Perceived Access to Skilled Breastfeeding Counselling

Output

Outcome

% of mothers of children aged 0–23 months who report that it would be easy for them to access skilled breastfeeding counselling

This indicator measures the proportion of mothers of children aged 0–23 months who can identify a skilled breastfeeding counselling provider or service and report that obtaining counselling would be easy if they needed it. It helps programmes assess whether counselling is both known and perceived as accessible. It does not measure actual service use, objective accessibility, timeliness, counselling quality or breastfeeding outcomes.

Collect the following data through individual interviews with a representative sample of mothers of children aged 0–23 months:

      

RECOMMENDED SURVEY QUESTIONS (Q) AND POSSIBLE ANSWERS (A)

Q1: Do you know of any person or service in this area that provides breastfeeding counselling or practical breastfeeding support?

A1: yes / no / is not sure

     

(ask Q2 only if Q1 is YES; do not read out the names of possible providers or services)

    

Q2: Who or which service provides this support?

A2: Code the response as:

1) identifies at least one verified, currently operational counselling provider or service

2) identifies a person or service that does not meet the verification criteria

3) cannot identify a specific person or service

      

(ask Q3 only if the respondent identifies a verified provider or service in Q2)

    

Q3: If you needed breastfeeding counselling now, how easy or difficult would it be for you to obtain it from the person or service you have just identified?

A3:

1) very easy

2) fairly easy

3) neither easy nor difficult

4) fairly difficult

5) very difficult

6) it would not be possible

7) does not know

    

   

To calculate the indicator value, divide the number of respondents who both identify a verified provider or service in Q2 and answer ‘very easy’ or ‘fairly easy’ in Q3 by the total number of eligible respondents interviewed. Multiply the result by 100 to convert it to a percentage. 

This data can be disaggregated by maternal age, disability status, wealth group, location and child age group, and, if relevant and feasible, also by displacement status, ethnicity or language group.

1) Before data collection, prepare an up-to-date list of breastfeeding counselling providers and services available to the sampled population. Confirm that each service is operational and that its providers have completed the required training or meet an equivalent nationally approved competency standard. Provide enumerators with the verified provider list, including commonly used provider or service names, roles, organisations and locations. Train them to code the response immediately, without reading out or suggesting the names of possible providers.

2) The classification of ‘very easy’ and ‘fairly easy’ as easy access is a programme-defined threshold rather than a globally standardised cut-off. Report the full distribution of Q3 responses where feasible, cognitively test the translated response scale and use the same wording and threshold across survey rounds.

3) Consider asking an additional question to identify barriers to accessing breastfeeding counselling. This question is not used to calculate the indicator value, but it can help programmes understand why counselling may be difficult to obtain and how access could be improved.

Q4: What, if anything, would make it difficult for you to obtain breastfeeding counselling if you needed it?

Record all reasons provided. Develop locally appropriate response codes for common barriers, such as distance, transport, cost, opening times, provider availability, disability access, language, privacy, safety, family restrictions, discrimination or lack of trust. Include an ‘other – specify’ option.

    

4) Pair this indicator with a separate measure of counselling use. Depending on the programme, measure either the proportion of mothers of children aged 0–23 months who received breastfeeding counselling from a verified provider during a clearly stated recall period, or the proportion of mothers who experienced a recent breastfeeding difficulty and obtained appropriate support. Define the recall period before data collection and report this measure separately. Receipt of counselling does not by itself demonstrate adequate frequency or quality.

 

5) This indicator relies on accurate age assessment. Since people often do not remember the exact dates of their children’s birth, the data collectors should always verify the child’s age. This can be done by reviewing the child’s birth certificate, vaccination card or another document; however, since many caregivers do not have such documents (and since they can include mistakes), it is essential that your data collectors are able to verify the child’s age by using local events calendars. Read FAO’s Guidelines (see below) to learn how to prepare local events calendars and how to train data collectors in their correct use.

Also consider using the following indicators:

• Addressing Breastfeeding Difficulties (assesses mothers’ knowledge of appropriate responses to common breastfeeding problems)

• Exclusive Breastfeeding Under Six Months (measures a key breastfeeding practice that effective counselling is intended to support)

• Continued Breastfeeding 12-23 Months (measures continued breastfeeding during the later part of the counselling period)

• Community Health Volunteers’ Knowledge and Skills (assesses provider competence where community volunteers deliver counselling)