Illustrative Example: Choose Intended Audiences (Step 3)
Potential audiences for improving optimal breastfeeding practices include expectant and new mothers, fathers, grandmothers and other caregivers, faith leaders and communities, other community leaders and the broader community, political leaders and others. Note: The audience information in this example comes from studies from many countries. You will need to consult or conduct local research on breastfeeding beliefs and practices and health provider knowledge, attitudes, and practices about optimal and local infant/child feeding practices in your location. Use local research to define the primary and influencing audiences and to inform the audience profiles and strategy. The people who most influence infant feeding may vary by and within countries and communities.)
Primary and Influencing Audience Segments
(with rationale for their selection)
Primary audience 1: Pregnant women and mothers of children 0–24 months old – Pregnant women and new mothers are the primary caretakers of infants. Unless a wet nurse or milk bank is used, mothers are also the only ones who can produce breast milk for their children. Women knowing and using optimal breastfeeding practices can improve their child’s survival chances, health, and development. (Note: If needed, you can divide these women into even more targeted segments according to education, age, ethnic group, and other factors. Local research will show what characteristics matter for breastfeeding behaviors and what communication channels best reach them each segment.) Primary audience 2: Grandmothers (of the child) and family members who provide newborn care –Grandmothers and other relatives often help with feeding and care when the mother is away, resting or busy. Therefore, it is important to reach them with information about breastfeeding and the risks of introducing other food and drink too early. Mothers and fathers often also place a high value on the advice and knowledge of family elders when making decisions about feeding a new baby. Grandmothers in particular often have a strong voice in decisions about infant and child feeding. They can be a strong force in maintaining or changing social norms and cultural practices regarding infant feeding. Primary Audiences
Influencing Audiences
Influencing audience 1: Fathers – While newborn care may be seen as “women’s responsibility,” the father of the child can have a strong influence on breastfeeding practices. If the father is supportive, the mother is more likely to continue breastfeeding and eat more nutritious foods more often while breastfeeding. If the father believes early supplementation is better for the child, the mother is more likely to add other food and drink early. And if the father supports the mother in getting antenatal and postnatal care, the mother is more likely to go. Also, if the father supports the mother in attending antenatal and postnatal visits, the mother is more likely to attend. As well, fathers can be supportive of reducing a mother’s workload so they have time to practice active breastfeeding. Educating fathers and helping them to be supportive is crucial to increasing optimal breastfeeding practices.
Influencing audience 2: Faith communities – Faith communities can be recruited to help make optimal breastfeeding practices the normal things for their members and communities to do. They can show how important breastfeeding is using religious texts and traditions. They can foster safe discussions about barriers to breastfeeding and actions to overcome them within faith-based support groups. They can spread the word about the benefits of maternal nutrition, breastfeeding and the risks of mixed and artificial feeding. They can model appropriate behaviors—for example, they can look favorably on mothers who breastfeed on demand. They can support mothers who have trouble breastfeeding. They can encourage family members to support mothers—by helping reduce her workload, for example. They can encourage fathers to be supportive and helpful to breastfeeding mothers.
Influencing audience 3: The communities– Community norms play a large role in breastfeeding practices. Helping communities change their expectations and beliefs about breastfeeding can be crucial to sustaining improved breastfeeding practices over time.
Influencing audience 4: Policymakers – Policymakers can ensure Baby-Friendly Hospital programs are widely implemented. They can prioritize SBCC programs that increase breastfeeding. They can introduce policies to increase maternity leave so mothers can easily practice exclusive breastfeeding longer. They can ensure funding to temporarily supplement family income while a mother stays home to breastfeed. They can restrict marketing of infant formula. (Faith and other community leaders are often in a position to advocate with political leaders for such changes.)
Audience Profiles
Primary Audience 1:
Pregnant Women and Mothers of Infants 0-24 Months
Halima, 34, expectant mother living outside of Abuja, Nigeria
Halima is pregnant, married, with 3 boys, ages 9, 6, and 4. She attended Qur’an school as a girl. Her first child died soon after birth, at home. She had her next child at the district hospital and the third one at home alone because the baby came too fast. The next time, she stayed with a relative who lived closer to the health center as her due date approached. Halima keeps a small vegetable plot and owns a few chickens; she earns extra money selling vegetables and eggs. She wants her children to attend school, so she saves as much money as she can. Her husband has gone to the capital city to look for better work, and he comes home some weekends; he sends money when he can, to her mobile phone. Halima’s house has an old latrine, and she gets water from a nearby stream. Halima attends the community health talks when the health worker comes several times a year. She has been preparing for some time for the birth of this child. Even though she is six months pregnant, she has not yet had time to go and wait at the ANC clinic. She plans to do so this month. The nearest health center is 10 kilometers away, and she plans to deliver there. She has breastfed all of her children for around two years, but has given them water almost from the beginning. She has given them porridge and whatever the family ate by the third or fourth month.
Sunita, 21, Lamjung, Nepal.
Sunita has given birth twice without her husband being there. Her first child was born when her husband was working abroad. Sunita was only 18 years old and had been married just one year. She lived with her in-laws and assumed the traditional role of the daughter-in-law. This role included full responsibility for the household chores, even throughout her pregnancy. Unaware of the importance of antenatal check-ups or even the location of the nearest health post, Sunita never sought formal healthcare. When she felt ill, she consulted local traditional healers for advice. She gave birth at home, assisted only by a few local women. Her first child died within fifteen days of birth. During her second pregnancy, she ate more regularly and was more cautious about straining herself doing household chores. She delivered a baby girl at home, who is now 4 months old, and has since resumed her heavy workload. Sunita feeds her daughter a little porridge and some water because she fears her breast milk is not enough and her baby cries all the time. She also feels that she doesn’t have enough time to breastfeed every time the baby is hungry.
Ria, 26 years old, Bawadesolo, Nias Island, Indonesia.
Ria is married and just found out she is pregnant with her 3th child. Her first child died soon after birth, at home. She did not live long enough to be breastfed, as the custom is to throw away colostrum. She had her second child at the district hospital and was told to breastfeed right away. (She did not tell her mother-in-law that she gave the first milk to the newborn.) That child is now 11 months old.Ria plans to stop breastfeeding now that she is pregnant again. She is worried about what the child will eat, since her family is quite poor. In addition to managing her household she sells vegetables in the local market. She has heard from relatives in the city that infant formula is good for the baby and would give her more time to do other things. She wants to try it but is not sure she can afford it. Her mother and older sisters give her lots of advice.
Primary Audience 2:
Grandmothers and Family Members Who Provide Newborn Care
Mrs. Tiwari, 57, grandmother, Deoghar District, Jharkhand State, India.
Mrs. Tiwari is very proud that her son is married, has one child plus a new one on the way, and that he has a job to provide for his family. Her daughter-in-law is respectful and is good at keeping the home. They get along well. Mrs. Tiwari raised four healthy children by asking her own mother-in-law for advice and remedies, and she expects her daughter-in-law to consult with her on how to care for the new baby. Her family has a long tradition of feeding newborns a special tea just after birth and throwing away all colostrum. She is certain that this cleans the insides of the child and prepares it to breastfeed once the “normal” milk arrives. Mrs. Tiwari cares about her family’s reputation but also wants the best for her family. Mrs. Tiwari listens to the radio and speaks to her friends at the temple each morning, and they share stories about their families.
Miriam, 40, older sister, Kinshasa, DR Congo.
Miriam is 40 years old and has given birth to 7 children with the help of a traditional birth attendant. One of her children died within weeks of his birth. Another died before age 2. Some of her deliveries were difficult, but most of her children survived. She believes the old ways are good ways since they have worked for generations. All of her children were breastfed, and she started giving thin porridge when they seemed to need it, at 3 or 4 months. When the government opened a health center in her village, she began taking her children for immunization. Nonetheless, she rarely seeks treatment at the government health center, preferring to seek assistance from her long-trusted healer. She is helping her much younger sister prepare for the birth of her first child and will be there when the child is born.
Influencing Audience 1: Fathers
Marco, married father, 30, Atauro, Timore-Leste.
Marco has two children, ages 8 months and three years. He works in construction and has worked consistently for the past few years. He is happy and proud that his wife is expecting their third child. They do not normally discuss the pregnancy or what happens at her ANC visits – that is the women’s domain. He does, however, comment on what the children eat and how well they are growing. Marco is proud that his children are healthy and that he is able to support his wife so she can stay at home and take care of the children. He is responsible for making decisions for his family on everything from health care to education to regular purchases. Marco doesn’t know much about breastfeeding except that almost all women do it at some point. He likes feeding his young children as soon as he can because it gives them quality time together. He finds his wife more attractive when she is not breastfeeding.
Thomas, 35, married father of one, living in Kadoma, Zimbabwe.
Thomas is 25 years old with one wife. They are expecting their first child. A devout Christian, he believes it is his role to make all of the important decisions for his family after consulting with his wife. As is the tradition, family elders also have certain expectations and offer advice and wisdom. Both he and his wife must work long hours. His wife has mentioned that the ANC nurse told her she will need to buy infant formula when she returns to work. He has never accompanied his wife to the ANC clinic, but he is not sure that is good advice.
Haider, 40, married father of three, living in rural Chittagong, Bangladesh.
Haider completed 7 years of formal education and works for a local merchant. His home has electricity, a tin roof and a toilet. He watches TV with neighbors but has his own mobile phone. A TBA delivered Haider’s one-month old child. Haider’s mother is staying with the family for the newborn’s first 45 days. After that, his wife will have to resume all her normal chores. His wife did not attend ANC because he did not believe it was necessary and would have had to go with her. He believes all babies need water in addition to breast milk. He is proud to be able to buy tinned milk for his baby as well. Lately, the baby has been crying a lot and not sucking well. He hopes he will not have to take the baby and his wife to the health clinic, as that will cost him time and money.
Influencing Audience 2: Faith Leaders and Faith Communities
Moussa, 57, religious leader in Niamey, Niger.
Moussa is 57 years old and has four children. He serves as a religious leader in his village. The men and women in his community look to him for his knowledge and wisdom on life matters as well as religious matters. He welcomes opportunities to improve health in his area, and new health programs often consult him before starting. He has a healthy, hard-working family with a very productive farm. His first wife died in childbirth. The child was never breastfed and survived for only a few weeks. He knows first-hand how hard this was for him and his other children.
Influencing Audience 3: Community Leaders and Members
Lin, female community leader, 40, Thanlyin township, Myanmar.
Lin leads a local women’s group and has five children. She wants to see the condition and position of women in her community improve.Her group holds monthly meetings where they discuss problems and what is going well. They also share solutions and things they have learned. Each month they focus on a specific topic. They also discuss whatever attendees are concerned about at that time.Group members contribute a small sum of money each month to give to the member whose turn it is to receive. The women use this money for special purchases – seeds, equipment, preparing for a new child, health care, or large household items, for example.Lin knows the life history of everyone in the group and regularly visits them. She listens and gives advice. She has seen too many babies in her village die within the weeks after birth. She believes in some traditional ways, but she also sees the value in modern ways, including modern health care.
Photos, Courtesy of Photoshare, are used for illustrative purposes only.