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Table 2 Suggested improvements in the content of the health education and ways to implement the recommendations

From: 'No sister, the breast alone is not enough for my baby' a qualitative assessment of potentials and barriers in the promotion of exclusive breastfeeding in southern Zambia

Suggested improvements in the content of health education

   • Explain the underlying physiology, rationale and principles of exclusive breastfeeding including:

◦ No need for water

◦ Breast milk production increases by frequent suckling and decreases with less frequent suckling

◦ 'Crying baby' is not necessarily a sign of insufficient feeding, not necessary to give complementary food

◦ Explain the potential vicious cycle of perceived breast milk insufficiency

   • Highlight and explain the dangers of mixed feeding compared to exclusive breastfeeding

   • Discuss the issue of 'bad milk' openly and explain that it does not exist

   • Focus on HIV/AIDS and comprehend the participant's fear of stigma

   • Encourage already good practices

Suggested ways to implement the recommendations

   • Use the health personnel and the TBAs, as they are very much trusted in the community

   • Improve the training received by the health personnel and TBAs about:

◦ the dangers of mixed feeding, highlighting the importance of explaining this to the mothers

◦ HIV/AIDS and infant feeding

   • Increase health education and include the whole community, including fathers, mothers/mothers-in-law and other influential people (i.e. the woman's family) in the education sessions

◦ Use of role models, e.g. mothers who have succeeded with EBF, to educate other mothers

◦ Use many channels and integrate them into other programmes (school teaching, radio, newspapers, etc.)

   • Closer follow-up of EBF, for instance by peer-supporters for EBF or by further development and expansion of the exclusive breastfeeding support groups