Table 7 Key messages for health programs

The need to explain EBF clearly

Our findings indicate that the conceptualization of EBF in the community was different from its technocratic definition; women did not consider giving minor supplements to the infant as a violation of EBF. Health awareness messages need to clarify the meaning of EBF in communities.

Challenges in estimation of EBF rates

We found that women who had reported that they practiced EBF in the program baseline data, on detailed discussion, had not actually breastfed exclusively. In addition to clarifying the meaning of EBF, there is a need to modify the single 24-h recall technique of questioning women about EBF currently used in our programs.

The need to address suboptimal EBF practices and late weaning practices

Despite practising EBF, some women in our sample did not breastfeed on demand and did not know how often to breastfeed the child. We encountered cases where the mother had neither breastfed the child consistently nor given breastmilk substitutes. It is important for health messages to convey how EBF can be “done well.”, and to promote the introduction of complementary foods beyond 6 months.

EBF as a family decision

This study shows that immediate family is an important influencer of EBF. All awareness messages on EBF must be directed at families rather than mothers alone so that the mother gets optimal support to practice EBF well.