Research and Evaluation Gear Examples

Example:In Peru, the Continuous Demographic and Health Survey provides data annually on key breastfeeding indicators, including initial breastfeeding, exclusive BF < 6 months, and introduction of solid foods 6-9 months. The median BF duration indicator is reported every 2 years.

Score: Major Progress
Domain- Volume: Key breastfeeding practices are annually included in the national survey and data are renewed annually.

Example:In Brazil, the National Information System for Primary Care collects continuous data on the prevalence of EBF and BF for all health care users under 4 months of age. These data are available monthly and have full coverage. This data has been used to plan and monitor breastfeeding interventions and drive decision making. For example, after analyzing these data, the Ministry of Health created a technical manual addressing breastfeeding and young feeding guidelines to qualify the community-based health professionals.

Score: Major Progress
Domain- Existence: Yes
Domain- Coverage: Full national coverage.
Domain- Quality: System is electronic and key indicators are publicly reported.

Examples: In Brazil, the SISVAN (Food and Nutrition Surveillance System) provide monthly data of BF (exclusive and not exclusive) for national and subnational level (including municipalities). The reports are public and available online.

Score: Major Progress
Domain- Existence: Yes
Domain- Coverage: Data are available at all levels.

Example:The definition of vulnerable groups can change for each country. In Brazil, these groups include the quilombo’s people descendents (quilombolas), riverside population (ribeirinhos), black and brown people. The SISVAN (Food and Nutrition Surveillance System) provides breastfeeding data (exclusive and not exclusive) for each one of these vulnerable groups, monthly.

Score: Major Progress
Domain- Existence: Yes
Domain- Coverage: Data on vulnerable groups are available at all levels.

Examples:In USA, general data and standard reports of BF practices are public available on the CDC website. The data is made available annually though not every state provides the data annually or at all. The National Center for Health Statistics (NCHS) also developed the Research Data Centers (RDC) to allow researchers access to restricted data.

Score: Major Progress
Domain-Volume: Key breastfeeding practices are placed in the public domain annually.

Example:In 1992, India adopted the Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act (IMS Act). The monitoring is conducted by the Ministry of Women and Child Development and the monitoring of the enforcement of the Act is undertaken by personnel and organizations formally notified by the government.

Following WHO criteria, the monitoring of the Code in India is transparent, independent, free of commercial influence, and empowered run the monitoring system to track implementation of the Code. It is partially operational as it has been used to track but there is a need for further improvement in enforcement. Although there is no specific budget for this activity, which negatively impacts the sustainability of the monitoring system, the Breastfeeding Promotion Network of India supports the government to implement the Act by developing monitoring tools and periodically reporting to the Ministry of Women and Child Development.

Score: Partial Progress
Domain- Existence: Yes
Domain- Effective: A monitoring system is in place to track implementation of the Code and process indicators are publicly reported. The need for further improvement in enforcement has been recognized.

Examples: In 2011, the Australian Government implemented the Paid Parental Leave (PPL) scheme to provide eligible working parents with up to 18 weeks of Government-funded time off from work to care for a newborn or a recently adopted child. In addition to an extensive evaluation process of the scheme (including measuring breastfeeding rates before and after), the Department of Social Services (DSS) collects and publicly reports performance indicators measuring take up on a rolling three-year basis:

• Percentage and number of mothers for whom PLP has been paid as a proportion of all mothers in the same year
• Percentage and number of parents paid government-funded PLP by employers
• Percentage and number of families who have taken the full 18 weeks of PLP

Score: Major Progress
Domain- Existence: Yes
Domain- Effective: DSS monitoring system is in place to enforce maternity protection legislation and process indicators are publicly reported.

In 2010, the Republic Azerbaijan ratified the ILO Maternity Protection Convention 2000 (No 183). It isn’t clear how well the law is being implemented due to an inadequate monitoring system. The State Labour Inspection Services is an organization within the Ministry of Labour and Social Protection of Population involved with the monitoring of maternity protection. Specifically, it “monitors the compliance with special employment conditions for women workers, as well as the application of health and safety provisions in hazardous industries, not only for women workers”. There is no current evidence that monitoring is actively occurring as “there have been no dedicated reports and compliance with the provisions prescribed by the Labour Code”. Without any available statistics on the use of maternity leave and take-up of provisions for pregnant/nursing women, it is challenging to know the usage, uptake, and compliance associated with the maternity protection legislation in Azerbaijan.

Score: No Progress
Domain- Existence: No
Domain- Effective: No evidence of a monitoring system in place to enforce maternity protection legislation.

Example: Alive & Thrive operate one-on-one and group counseling for pregnant women and mothers with children under 2 years with trained, certified counselors in Viet Nam. Each franchise completes a Monthly Report Form (PB) including information about the number of counseling contacts for exclusive breastfeeding (EBF) promotion, EBF support and management, and complementary feeding education, and management. The monitoring system provides an easy and streamlined program that allows for sharing data in a timely manner to facilitate evidence-based decision-making and improve program quality. The design of this system took into account the existing infrastructure of the health care system.

Score: Partial Progress
Domain- Existence: Yes
Domain- Effective: Monitoring system is operational but process indicators are not publicly reported.

Example:In Brazil, a monitoring system was developed and hospitals that are designed as Baby-Friendly must complete self-assessment forms every two years in order for the MOH monitor their compliance with the BFHI/Ten Steps. Every year the monitoring results are reported to the state level responsible for following up on the quality of the BFHI implementation.

Score: Partial Progress
Domain- Existence: Yes
Domain- Effective: Monitoring system is operational but process indicators are not publicly reported.

Example: Alive and Thrive (A&T) evaluates and monitors its breastfeeding media campaign in Viet Nam to understand the reach of the key messages and resulting changes in beliefs and behaviors. Two years into the campaign four of every five pregnant women or mothers with children under two years old, in the catchment areas, received personal IYCF counseling services and the rate of exclusive breastfeeding up to 6 months rose from 26% to 48%. The monitoring system operates within the public health system at five levels: village, commune, district, province, A&T regional offices and A&T central office in Hanoi. At the village and commune levels, paper forms are used and all other levels use electronic forms. Data is submitted monthly and reports are produced on a rolling quarterly basis - produced monthly with performance indicators for the previous three months.

Score: Partial Progress
Domain- Existence: Yes
Domain- Effective: Monitoring system is operational but process indicators are not publicly reported.