Addressing Breastfeeding Difficulties

Output

Outcome

% of mothers of children aged 0–23 months who can correctly explain how to respond to at least X of X [specify numbers] specified common breastfeeding difficulties

Breastfeeding difficulties such as pain, poor attachment, engorgement and perceived insufficient milk can undermine breastfeeding confidence and continuation. This indicator assesses whether mothers can explain appropriate first actions and recognise when skilled support is needed. It measures knowledge only; it does not show whether a difficulty was resolved, whether appropriate support was accessible, or whether recommended breastfeeding practices were followed.

Calculate the indicator's value by using the following methodology:

1) Identify the breastfeeding difficulties to include in the survey. Consult targeted mothers to understand which difficulties are common and what local terms they use. Based on current national guidance, ask a qualified breastfeeding or health professional to confirm the correct responses, harmful practices and situations requiring skilled support.

2) Prepare one standardised, open-ended question for each selected difficulty. For example: What should a breastfeeding woman do if her nipples are sore? What should she do first, and when should she seek help from a trained health worker or breastfeeding counsellor?

3) Before data collection, agree on what counts as a correct answer for each breastfeeding difficulty. Prepare a simple answer guide showing the key actions the respondent should mention, any potentially harmful responses, and when skilled support should be sought. Train data collectors to use this guide consistently and test their understanding during field-based practice.

4) Define how many breastfeeding difficulties a respondent must answer correctly to meet the required knowledge standard. When setting the knowledge threshold, consider whether correct answers to a limited number of questions about serious difficulties or situations requiring skilled support should be mandatory.

5) Conduct individual interviews with a representative sample of mothers of children aged 0–23 months targeted by the intervention. Data collectors should ask all prepared questions. Instruct them not to read out possible answers. If probing is needed, use the same neutral question for all respondents, such as: What else, if anything? Classify each answer as:

a) the explanation was correct

b) the explanation was incorrect or not adequate

c) no explanation was provided

6) To calculate the indicator's value, divide the number of respondents who meet the required knowledge standard set in step 4 by the total number of respondents interviewed. Multiply the result by 100 to convert it to a percentage.

Also report the percentage of respondents who answered each individual question correctly. Use the same breastfeeding difficulties, questions, probes, answer guide and knowledge threshold in each survey round. If any of these change, do not directly compare the results.

This data can be disaggregated by respondent’s number of children and, if relevant and feasible, also by access to skilled breastfeeding counselling and location.

1) Data collectors need to be well trained in understanding the selected breastfeeding difficulties and the agreed correct responses. They should practise using the answer guide so that they can consistently decide whether an explanation is correct, not adequate or absent. Give this particular attention during training and field-based piloting.

2) If a respondent reports a current breastfeeding difficulty, data collectors should follow an agreed referral procedure and provide information on where she can access support from an appropriately trained health worker or breastfeeding counsellor. Data collectors must not provide clinical advice unless they are qualified and authorised to do so.

3) Some respondents may feel uncomfortable discussing breastfeeding with a male data collector. Consult members of the target group about acceptable interviewer characteristics and, where feasible, assign female data collectors if this is preferred. Conduct interviews in a setting that protects the respondent’s privacy.

Also consider using the following indicators:

• Access to Skilled Breastfeeding Counselling (measures awareness of the skilled support needed when knowledge alone is insufficient)

• Exclusive Breastfeeding Under Six Months (measures the principal breastfeeding practice this knowledge is intended to support)

• Continued Breastfeeding 12-23 Months (assesses whether breastfeeding continues through the second year)

• Baby Friendly Health Facilities (captures the facility-level enabling environment for appropriate breastfeeding support)