Visualizing Zambia’s success with breastfeeding

By Katie Leach-Kemon and Nancy Fullman, special to Humanosphere

The benefits of breastfeeding to the health and development of newborn children are well-documented, with ‘exclusive’ breastfeeding in the first six months of life shown to enhance children’s immunity to infectious disease.

Only about one in five American mothers breastfeed their children exclusively for six months, according to the CDC, but in Zambia, eight out of ten mothers feed their newborns this way.

A recent study by the Institute for Health Metrics and Evaluation (IHME) found that multiple health system performance metrics, such as antenatal care, skilled birth attendance, and polio vaccination, were stagnating or declining in districts across Zambia – but it also found that exclusive breastfeeding is on the rise.

Promoting exclusive breastfeeding for the first six months of life is important for all countries but is especially important in Zambia given its high prevalence of malnutrition as well as HIV and other infectious diseases. Lack of access to clean water in Zambia makes formula an unsafe alternative to breastmilk for children.

Breastfeeding provides babies with important antibodies against diseases. Also, studies have found that exclusive breastfeeding, as opposed to mixed feeding, for infants until age 6 months is the best way to protect children from HIV. Researchers believe that mixed feeding makes infants under 6 months more likely to acquire HIV since it harms the infants’ digestive systems, which in turn makes them more vulnerable to the virus.

The scale-up of selected child health interventions in Zambia

Zambia Breastfeeding 1

Source: Assessing Impact, Improving Health: Progress in Child Health Across Districts in Zambia

The figure above shows how exclusive breastfeeding rates in the country as a whole rose dramatically after Zambia signed the Innocenti Declaration in 1990, which set child survival targets related to breastfeeding. The increase in exclusive breastfeeding may be due to expanded lactation training for health workers and an increase in the number of hospitals certified as “Baby-Friendly,” which means that these hospitals “implement practices that protect, promote and support breastfeeding.”

Progress in exclusive breastfeeding stagnated in the early-to-mid 2000s, however, which was likely due to concerns about transmission of HIV through breastmilk. Then, the National AIDS Council released new guidelines on the prevention of mother-to-child transmission of HIV/AIDS (PMTCT), which advised HIV-positive mothers to breastfeed exclusively for six months unless “replacement feeding is acceptable, feasible, affordable, sustainable and safe.”

Around 2007, rates of exclusive breastfeeding began to climb once again in Zambia.

Also, in 2009, the Zambian Ministry of Health launched an advocacy campaign to promote exclusive breastfeeding. This was part of a broader national effort to improve maternal and child nutrition that included media campaigns, training of health workers and volunteers, and ongoing mentoring of health workers. Below is a video used by the Zambian government to promote breastfeeding:

Coverage of exclusive breastfeeding by district in Zambia, 2000, 2005, and 2010

Zambia Breastfeeding 2

Source: Benchmarking health system performance across districts in Zambia: a systematic analysis of levels and trends in key maternal and child health interventions from 1990 to 2010

Diving down to the district level, researchers found that exclusive breastfeeding increased from 2000 to 2010 across districts in Zambia (see figure above). In Lufwanyama District (see figure), which is in the Western part of the country, exclusive breastfeeding increased consistently between 1990 and 2010 (light green line). In 2010, rates were among the highest in Zambia at 95%.

Rates of exclusive breastfeeding in Lufwanyama District, 1990-2010

Zambia Breastfeeding 3

Source: Assessing Impact, Improving Health: Progress in Child Health Across Districts in Zambia

In contrast to the dramatic progress made by Lufwanyama, in the Nakonde District, which lies on the border with Tanzania, exclusive breastfeeding rates have declined since the mid-2000s (light green line).

Rates of exclusive breastfeeding in Nakonde District, 1990-2010

Zambia Breastfeeding 4Source: Assessing Impact, Improving Health: Progress in Child Health Across Districts in Zambia

It isn’t clear why exclusive breastfeeding has risen so much in the Lufwanyama District or why it has steadily declined in Nakonde. Further investigation into the keys to Lufwanyama’s success could prove useful to other districts who are looking to replicate it.

Rates of exclusive breastfeeding have increased in most districts. More information about trends in exclusive breastfeeding and other health indicators in Zambian districts can be found in IHME’s report, Assessing Impact, Improving Health: Progress in Child Health Across Districts in Zambia.

Katie Leach-Kemon and Nancy Fullman are policy translation specialist at the University of Washington’s Institute for Health Metrics and Evaluation. 


About Author

Katie Leach-Kemon

Katherine (Katie) Leach-Kemon is a policy translation specialist at the Institute for Health Metrics and Evaluation (IHME). Katie specializes in two of IHME's research areas, the Global Burden of Disease and health financing. Katie has helped produce IHME's Financing Global Health report since it was first published in 2009. She received an MPH from the University of Washington and served as a Peace Corps volunteer in Niger. Her work has been published in The Lancet, Health Affairs, and the Journal of the American Medical Association. You can follow her on Twitter @kleachkemon.