Illustrative Example: Determine Activities and Interventions (Step 5)

SBCC approaches, activities and illustrative examples are presented here as potentially appropriate choices for communicating with audiences about breastfeeding. These suggestions are a starting point—you might think of others that fit your situation well. Include in your strategy only the approaches and activities you have the resources and experience to carry out successfully. Close collaboration with communication and creative professionals can help ensure that design and execution are innovative and compelling.

Please note that FBO messaging about breastfeeding should be consistent with national and local efforts. It can be integrated into essential newborn care, IYCF, MCH, and SBCC efforts.

Reviews from many successful countries have shown that success on breastfeeding can be achieved by:

Doing all of the right things (comprehensive, evidence-based package, based on assessment of needs and situation)
At all levels (national, health system, community, communication)
In the right way (applying best practices, using effective strategies, providing appropriate training & supervision)
For everyone (national scale and ensuring equity)
All the time (sustained, ongoing implementation, fully institutionalized)

Some FBOs might need substantial support to plan and implement such a comprehensive program, so it is important to find out what others are doing (or willing and able to do) to increase optimal breastfeeding and to collaborate and coordinate with them when possible. For example, if a larger NGO or the MOH is implementing a mass media campaign, the FBO might:

Implement peer support through mothers’ groups, prayer groups or other supportive groups,
Use religious services to deliver breastfeeding messages that reinforce the mass media effort,
Train and send experienced mothers to maternity wards to support women just learning to breastfeed,
Organize community dialogues on the importance of optimal breastfeeding and risks of not breastfeeding,
Organize workshops or one-on-one sessions where women learn how to practice optimal breastfeeding, including correct positioning and active feeding, and
Organize workshops where women learn what, when, and how to prepare appropriate foods for complementary feeding.

If the FBO has a health facility, it should also institute the Baby Friendly Hospital Initiative (BFHI) and ensure appropriate staff are trained and doing what they are supposed to do to promote and facilitate early and exclusive breastfeeding. FBO health facilities can also ensure breastfeeding counseling and materials are provided to anyone seeking MCH services. Key breastfeeding interventions proven to be effective include:

Legislation to protect breastfeeding
Institutionalizing the BFHI/10 Steps
Counseling & support through primary health care (integrated IYCF counseling)
Counseling & support by trained community cadres (integrated IYCF counseling)
Mother to mother support groups in the community
Implementation of an evidence-based comprehensive communication strategy

Depending on country context, it may also be important to have interventions that address policy and practice (including pre-service education), supply, and monitoring.

Examples of breastfeeding interventions, materials, and programs can be found in Resources.

Mass Media

INTERVENTION AREA	ILLUSTRATIVE ACTIVITIES	PURPOSE	INTENDED AUDIENCE
Local mass media	Develop sermons that promote breastfeeding. Disseminate them by radio, TV, CD/DVD, web Develop radio and TV spots on breastfeeding. For example: Real women breastfeeding and talking about how it improves their and their child’s life Grandmothers sharing what they have learned and witnessed about the benefits of colostrum, exclusive breastfeeding, and supporting the workload; Women of all social strata who breastfeed instead of giving formula; emphasis on how much nicer, cleaner, and safer it is. (A successful TV spot in Viet Nam showed babies talking about the benefits of breastfeeding and one baby asking its mother to breastfeed only). Integrate breastfeeding and other newborn care topics into a multi-episode radio serial on MNCH Produce radio call-in shows with breastfeeding as a health and nutrition topic	Increase awareness and knowledge of benefitsIncrease acceptability of optimal breastfeeding practicesDepict role models practicing desired behaviors; stimulate social dialogue about everyone’s role in protecting maternal and child healthAnswer listener questions to further dispel myths and provide accurate informationShift social norms around breastfeeding	Pregnant women/new mothersGrandmothers and other caregiversFathersFaith communitiesBroader communitiesSpots will also reach some health providers, faith leaders, and political leaders
Print media	Develop/adapt take home brochures/leaflets on breastfeeding, stickers to remind women to seek help if they are having trouble breastfeeding Posters “Overcoming the barriers” action cards Circulars with religious justification, sermon excerpts	Increase awareness about breastfeeding benefits and formula/mixed feeding risksRemind audiences of key messages	Pregnant women/new mothersFathersFaith communities
Digital media and mHealth	Produce SMS service on breastfeeding benefits, breastfeeding tips, reminders of when and where to go for help, encouragement (including religious references) Develop SMS messages reminding pregnant women to decide to breastfeed, and to give the first milk Host infant and young child feeding hotline (phone and/or SMS-based) Where appropriate, social media pages on breastfeeding Develop short video clips and short FAQs that model breastfeeding promotion and education (accessible on basic and smart phones)	Increase awarenessStimulate social dialogueIncrease knowledge and skills	Pregnant women/new mothersFathersFaith communities

Community-Based Services, Outreach and Community Approaches

INTERVENTION AREA	ILLUSTRATIVE ACTIVITIES	PURPOSE	INTENDED AUDIENCE
Traditional birth attendant (TBA) outreach	Train TBAs to advise giving colostrum, assist with positioning child for initial breastfeeding, and recommend exclusive breastfeeding for the first six months and continued breastfeeding from 6-24 months. Develop/adapt materials and job aides (practice dolls, flipbooks, pictorial checklists, etc.) to provide guidance for counseling on breastfeeding Develop certificate or laminated card showing TBA as having completed breastfeeding/IYCF training	Improve knowledge and skillsImprove linkages with faith community and health systemAcknowledge TBA value	TBAs
Community Health Worker (CHW) outreach	Train CHWs to conduct community-based breastfeeding education and counseling Establish CHW radio listening groups for distance learning program Develop/adapt materials and job aides (practice dolls, flipbooks, pamphlets, checklists, referral cards, etc.) to provide guidance on breastfeeding and IYCF counseling including problem solving Develop songs, logos, buttons, badges, and other items that support the central positioning and promotion of acceptability	Improve knowledge and skillsProvide peer-supported learning opportunitiesEnsure quality counseling, education and referralPromote optimal breastfeeding practice as the new norm Provide incentives	CHWs
Community approaches	Promote healthy lifestyles including optimal breastfeeding, and hygiene, into spirituality during sermons or other religious teachings Hold awareness raising campaigns around optimal breastfeeding during Breastfeeding Week (August 1-7 every year). Incorporate breastfeeding as a key topic for faith-based mothers’/women’s groups Organize support groups for breastfeeding women Organize discussion groups for grandmothers, other family members and community leaders as appropriate Invite respected clergy and health professionals to speak and answer questions Incorporate breastfeeding as a key topic for faith-based women’s groups Organize support groups for mothers Organize discussion groups for grandmothers, other family members and community leaders as appropriate Use FBO events to promote optimal breastfeeding practices Organize community events that promote optimal breastfeeding practices as the norm—perhaps in conjunction with other MNCH or nutrition practices—such as community theater, world breastfeeding week events, etc.	Encourage social dialogue on relevant breastfeeding topicsIncrease social support for optimal breastfeeding practicesDecrease social support for mixed and formula feedingCreate/improve environment for cultural shiftIncrease breastfeeding prevalence and duration	Pregnant womenGrandmothersFathersCommunities TBAs
Peer Educators/ Champions	Find satisfied mothers to use as community advocates Coach peer educators/champions on key messages Identify “everyday heroes” - grandmothers in the community who support optimal breastfeeding practices and are helping to ensure the health of their families. Celebrate them at community events and through community and mass media Identify women and family members who have suffered the loss of a newborn or constant childhood illness and are now using optimal breastfeeding practices to save other families from such both. Have them speak at community meetings, in mass media, at work where appropriate, and one-on-one with their neighbors	Encourage social dialogue on preventing neonatal deathsIncrease social support for optimal breastfeeding practices	WomenGrandmothers and other caregiversFathers and communities

Structural

INTERVENTION AREA	ILLUSTRATIVE ACTIVITIES	PURPOSE	INTENDED AUDIENCE
Policy and guidelines	Advocate to public and private sector leaders to adopt and enforce policies and procedures that promote and allow for optimal breastfeeding practices (e.g., breastfeeding rooms, etc.) Distribute up-to-date breastfeeding guidelines for use at all health facilities Distribute policy/guidelines to companies that produce or market infant formula Update monitoring and supervision tools to include breastfeeding counseling, baby-friendly delivery rooms, and other BFHI indicators Twitter feed on international, national, and local impact of breastfeeding; FBO breastfeeding activities, progress and lessons learned; and other relevant information Allowing breastfeeding in religious institutions and/or during religious services/celebrations	Increase knowledgeEnsure appropriate guidelinesEnsure practice matches policy	Health district and facility decision-makers and implementers
Pre-service, in-service, on-the-job, and refresher training	Integrate optimal breastfeeding practices and counseling into pre-service, in-service, on-the-job and refresher training at all FBO institutions (for all providers including doctors, nurses, midwives, physician assistants, CHWs, and pharmacists)	Increase awareness and practice	Health providers
Digital/distance learning	Develop short video clips and print FAQs that model education and counseling that can be disseminated via video, smartphones, tablets and online Use Twitter or other social media as a discussion forum to share program implementation ideas, problems, and solutions	Increase and refresh knowledge and skills	ANC providers Skilled birth attendants Supervisors of CHWs
Other continuing education	Offer breastfeeding counseling workshops and online courses that include up-to-date guidelines and best practices Distribute updated breastfeeding job aids	Increase awareness and improve practice	Professional associations for health providers