Poor breastfeeding practices lead to up to 11.6 percent of deaths in children under five years old. Breastfeeding not only supplies adequate nutrition to a growing newborn but also reduces vulnerability to illness. Breastfeeding also confers significant benefits to the mother, reducing the likelihood of facing postpartum depression, breast cancer, or type 2 diabetes. Yet global breastfeeding rates remain at 48% (WHO 2023).
From 2010 to 2014, A&T piloted a set of interventions, (1) intensive interpersonal counseling; (2) community mobilization; and (3) a mass media campaign, to increase exclusive breastfeeding practices among pregnant mothers and mothers of children less than 2 years of age in Bangladesh. In the group that received intensified treatment, exclusive breastfeeding nearly doubled from 48.5 percent to 87.6 percent.
These types of interventions, although often successful, have been noted as generally failing to achieve and maintain scale.
From 2014 to 2016, BRAC continued and scaled up implementation with modifications such as an added focus on maternal nutrition in counseling and less frequent training and supervision of frontline workers. Interventions with mothers were paired with policy advocacy to create a supportive environment for optimal breastfeeding practices. Namely, A&T engaged with a national alliance of IYCF stakeholders; conducted outreach with journalists; and held individualized dialogue with government decision-makers and donors. Even with reduced program intensity, groups that continued to receive interventions in the 2-year follow-up period demonstrated a sustained impact on breastfeeding practices.
The National IYCF Alliance–comprising A&T, BRAC, UNICEF and the government as its nucleus plus over 20 other stakeholders–led to building up resources for scale and is now a formal structure of the government of Bangladesh. Currently, government frontline health workers execute the improved counselling during home visits, which is an intervention supported by community mobilization as well as mass media campaigns primarily reaching mothers.
Number of beneficiaries:
- 2010-2014: 8.5 million mothers (5% of total 2014 Bangladesh population)
Budget:
- 2018-2022: $1,169,193 USD
Multi-level governance involving national government, international organizations, and country-based NGO.
Alive & Thrive first partnered with the Bangladesh NGO BRAC to conduct initial implementation research from 2009 to 2014. BRAC offers widespread maternal, newborn, and child health services, including prenatal care. BRAC workers provide nutrition education, supplements, counseling, and other medical services to women, primarily in rural areas.
A&T initially collaborated with the Bangladesh government to disseminate national broadcasts on IYCF practices for the mass media intervention. After the proof-of-concept phase, the government adopted A&T’s mass media materials to continue broadcasting IYCF videos nationally. As part of scale-up efforts, A&T also developed a national training module for government health providers.
Since 2016, Alive & Thrive has shifted its relationship with the Bangladesh government to policy advocacy. It provides technical assistance to the government’s National Nutrition Services to demonstrate and support the scale up of interventions to improve maternal nutrition, adolescent nutrition, and IYCF in rural and urban settings.
IFPRI’s role in this program has been to evaluate the impact of these integrated approaches to improving IYCF practices, child nutrition, and child development. The impact evaluation has informed global debate on nutritional interventions. Stakeholders such as the government of Bangladesh and international organizations have actively utilized the findings to guide their policy and programmatic decisions in the fields of health, nutrition, and social welfare.
A&T Bangladesh Baseline and Endline Surveys available on IFPRI Dataverse
Journal articles:
Manuals:
Implementation Manual: Community-based Maternal Nutrition Program
Tools for Delivering Maternal Nutrition Programs
Blogs:
Starting off right: Scaling up breastfeeding practices in Bangladesh and Viet Nam
Breastfeeding practices can be improved at large scale for better health and nutrition
An IFPRI evaluation study demonstrated that combining social and behavior change communication—(1) intensive interpersonal counseling, (2) broader methods of outreach, and (3) policy advocacy at the national level—was most effective in scaling up exclusive breastfeeding practices.
Given the need to maintain appropriate IYCF practices among new cohorts of infants and young children, it is important to sustain effective behavior change communication interventions until these practices are incorporated as the norm among the target population. Although knowledge is an important determinant of practice, the gap between knowledge and practice related to child feeding persists, pointing to the need for continued efforts in reducing sociocultural barriers and creating enabling environments for optimal feeding practices.
Programs focusing on behavior change must be coupled with other interventions to address trends that impact women’s abilities to adopt exclusive breastfeeding practices—for example, increases in caesarean section births and maternal workforce participation in many parts of the world.
Results have shown that Alive & Thrive’s basic template of interventions can be applied in diverse countries and cultures, using different service delivery platforms operating in differing contexts.
Collaboration between researchers and program staff has helped the initiative to be successful and have global impacts as it can be applied at scale.
SDG 2 – Zero hunger
- Target 2.2 - By 2030, end all forms of malnutrition, including achieving, by 2025, the internationally agreed targets on stunting and wasting in children under 5 years of age, and address the nutritional needs of adolescent girls, pregnant and lactating women and older persons
- Indicator 2.2.1 - Prevalence of stunting (height for age <-2 standard deviation from the median of the World Health Organization (WHO) Child Growth Standards) among children under 5 years of age
- Indicator 2.2.2 - Prevalence of malnutrition (weight for height >+2 or <-2 standard deviation from the median of the WHO Child Growth Standards) among children under 5 years of age, by type (wasting and overweight)
- Indicator 2.2.3 - Prevalence of anaemia in women aged 15 to 49 years, by pregnancy status (percentage)
SDG 3 – Good health and well-being
- Target 3.2 - By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births
- Indicator 3.2.1 - Under-five mortality rate
- Indicator 3.2.2 - Neonatal mortality rate
SDG 2 – Zero hunger
- Target 2.2 – By 2030, end all forms of malnutrition, including achieving, by 2025, the internationally agreed targets on stunting and wasting in children under 5 years of age, and address the nutritional needs of adolescent girls, pregnant and lactating women and older persons
- Indicator 2.2.1 – Prevalence of stunting (height for age <-2 standard deviation from the median of the World Health Organization (WHO) Child Growth Standards) among children under 5 years of age
- Indicator 2.2.2 – Prevalence of malnutrition (weight for height >+2 or <-2 standard deviation from the median of the WHO Child Growth Standards) among children under 5 years of age, by type (wasting and overweight)
- Indicator 2.2.3 – Prevalence of anaemia in women aged 15 to 49 years, by pregnancy status (percentage)
SDG 3 – Good health and well-being
- Target 3.2 – By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births
- Indicator 3.2.1 – Under-five mortality rate
- Indicator 3.2.2 – Neonatal mortality rate
Poor breastfeeding practices lead to up to 11.6 percent of deaths in children under five years old. Breastfeeding not only supplies adequate nutrition to a growing newborn but also reduces vulnerability to illness. Breastfeeding also confers significant benefits to the mother, reducing the likelihood of facing postpartum depression, breast cancer, or type 2 diabetes. Yet global breastfeeding rates remain at 48% (WHO 2023).
From 2010 to 2014, A&T piloted a set of interventions, (1) intensive interpersonal counseling; (2) community mobilization; and (3) a mass media campaign, to increase exclusive breastfeeding practices among pregnant mothers and mothers of children less than 2 years of age in Bangladesh. In the group that received intensified treatment, exclusive breastfeeding nearly doubled from 48.5 percent to 87.6 percent.
These types of interventions, although often successful, have been noted as generally failing to achieve and maintain scale.
From 2014 to 2016, BRAC continued and scaled up implementation with modifications such as an added focus on maternal nutrition in counseling and less frequent training and supervision of frontline workers. Interventions with mothers were paired with policy advocacy to create a supportive environment for optimal breastfeeding practices. Namely, A&T engaged with a national alliance of IYCF stakeholders; conducted outreach with journalists; and held individualized dialogue with government decision-makers and donors. Even with reduced program intensity, groups that continued to receive interventions in the 2-year follow-up period demonstrated a sustained impact on breastfeeding practices.
The National IYCF Alliance–comprising A&T, BRAC, UNICEF and the government as its nucleus plus over 20 other stakeholders–led to building up resources for scale and is now a formal structure of the government of Bangladesh. Currently, government frontline health workers execute the improved counselling during home visits, which is an intervention supported by community mobilization as well as mass media campaigns primarily reaching mothers.
An IFPRI evaluation study demonstrated that combining social and behavior change communication—(1) intensive interpersonal counseling, (2) broader methods of outreach, and (3) policy advocacy at the national level—was most effective in scaling up exclusive breastfeeding practices.
Given the need to maintain appropriate IYCF practices among new cohorts of infants and young children, it is important to sustain effective behavior change communication interventions until these practices are incorporated as the norm among the target population. Although knowledge is an important determinant of practice, the gap between knowledge and practice related to child feeding persists, pointing to the need for continued efforts in reducing sociocultural barriers and creating enabling environments for optimal feeding practices.
Programs focusing on behavior change must be coupled with other interventions to address trends that impact women’s abilities to adopt exclusive breastfeeding practices—for example, increases in caesarean section births and maternal workforce participation in many parts of the world.
Results have shown that Alive & Thrive’s basic template of interventions can be applied in diverse countries and cultures, using different service delivery platforms operating in differing contexts.
Collaboration between researchers and program staff has helped the initiative to be successful and have global impacts as it can be applied at scale.
Maternity protection/benefits; Integrated programmes for human capital development, including health and education and early childhood development
Multi-level governance involving national government, international organizations, and country-based NGO.
Alive & Thrive first partnered with the Bangladesh NGO BRAC to conduct initial implementation research from 2009 to 2014. BRAC offers widespread maternal, newborn, and child health services, including prenatal care. BRAC workers provide nutrition education, supplements, counseling, and other medical services to women, primarily in rural areas.
A&T initially collaborated with the Bangladesh government to disseminate national broadcasts on IYCF practices for the mass media intervention. After the proof-of-concept phase, the government adopted A&T’s mass media materials to continue broadcasting IYCF videos nationally. As part of scale-up efforts, A&T also developed a national training module for government health providers.
Since 2016, Alive & Thrive has shifted its relationship with the Bangladesh government to policy advocacy. It provides technical assistance to the government’s National Nutrition Services to demonstrate and support the scale up of interventions to improve maternal nutrition, adolescent nutrition, and IYCF in rural and urban settings.
IFPRI’s role in this program has been to evaluate the impact of these integrated approaches to improving IYCF practices, child nutrition, and child development. The impact evaluation has informed global debate on nutritional interventions. Stakeholders such as the government of Bangladesh and international organizations have actively utilized the findings to guide their policy and programmatic decisions in the fields of health, nutrition, and social welfare.
Number of beneficiaries:
- 2010-2014: 8.5 million mothers (5% of total 2014 Bangladesh population)
Budget:
- 2018-2022: $1,169,193 USD
A&T Bangladesh Baseline and Endline Surveys available on IFPRI Dataverse