In resource-constrained settings, early and exclusive breastfeeding prevents infant and child deaths from diarrhea and other infectious diseases, supports normal growth and improves cognitive performance throughout childhood.
Despite this, optimal breastfeeding practices are declining globally, with less than half of the world’s newborns benefiting from early breastfeeding and about one-third exclusively breastfed for the first six months of life. Low-cost and effective strategies to improve breastfeeding behaviors in underserved areas are urgently needed.
Two ways to efficiently reach out to a large number of women on breastfeeding are through microfinance programs and cellphone messages. Incorporating health programs into microfinance takes advantage of the social networks and social support inherent in group activities — a type of support that can help change breastfeeding behaviors.
Mobile phone messages are also a great way to increase the number of repeated contacts with women who most need encouragement to breastfeed. Partners for Development, a nonprofit organization that works with vulnerable populations in the areas of health, agriculture, food security, livelihoods, and microfinance in Africa and Southeast Asia, and researchers from the University of North Carolina tested these ideas in northeast Nigeria by integrating group breastfeeding promotion and mobile messaging into a microcredit program. The integrated program increased the number of women who started breastfeeding early and exclusively breastfed their infants for six months.
We reached out to women participating in a microcredit program, a system in which small business owners, often women, receive loans to begin or advance their enterprise. Small groups of five to seven friends, neighbors and/or relatives join the program together and meet regularly with several other small groups to repay their microloans.
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Every month, credit officers led discussions about breastfeeding during microcredit meetings. The sessions covered recommendations for early and exclusive breastfeeding, benefits of following breastfeeding recommendations, breastfeeding techniques and timing for introducing complementary foods. Key messages from the meetings were sent as text and voice messages to mobile phones given to group leaders, who were instructed to share the messages. Group members selected some messages to be dramatized or turned into songs and performed at monthly microcredit meetings.
Giving small groups of women access to mobile phones was a key component of the program. It pushed them together to review and discuss the messages. Many groups also shared the messages with other community members, thereby facilitating a shift in social norms related to breastfeeding practices.
“This is a trust given to me that when a message comes to the phone, I must try my best to share it with women in the group,” one user explained. “I don’t only share with members of the group, but include neighbors. Even during casual discussions, as we pass time, I find a way to chip in something about our program to attract them. This way, they have accepted the messages I share that come through the phone.”
By building innovative face-to-face and mobile health components onto a microcredit program, we can spread messages to women in the groups and their friends and neighbors, greatly broadening the impact. The intervention could be scaled up in Nigeria and adopted more widely given that nearly 200 million women — many of childbearing age — are involved in microfinance globally. Assuming that each woman participating can have an impact on five of her family members and friends, this type of program, if scaled up, has the potential to benefit 1 billion worldwide.
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