The key to successful breastfeeding is likely to be Information, Education and Communication (IEC) strategies aimed at behavior change . According to a study by Sable and Patton from Missouri, USA in 1989–91, only 37% of antenatal women reported that their health providers advised them to consider breastfeeding . In our study, though 75% of the antenatal mothers were "booked", only 21% had received antenatal counseling on breastfeeding. It is evident that counseling on breastfeeding is not given due importance as part of antenatal visits. Though a trial by Alexander et al suggested that routine breast examination during antenatal care does not increase the chances of successful breastfeeding , detection of retractile nipples in the antenatal period followed by appropriate manoeuvres to make the nipples protractile may help in ensuring the success of breastfeeding in the postnatal period . However, further research on this issue is required.
In this study, awareness related to breastfeeding among mothers in the "counseled" group was better than those in the "not counseled" group. We hypothesize that the women who received antenatal advice would be more likely to practice exclusive breastfeeding; however, only follow up studies can validate our hypothesis. Even in the "counseled" group awareness among mothers with regard to correct breastfeeding technique and concept of continuing breastfeeding during illness in the baby is not different from those in the "not counseled" group.
Where breastfeeding practices are suboptimal, simple one-encounter antenatal education and counseling may improve breastfeeding practice up to 3 months after delivery . Provision of printed or audiovisual educational material is not enough. During antenatal visits, Health care providers should make every effort to have face-to-face encounter to give accurate information on breastfeeding and clarify misconceptions among expectant mothers. Health care providers also need education and training in breastfeeding support and management. Further research is needed to know why health care providers do not discuss the benefits of breastfeeding with women antenatally.
The Baby Friendly Hospital Initiative (BFHI), launched in 1991, is an initiative to ensure that all maternity services whether free standing or in a hospital, become centers of breastfeeding support . A maternity facility can be accredited "Baby Friendly" when it does not accept free or low-cost breastmilk substitutes, feeding bottles or teats, and has implemented the Ten Steps to successful breastfeeding. Step Three is "Inform all pregnant women about the benefits and management of breastfeeding". According to Breastfeeding Promotion Network of India (BPNI), only 10% of hospitals and maternity facilities in India had BFHI status in 2005 . This reflects the fact that more effort is needed to make all existing hospitals "Baby Friendly". Our hospital is also working towards accreditation. If appropriate measures are undertaken to strengthen training in breastfeeding counseling and the number of trained professional/peer counselors at all levels is increased, exclusive breastfeeding might become a social norm.