Evaluation of the effect of a breastfeeding message integrated into a larger communication project
Objective and Methods: Most breastfeeding project evaluations examine the effects of separate projects and many do not use experimental designs. We evaluated the impact during the 3rd year (March 1992-March 1993) of a simple breastfeeding message integrated into a large-scale 3 year vitamin A project in northern Bangladesh. It encouraged mothers to breastfeed for at least 2 years. Less formally, mothers were also advised to give colostrum.
Results: In both project (experimental) and non-project (control) areas, the proportion of mothers of children aged 1-6 years who said they gave colostrum increased from about 69 per cent to about 77 per cent. However, children born during the year that transpired between the pre- and post-surveys were too young to be included in the post-survey. Thus this difference is an example of women reporting what they perceived as the norm or the 'correct' answer instead of what they actually did with their children. Thus the norm changed during the evaluation year, but it did so equally in both project and non-project areas. Although reported breastfeeding levels remained stable among older groups, the proportion of children in the 2nd and 3rd years of life reported to be currently breastfeeding increased to a similar extent in both areas. This could indicate either a change in perception or a change in behaviour. Suckling frequency, not mentioned in local or national breastfeeding promotion, was unchanged in both areas at about 15 times a day for children in the 2nd year of life, and maintained at about eight to 10 times a day even for the small proportion who were still breastfed in the 5th (about 9 per cent) or 6th (about 2 per cent) years of life. While project messages (especially by radio) could have spread to the nearby non-project area, it is unlikely that the impact would be equal. More likely these changes were the result of secular changes occurring at this time throughout Bangladesh.
Conclusion: Thus this evaluation found no evidence that the integration of a simple message about breastfeeding into a larger project had any measurable effect in the project area compared to the non-project area. More effective approaches may be required, tailored to the particular needs of women in the area.