Kristina Granger strategizes how to promote and educate moms about healthy breastfeeding practices and options on a daily basis. As a social and behavior change professional with the USAID-financed, JSI-implemented SPRING Project, she has always been passionate about the importance of her work, but things took on a whole new dimension in Spring 2014 when her first child was born—and born prematurely.
Jackson’s first month in the ICU brought unexpected challenges that no parent—first-time or otherwise—is ready to bear, but the experience also led Kristina to reconsider what she thought she knew about breastfeeding on both practical and emotional levels.
In the developing world, the practical-emotional dichotomy is especially relevant. Programs must continuously ensure they’re facilitating real dialogue that acknowledges individual circumstances, in order to then determine what women need en masse and how they should change their behaviors.
One question Kristina continued to come back to was how to connect mothers with information about breastfeeding enough that they incorporate it into their own infant care practices. Logically, it seems reasonable to assume that if women are given statistical information about the benefits of breastfeeding, as well as practical information about the procedure, it should be enough to convince them to do so. As a professional on various SPRING initiatives, this is just what Kristina was used to as she and her team worked to improve the counseling offered to new moms by health workers and trained community volunteers.
It became increasingly clear as Kristina prepared for the arrival of her son that while training and counseling can provide critical information, it sometimes isn’t enough. A health worker or volunteer often has a fleeting and ephemeral interaction with mothers and while their guidance as professionals is certainly respected, a mother’s relationship with her child is intimately personal. This emotional nuance can be overpowering, making information from friends, family, and peers much more trusted.
As her own need for guidance grew, Kristina realized just how important it was to her to interact with others encountering the same questions and frustrations as she was. “Let me make one thing clear right away,” she says, “breastfeeding is neither simple nor intuitive. Like many new mothers, I benefited from the support of hospital staff and lactation counselors, read a number of books, and reached out to my local La Leche League to attend monthly support meetings.”
More than anything, though, she admits to having spent a great deal of time on the internet: “My Google searches produced tons of links (some good and some bad) and I’m sure I’ve looked at them all. But, hands down, nothing compares to what I heard directly and in online chat groups from other mothers who were also dealing with the challenges of breastfeeding—and especially issues specific to feeding a premature infant.”
What’s noteworthy about personal mother-to-mother support is that it can rapidly develop from a broad comment to a targeted exchange about a single detail. This natural expanding and contracting nature of conversation is difficult to replicate in communication strategies. “A constant point of discussion in behavior change and communication networks is about the right amount of information or the right frequency of communication contacts,” says Kristina. “I look at the counseling materials we use in SPRING countries and usually find only one or two cards devoted to breastfeeding. At first, this makes me think that we’re minimizing one of the most complex challenges mothers face soon after birth.”
To some extent, the emotional component is already being incorporated into SPRING’s work. Digital Green is a program that invites mothers in the community who are already breastfeeding to recommend feeding behaviors by appearing in video tutorials that are disseminated to women’s self-help groups. According to Kristina, it has proven to be an effective approach, primarily thanks to its use of “mothers to teach mothers of similar backgrounds and means—who are from the same communities—in order to effectively foster behavior change.” Indeed, it was the growing personal awareness of the power of this technique that led Kristina to wonder if more could be done to mobilize mother-to-mother support.
At the same time, an onslaught of information before a woman is ready for it can be intimidating—and just as ostracizing as too little. Kristina realized that balancing the two and being ready to provide information adapted to women and mothers with a range of needs and curiosity levels was hugely important. “I know I’m not the only mom who worries each day about things like milk supply, feeding timing, and breastfeeding techniques,” she says, “but I’m also a public health specialist who realizes that mothers everywhere are bombarded with information to the point where it can all become quite confusing and some simply don’t care to listen anymore.”
In any educational communications strategy, there are multiple factors jostling for attention. As much as timeliness and flow of information are important to actually reaching audiences, the content must also be relevant and satisfy a mother’s interests and needs. “Covering just the basic points in standard communications materials and activities may indeed be the best way to broaden an understanding of breastfeeding, but only if easy-to-access support mechanisms are also available to mothers with specific needs or who want to know more.”
But how do we determine those needs? It’s easy for skilled professionals to believe they simply need to disseminate information about best practices and assume the rest will take care of itself, but this discredits the individuality of mothers, children, and families. Health workers need to collaborate with each mother in order to make care decisions that are acceptable and feasible to each. “In my own case,” says Kristina, “getting to the point where we could exclusively breastfeed would have been simpler if the doctors and nurses had meaningful conversations with me about my feeding wishes instead of making decisions on bottles and feeding tubes [for me].”
The final pieces of this puzzle are the actual communications channels. “In our field, we seem to be always looking for the magic bullet—the one approach or communication channel that tips the scales and leads directly to widespread uptake of recommended behaviors,” says Kristina. But there is simply no single type of support that will have an impact on every mother across the board. Instead, different communications activities must be woven together in various patterns and combinations, providing adaptable support systems for mothers and helping keep babies healthy and well-nourished.
“Perhaps I would still have succeeded in reaching my breastfeeding goals without the benefit of La Leche League meetings, quizzing my mom friends, or Facebook support groups,” says Kristina, “but each of these outlets contributed to giving me more confidence in my ability to effectively breastfeed my child and provided critical empathy and support to keep me from giving up when I needed it most.”
When it comes to development planning, it must be remembered that the end user is an individual, and each is unique. It simply isn’t enough to hold sporadic village meetings and think it achieves true community involvement and buy-in. Rather, participants need to be involved at all levels of programming. Doing so could significantly change the direction of care and lead to greater, more sustainable impact. “In our SBCC work, it’s important that we don’t overlook the proven technique of establishing support networks to foster and—perhaps more importantly—affect meaningful change.”
Part Two: Looking Back on Our First 1,000 Days
* This article was originally published by the now defunct 1,000 Days Blog