Integrating a Targeted Breastfeeding Promotion Intervention into Routine Health Services in Private Health Facilities in Lagos State, Nigeria is Feasible

The majority of health providers in Lagos, Nigeria are private, but few of them offer breastfeeding counseling. From May 2019-April 2020, Alive & Thrive implemented a breastfeeding promotion intervention in collaboration with 10 private health facilities in Lagos. The intervention included implementation of the Baby-Friendly Hospital Initiative, training for providers, and provision of breastfeeding counseling to women in person and on Whatsapp, breastfeeding Whatsapp support groups, and infant and young child feeding (IYCF) counseling materials. The objective of our research was to examine the feasibility of integrating the intervention into routine health services using a mixed-methods process evaluation. We conducted in-depth interviews (IDIs) with 20 health facility leaders and providers, 90 structured observations and exit interviews with women during the 3rd trimester and at 6 weeks postpartum. The IDIs were transcribed and analyzed thematically in Dedoose software (version 8), and the structured observations and exit interviews were summarized as proportions. The IDIs indicated that almost all health facility leaders and providers had positive experiences with the intervention. Facilitators included the training received, support from facility leaders, and availability of IYCF counseling materials. Barriers included increased workloads, paperwork, and health providers’ use of personal time for counseling on Whatsapp. Observations and exit interviews suggested that breastfeeding counseling improved over time. Exit interviews also showed that most mothers were very satisfied with services and were very confident they could carry out the breastfeeding advice they had received. Provision of breastfeeding counseling and support through private health facilities is feasible, but service delivery challenges must be considered for successful scale-up of the intervention in Nigeria. This research was funded by The Alive & Thrive initiative, managed by FHI Solutions, and funded by the Bill & Melinda Gates Foundation Irish Aid, and other donors.