic with men. Discuss with your male and female colleagues (preferably also members of your target group) whether male data collectors should be collecting data for this indicator or whether female-only data collectors need to be assigned (e.g. well-trained Community Health Workers).

5) While the resources recommended below give you a general overview of the most common lactation problems and solutions, the identification of local breastfeeding problems and best solutions always needs to be based on assessment among and consultation with the local women, health authorities (Ministry/ Department of Health) and health workers.