Publications Summary

Document Type
Working Papers
Publication Topic(s)
Health facilities/SPA surveys, Nutrition
Malawi, Haiti
Recommended Citation
Mallick, Lindsay, Rukundo K. Benedict, and Wenjuan Wang. 2019. Examining the Role of Health Facilities in Supporting Early Breastfeeding in Haiti and Malawi. DHS Working Paper No. 161. Rockville, Maryland, USA: ICF.
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RIS format / Text format / Endnote format
Publication Date
August 2019
Publication ID


Early initiation of breastfeeding (within an hour of birth) has numerous benefits for newborn health and survival. Optimal breastfeeding supports child growth, health, and development. Health facilities provide essential pregnancy, maternal, and newborn care services and offer support for early breastfeeding. In this study, we examined the relationship between the breastfeeding-related health service environment during antenatal care (ANC) and early initiation of breastfeeding. Using data from recent Service Provision Assessment (SPA) surveys in Haiti and Malawi, we defined three variables related to the health service environment: availability of facilities with ANC services that report routine counseling on breastfeeding; provider training on breastfeeding; and observation of breastfeeding counseling during ANC and client’s report of it. We linked SPA data geographically to corresponding data from the Haiti and Malawi Demographic and Health Surveys (DHS). Multilevel, multivariable logistic regressions examined associations between the three health-service-related variables and women’s early initiation of breastfeeding controlling for women’s background characteristics, with separate analyses for urban and rural residence. Over 95% of facilities in both urban and rural areas of Haiti and Malawi reported routinely providing breastfeeding counseling during ANC. The study found, however, that only 26%-40% of providers had received recent training in counseling on breastfeeding, and only 4%-10% of clients received counseling. Counseling was generally more common among clients who attended ANC with a provider who had received recent training. After linking SPA and DHS data, our analysis showed that having more providers recently trained on breastfeeding was significantly associated with increased odds of early breastfeeding among ANC clients in urban areas of Haiti and Malawi. Additionally, women in urban areas of Malawi who had more counseling during ANC were more likely to initiate breastfeeding within an hour of birth compared with women in areas with less counseling. Our study identified gaps in the health system’s capacity to implement the recommended global guidelines in support of optimal breastfeeding practices. While breastfeeding counseling during ANC can promote early breastfeeding, both the level and the quality of counseling are often inadequate. The study provides evidence that increased provider training could help to improve counseling and support for early initiation of breastfeeding.


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