Traditional Birth Attendants can be trained to maximize breast feeding and decrease prelacteal feeding in Ethiopia's Amhara region

The World Health Organization recommends that newborns begin breastfeeding within the first hour after birth. The Ethiopia Demographic and Health Survey (EDHS, 2005) indicates that in the northern region of Amhara, this milestone is met in only an estimated 63% of all cases. Interview of mothers and health workers in this region found that colostrum is widely thought to cause abdominal pain or other harm to the infant and may be partially discarded at the start of breastfeeding. Additional public health concerns are the separation of mother and baby during delivery of the placenta and in the hours immediately following birth and widespread (63%) traditional practice of prelacteal feeding of unpasteurized butter, cow's milk or yeast and water. Our experience with Amhara communities suggests that women have a great desire for education about infant/child care and nutrition. An estimated 94% of all births in Ethiopia take place at home, and approximately one third of births (30%) in Amhara are attended by a Traditional Birth Attendant (TBA) (EDHS, 2005). With health access in Ethiopia limited by the strain of population growth coupled with “brain drain” of qualified health personnel, a practical solution to improving breastfeeding initiation and postnatal infant nutrition might be training TBAs to implement WHO recommendations through birth methods that include early skin-to-skin contact and protection of the mother-baby dyad in the hours immediately after birth. The emerging use of mobile telephones and reports of regular consultation among TBAs would facilitate educational and follow-up efforts.