Improving breastfeeding practices: A case study from India

Strategic communication involves the use of multiple activities to reach intended audiences. UNICEF, India is working in 16 districts across India to promote specific breastfeeding behaviors: feeding colostrum, early initiation (<1 hour of birth) and exclusive breastfeeding for six months. The intervention uses trained village volunteers, group meetings, folk media, mass media and local print materials.

The first round of the impact assessment was undertaken with mothers with children between 0 – 6 months in three districts. A total of 1400 women were sampled using random systematic methods. Data was collected by a local research agency AC Nielson under contract to UNICEF, India.

Structural equation modeling was used to assess the direct effect of intervention exposure on behaviors as well as indirect effect through cognitive, emotional and social factors that mediate breastfeeding practices. The mediators included nine elements: knowledge, beliefs, advantages, risks, self-efficacy, interpersonal communication, social norms, social influence and perceived prevalence. Fifteen demographic, economic and behavior predictors (gender, birth order and exact age of index infant) were included as control variables. Results revealed no significant direct effect of intervention exposure on behaviors. However, clear indirect impact of the intervention on all individual mediators, except knowledge (possibly due to ceiling effects) was found. In turn specific mediators: perceived risks of not practicing exclusive breastfeeding, beliefs associated with feeding colostrum, self-efficacy, interpersonal communication and perceived prevalence were significantly correlated with breastfeeding behaviors. The potential impact of strategic communication interventions focusing on these significant mediators to promote breastfeeding behaviors is clear.