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Improving hospital care for breastfeeding support in Indonesia

PI: Francisca Handy Agung, Center for Health Research, Universitas Indonesia
USG-Supported Partner: Valerie Flaherman, University of California, San Francisco School of Medicine
Project dates: February 2015 - January 2017

Project Overview:
Breastfeeding, especially exclusive breastfeeding, is one of the most effective preventive health measures available to reduce infant morbidity and mortality. For all newborns, but especially for the sick ones, breastfeeding is a simple life saving method. To improve worldwide breastfeeding initiation and duration rates, the WHO and UNICEF launched the Baby-Friendly Hospital Initiative (BFHI) in 1991. The BFHI consists of the Ten Steps to Successful Breastfeeding and the WHO International Code of Marketing of Breast-milk Substitutes. The BFHI is currently the gold standard for evidence-based breastfeeding care in hospitals. Data continues to accumulate showing that adherence to the Ten Steps predict breastfeeding duration and exclusivity long after hospital discharge. However, despite the strong evidence for the Ten Steps, hospital compliance in Indonesia is poor. A national survey for hospitals in Indonesia in 2011 found only 8% of state hospital complying with 7 out of 10 steps of successful breastfeeding.

In order to improve hospital care for breastfeeding we need to identify the barriers and opportunities of BFHI Implementation in Indonesia and obtain solid local evidence on implementing of BFHI by performing a pilot project. Thus, this project will consist of 2 studies. Study 1 is a qualitative study exploring the barriers and facilitators of BFHI implementation in Indonesia. This study will cover various stakeholders related to hospital support for breastfeeding in Indonesia from all levels: Ministry of Health, Provincial and district health offices, related professional organization, several selected hospitals, and community mother support groups. Three provinces that will be involved are Jakarta, West Java, and Banten. One district will be selected for each province and three hospitals will be selected in the respective district. Study 2 is a quasi-experimental study which will be conducted in Banten Province involving 6 hospitals with different types of services and ownership that will be randomly allocated to intervention and control groups - 3 hospitals for each group. The intervention is WHO BFHI section 2 (training for hospital managers), WHO BFHI section 3 (training for maternity staff), and 12 months technical assistance performed by Indonesian Breastfeeding Center. The outcomes of this study are the performance of hospitals on BFHI implementation using WHO module, breastfeeding self efficacy scale, family breastfeeding support scale, LATCH score, and breastfeeding rates. These outcomes will be measured both for healthy and sick newborn.

Summary of Recent Activities: 

During this reporting period, from April – June 2017, the project team finished end line data collection. Following the completion of data collection, data was cleaned and inputted. In early May 2017 , two members of study team went presented two abstracts at the Pediatric Academy Society (PAS) Meeting in San Francisco. This also allowed for the opportunity to meet with their US collaborator from the University of California, San Francisco. During the visit, the US collaborator helped the team with data analysis. The PAS Meeting allowed for the study team to develop networks with other researchers working on studies in developing countries, specifically in Indonesia. They hope to build a future collaborative networking either in research or education/ training. The PEER study was also presented at the Evidence Summit on Reducing Maternal and Neonatal Mortality in Indonesia. The summit was held in May 2017 and was hosted by the Indonesian Academy of Science (AIPI) in collaboration with the USAID Indonesia mission.

PEER Health Cycle 2 Recipients