Academy for Educational Development

Improved Breastfeeding Practices:
The LINKAGES Legacy

Any serious effort to address malnutrition and child mortality must focus on improving feeding practices in the first two years of life. Analyses published in the medical journal The Lancet suggest that improvements in breastfeeding and complementary feeding together would prevent 19 percent of deaths among children under age five.

Recognizing the importance of feeding practices for child survival, growth, and development, USAID funded the LINKAGES Project, a 10-year (1996–2006) program managed by AED. The project’s mandate was to demonstrate that exclusive breastfeeding is an achievable goal, improve breastfeeding practices in a wide geographic area in three to five countries, and document what works at the community level.

LINKAGES supported six long-term, large-scale country programs, reaching populations from 1 to 15 million. The following gains in exclusive breastfeeding among children younger than six months of age were achieved:

• 66 percent increase in Madagascar,

• 30 percent in Zambia,

• 20 percent in Bolivia, and

• 16 percent in Ghana (see figure at right).

In the Oromia region of Ethiopia, exclusive breastfeeding increased by 59 percent, and in Jordan, a steep and dramatic decline in exclusive breastfeeding was reversed.

In addition to the six large-country programs, LINKAGES helped another 24 countries implement smaller-scale community activities, adopt policy initiatives, strengthen the capacity of health providers and community health promoters, conduct behavioral assessments, and develop behavior change communication.

To achieve broad geographic coverage, partnerships were essential. LINKAGES facilitated strategic-planning and consensus-building meetings among government departments, donors, and NGOs.

“One of the first activities in Madagascar and Ethiopia was harmonizing the messages of more than 50 partners,” said Regional Advisor Dr. Agnes Guyon.

Although the LINKAGES Project ended in October 2006, its impact will continue through trained health providers and promoters, counseling materials, national guidelines, preservice curricula, and the example of those who have adopted improved feeding practices.

“The mother is our best partner,” Guyon observed. LINKAGES’s legacy will be maintained by women such as Elfenesh, a mother of four who was trained as a community health promoter in Ethiopia.

“I try to take the new knowledge I received during training and make changes in my own life. My own personal example is the best message I can give,” she said.

—Luann Martin

For more information, please visit www.linkagesproject.org or contact Luann Martin at lmartin@aed.org.