Reach of Breastfeeding Counselling, Support or Messages

Output

% of mothers of children aged 0–23 months who received counselling, support or messages on optimal breastfeeding at least once in the previous 12 months

This indicator measures the proportion of mothers of children aged 0–23 months who were reached by counselling, support or messages on optimal breastfeeding at least once during the previous 12 months. Such support can help mothers build their knowledge, skills and confidence and prevent or address breastfeeding difficulties. The indicator does not show whether mothers currently have access to counselling, whether they received support at the recommended times or frequency, whether the provider was competent, whether the support was of adequate quality, or whether breastfeeding practices improved.

Collect the following data by conducting individual interviews with a representative sample of mothers with at least one living child aged 0–23 months. Before data collection, adapt the examples of providers and communication channels to those used in the survey area. Use locally understood descriptions of counselling and support. Do not rely only on the word “counselling”, as respondents may interpret this term differently.

Introduce the questions by saying: Now I would like to ask about any information or help you received concerning breastfeeding during the past 12 months.

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

Q1: During the past 12 months, did a health worker, community worker, trained peer counsellor or another breastfeeding support provider talk with you about breastfeeding or give you advice specific to your situation?

A1: yes / no / does not know or cannot remember

Q2: During the past 12 months, did a health worker, community worker, trained peer counsellor or another provider observe you breastfeeding or give you practical help with breastfeeding, such as help with positioning and attachment, expressing milk or addressing a breastfeeding difficulty?

A2: yes / no / does not know or cannot remember

Q3: During the past 12 months, did you receive or hear any general message about recommended breastfeeding practices through a health or community contact, group activity, telephone or SMS, radio, social media, poster, leaflet or another communication channel?

A3: yes / no / does not know or cannot remember

(ask the following question if the respondent answered YES to Q1, Q2 or Q3; record all answers that apply)

Q4: Who or what provided the counselling, support or message?

A4: (multiple answers possible)

1) health worker at a health facility

2) community health worker or volunteer

3) trained lay or peer counsellor / breastfeeding support group

4) private health professional or lactation consultant

5) telephone, messaging or online counselling service

6) community meeting, group activity or other event

7) radio, SMS, social media, website, poster or printed material

8) family member or friend who was not acting as a trained counsellor

9) other – specify: ................................

10) does not know or cannot remember

Q5: When was the most recent time you received any of this counselling, support or information?

A5:

1) month and year: ................................

2) approximately ........ months ago

3) does not know or cannot remember

Use a local events calendar where respondents have difficulty identifying whether the contact occurred within the previous 12 months.

To calculate the indicator’s value, divide the number of respondents who reported at least one eligible type of breastfeeding counselling, support or message in Q1, Q2 or Q3, and whose answer to Q5 confirms that it occurred during the previous 12 months, by the total number of eligible mothers interviewed. Multiply the result by 100 to convert it to a percentage.

Counselling and practical support reported in Q1 or Q2 should count when provided through a health service, community service, trained peer or lay counsellor, formal support group, or another recognised breastfeeding support provider. Informal advice received only from an untrained family member or friend does not enter the numerator. General breastfeeding messages reported in Q3 can count when received through an identifiable health, community, programme, public-information or communication channel. Do not count commercial promotion of breast-milk substitutes as an eligible breastfeeding message.

Include all eligible mothers in the denominator. If the required information is missing, invalid or recorded as “does not know or cannot remember”, the respondent does not enter the numerator but remains in the denominator.

Report the proportions answering YES to Q1, Q2 and Q3 separately alongside the overall indicator value. Do not add these percentages together, as one respondent may have received several types of support or information.

This data can be disaggregated by child age group (0–5, 6–11 and 12–23 months), maternal age, place of residence or programme area, household wealth and maternal education, and, if relevant and feasible, also by disability status, displacement status, ethnicity or language group.

1) Counselling, practical support and general messages are different forms of exposure. Individual counselling involves interaction and advice responsive to the mother’s situation. Practical support can include observing a breastfeed or assisting with positioning, attachment, expressing milk or a breastfeeding difficulty. A general message may involve one-way communication without personal interaction. The overall indicator counts all three, but always report them separately. Do not describe the overall result as “coverage of skilled breastfeeding counselling”.

2) This indicator is related to, but different from, the indicator on perceived access to skilled breastfeeding counselling. This indicator measures whether a mother was reached during the previous 12 months. The perceived-access indicator measures whether she can currently identify a verified counselling provider and reports that obtaining counselling would be easy. A mother may have received support previously but no longer find it accessible, or may report easy current access without having received support during the past year. If both indicators are included in the same survey, analyse them together but do not combine them into one indicator.

3) The 12-month recall period can result in forgotten contacts, confusion about timing or the reporting of events that occurred more than 12 months ago. Ask about concrete forms of contact rather than relying only on the term “counselling”. Use Q5 and a local events calendar to support recall. Report the proportion of respondents answering “does not know or cannot remember”.

4) The indicator measures exposure from any eligible source. It should be interpreted as the reach of a specific project only when Q4 confirms that the counselling, support or message came from that project or one of its supported delivery channels. Messages received through government services, other organisations, media or informal channels may otherwise be incorrectly attributed to the project.

5) The indicator does not assess whether the advice or message was accurate, age-appropriate, responsive to the mother’s needs or consistent with national and WHO recommendations. Where counselling quality or message fidelity is important, assess it separately through provider observation, competency assessment, review of materials or additional questions about the content received.

6) Include mothers regardless of whether they are currently breastfeeding. A mother may have stopped breastfeeding, may be feeding expressed or donor human milk, or may be using breast-milk substitutes. Data collectors should use non-judgemental language and should not imply that a mother is responsible for barriers, difficulties or feeding decisions.

7) This indicator relies on correct identification of children aged 0–23 months. Verify the child’s date of birth using a birth certificate, vaccination card or another available document. Where reliable documentation is unavailable, support caregiver recall with a local events calendar (see FAO guidance below). Do not exclude a mother solely because documentary proof is unavailable.

8) This indicator is included in WHO’s Global Nutrition Monitoring Framework. WHO and UNICEF are still developing and validating the indicator, and WHO has not yet specified a standard data source. The questions above are an IndiKit operationalisation for programme monitoring and should not be described as an official validated WHO questionnaire. Pre-test the questionnaire before use.

Also consider using the following indicators:

• Perceived Access to Skilled Breastfeeding Counselling (measures whether mothers can identify skilled counselling support and perceive it as easy to access now)

• Exclusive Breastfeeding Under Six Months (measures an important breastfeeding practice that counselling and support aim to enable)

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

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

• Community Health Volunteers’ Knowledge and Skills (assesses provider knowledge and practical skills where community volunteers deliver breastfeeding support)