Success with health worker lactation management training in Kathmandu Valley, Nepal

The Nepal Health Research Council held the Third National Summit of Health and Population Scientists in Nepal on April 10-12 2017. The ARCH Nepal team presented an abstract and poster on the effectiveness of lactation management training for health workers in Kathmandu Valley. This training program was developed in response to our previously published research which found that many mothers delivering their babies in Kathmandu Valley health facilities received recommendations to use breastmilk substitutes from health workers.

Initiation of breastfeeding within one hour of birth is key for supporting optimal breastfeeding practices through infancy. Health worker support is essential for improving breastfeeding rates in Nepal and around the world.

See the poster and abstract below for more details on this successful intervention. Read more about ARCH activities in Nepal.

Improving Early Breastfeeding Practices in Nepal through Lactation Management Training

Atul Upadhyay*, 1, Nisha Sharma1, Indu Adhikary1, Babita Adhikari1, Dale Davis1, Raj Kumar Pokhrel2, Giriraj Subedi2, Rajendra Prasad Pant2

 1Helen Keller International, Kathmandu, Nepal

2Child Health Division, Department of Health Services, Ministry of Health, Government of Nepal

*[email protected]

Although 98% of infants are ever breastfed in Nepal (MOHP et al., 2016), the rate of exclusive breastfeeding is low primarily due to predominance of pre-lacteal feeding. A recent study in Kathmandu Valley showed that 57% mothers (n = 304) provided a pre-lacteal feed to their newborn within 3 days of birth; almost always with infant formula (Pries et al., 2016). Interestingly, half of the mothers (48%) reported that the infant formula was recommended by health workers in hospitals. Referenced data also show  that mothers were 3.7 times more likely to use infant formula on health worker’s recommendation and are 6.4 times more likely to discontinue breastfeeding before 12 months if they use infant formula (Sobel et al., 2011).

To address the challenges of early breastfeeding practices, Helen Keller International (HKI) and the Ministry of Health (MOH) implemented a Lactation Management Training (LMT) for maternity and neonatal staff in nine hospitals that represent over 90% of facility births in Kathmandu Valley. The LMT employed a variety of training modules that focused on overcoming the barriers to early initiation of breastfeeding, including the misperceptions of having insufficient breastmilk, the risk of hypoglycemia, and the separation of mother and baby, as well as developing skills for encouraging skin-to-skin contact, and breastfeeding babies delivered by cesarean section. A session on the importance of national legislation, the BMS Act, was also included. .

Three months following the LMT, hospital staff reported improved early breastfeeding practices including correction of misperceptions, enhanced counselling and support to the mothers and limited use of infant formula. With successful implementation, LMT has the potential to encourage health workers to improve early breastfeeding practices for newborns by building their confidence and skills in counselling, supporting post-partum mothers, and reducing the use of pre-lacteal feeding. Therefore, by adapting this training, LMT can be key to improved breastfeeding practices in hospitals elsewhere.


Ministry of Health and Population (MOHP), New Era, ICF International Inc. Nepal Demographic Health Survey 2011. Kathmandu, Nepal: MOHP, New Era, ICF International Inc, Calverton, Maryland, 2012.

Pries, A. M., Huffman, S. L., Adhikary, I., Upreti, S. R., Dhungel, S., Champeny, M., & Zehner, E. (2016). Promotion and prelacteal feeding of breastmilk substitutes among mothers in Kathmandu Valley, Nepal. Maternal Child Nutr, Suppl 2, 8-21.

Sobel, H. L., Iellamo, A., Raya, R. R., Padilla, A. A., Olive, J. M., & Nyunt, U. S. (2011). Is unimpeded marketing for breast milk substitutes responsible for the decline in breastfeeding in the Philippines? An exploratory survey and focus group analysis. Soc Sci Med, 73(10), 1445-1448.