USAID Health Service Delivery (HSD) interventions are designed to increase the uptake of integrated reproductive, maternal, newborn and child health (RMNCH+) services—including supporting breastfeeding practices—within the continuum of healthcare in Jordan. Managed by Abt, this program achieves its goals via a continuum of care approach.
At the primary health care (PHC) level, USAID HSD developed a Woman and Child Health Comprehensive Counseling Program. This activity includes strengthening midwives’ skills in promoting breastfeeding and providing counseling. Each time a woman visits the health center during her pregnancy and postpartum period, midwives educate her on the benefits of early and exclusive breastfeeding, and the correct positioning of the infant.
Working with hospitals, USAID HSD supports the initiation of breastfeeding within the first hour after delivery. In Ministry of Health (MOH) hospitals, our team trained midwives who work in the labor rooms and postpartum clinics on breastfeeding initiation using didactic and on-the-job maternal clinical pathway workshops.
The nature of the workflow in Royal Medical Services (RMS) hospitals prevent the mother from being with her newborn immediately following delivery. However, USAID HSD helped RMS hospitals adjust their workflow to permit the nurse from the nursery to perform initial newborn care in the labor room. In the new workflow, the labor room midwife follows-up with the mother to ensure the initiation of breastfeeding within the first hour post-delivery.
In FY18, all 17 participating MOH and RMS hospitals achieved significant progress after working with USAID HSD. About 89 percent of women with a normal vaginal delivery successfully applied skin-to-skin contact and initiated breastfeeding within one hour of delivery.
USAID HSD also has actively coordinated with UNICEF, Health Care Accreditation Council, MOH, RMS and others as part of the Baby Friendly Hospital Initiative (BFHI) in Jordan. The program operates in three of the five BFHI sites where the initiative is being piloted and has supported breastfeeding training for the staff at these facilities.
A Community Effort
At the community level, USAID HSD supports Community Health Committees (CHCs), which are composed of 18-25 volunteers from the catchment areas around the PHC centers. The CHCs hold breastfeeding promotional events, including lectures, awareness days and health fairs.
Furthermore, USAID HSD established seven mother-to-mother breastfeeding support groups (MTMBFGs) composed of an average of 10-12 new mothers and pregnant women. The team, comprised of USAID HSD and MOH members, trained and supported seven volunteer female promoters, who lead these groups. USAID HSD recently trained an additional 11 MTMBFGs that will become active in FY20.
“When I attended the first breastfeeding support group session, my child was on mixed feeding because I thought that my milk was not enough,” said Hanan Khaleel Tailouni, a MTMBFG participant. “After the knowledge and the support that I have received during the session, I decided to … depend completely on my milk. My child is six months old now and I have started to introduce solid food according to the knowledge that I have learned from these sessions.”
USAID HSD also has established a Postpartum Counseling Program. The program reaches out to postpartum women before they leave the hospital and, after that, through the community outreach program’s household visits.
At the hospital, the labor ward midwives offer counseling on relevant health issues, notably practicing exclusive breastfeeding for the first six months of the infant's life. At the household level, female community health workers (CHWs) conduct household visits for WRA and children under five. These CHWs are trained in basic breastfeeding skills to assist women during the early postpartum period, and later to encourage them to continue exclusive breastfeeding. They also deliver messages to pregnant women about the importance of immediate breastfeeding and skin to skin contact.
While our hospital survey from FY18 tells us we’re on the right track, the mothers themselves are confirming it.