Percent of children born in the last 24 months who were put to the breast within one hour of birth
The percent of currently living (and deceased) children who were born within the last 24 months in a designated area and who were placed at the mother’s breast within one hour after delivery.
This indicator for timely initiation of breastfeeding is calculated as:
(Number of children 0 < 24 months put to the breast within 1 hour of delivery / Total number of children 0 < 24 months) x 100
The numerator and denominator include living and deceased children who were born (live births) within the past 24 months (UNICEF/WHO, 2009).
Recall data from mothers with children less than 24 months old. Evaluators may use program records to track trends in breastfeeding initiation among clients but, unless part of an experimental study, these data are not suitable for measuring the impact of program interventions on women with infants in the catchment area population.
Population-based surveys employing representative samples including Demographic Health Surveys (DHS) and the UNICEF Multiple Indicator Cluster Survey.
This indicator assesses the practice of placing the newborn at the mother’s breast within one hour after birth (ideally immediately following birth), and serves as a proxy for the timely initiation of breastfeeding. Mothers are more likely to successfully initiate lactation breastfeeding, to encounter fewer problems, and to maintain optimal breastfeeding behaviors if they initiate breastfeeding shortly after birth. Immediate placement of the infant at the mother’s breast allows time for the infant to initiate suckling and breastfeeding should begin no later than one hour after the delivery. Colostrum, the thick yellowish milk produced in the first few days after birth, is nutritious and helps to protect the infant against common infections. Thus, breast milk is the infant’s first immunization against common illnesses. The WHO/UNICEF Baby Friendly Hospital Initiative (BFHI) has laid out the linkages for how breastfeeding and complementary feeding contribute to achieving each of the eight of the Millennium Development Goals (WHO/UNICEF, 2009).
Early placement of the infant with the mother also allows skin-to-skin contact, which is important for bonding, maintaining infant body warmth, and may stimulate both mother and infant, thereby facilitating suckling. The BFHI recommends among its program expansion and integration criteria immediate skin-to-skin contact for at least 60 minutes after birth (see WHO/UNICEF, 2009, Section 1.5). A suggested additional indicator to capture this contact is: “Proportion of children born in the last 24 months who were placed skin to skin for at least one hour within 5 minutes of birth.”
A mother may have difficulty correctly recalling (months after the event) when she initiated breastfeeding for her youngest infant, particularly if she has had a difficult delivery. Thus, this indicator is subject to potential recall bias. This bias is likely to be even greater in populations unaccustomed to remembering and conceptualizing time. However, because this particular type of bias (toward a longer or shorter period than actually occurred) is assumed to be randomly distributed across a population, the potential bias should not skew the data to misrepresent the population’s general behavior related to breastfeeding initiation.
breastfeeding (BF), newborn (NB)
UNICEF and WHO, 2009, Tracking Progress on Child and Maternal Nutrition http://www.unicef.org/publications/files/Tracking_Progress_on_Child_and_Maternal_Nutrition_EN_110309.pdf
WHO/UNICEF, 2009, Baby-Friendly Hospital Initiative: Revised, updated and expanded for integrated care, Geneva: WHO. http://www.who.int/nutrition/publications/infantfeeding/bfhi_trainingcourse/en/