# Expenditures on Strengthening Large Scale Breastfeeding Counseling Programs in Bangladesh, Ethiopia, and Vietnam

## TL;DR

This study analyzed the costs of large-scale breastfeeding counseling programs in Bangladesh, Ethiopia, and Vietnam, showing they are affordable and effective.

## Contribution

The study provides realistic budget estimates for scaling up breastfeeding counseling in low- and middle-income countries.

## Key findings

- Per participant costs ranged from USD 0.55 to 1.90 annually across the three countries.
- Training and counseling accounted for 55.1% to 73.4% of total expenditures.
- Using existing systems can make large-scale breastfeeding programs affordable.

## Abstract

Timely support given to breastfeeding mothers can result in life‐saving benefits for both mothers and infants. Progress in achieving results from existing efforts to improve breastfeeding practices can be accelerated with adequate investments in effective interventions. We aimed to document expenditures incurred by three diverse programs in Bangladesh, Ethiopia, and Vietnam that demonstrated improved breastfeeding outcomes. Based on expenditure records, we retrospectively calculated annual and per participant expenditures. The results represent the incremental financial needs of strengthening existing efforts in low‐ and middle‐income countries to inform budget planning. The programs reached between 400,000 to 1.2 million pregnant women, infants, and mothers annually at an average expenditure of USD 0.55 to 1.90 per woman and infant. The largest proportion of expenditures were incurred for training frontline workers and delivering interpersonal communication or counseling. These ranged from 73.4% of total expenditures in Bangladesh to 63.9% in Ethiopia and 55.1% in Vietnam. Management and administration expenditures ranged from 13.3% and 19.6% across countries; the range in expenditures for planning and strategy development was 2.5%–9.9%; for materials development and production was 1.1%–15.1%; and for monitoring was 1.7%–18.7%. The results show that existing cadres of facility and community workers can deliver effective breastfeeding counseling on a large scale with substantial economies of scale. Budgetary needs will differ by country due to delivery system strengths and weaknesses, pre‐existing coverage, and demand for counseling services. The study provides a basis for realistic budget estimates for strengthening breastfeeding counseling in large‐scale programs.

The costs of enabling mothers' environment for breastfeeding through large‐scale programs that successfully address critical factors at multiple levels are only a fraction of the losses due to deaths and illnesses from poor breastfeeding practices. In Bangladesh, Ethiopia and Vietnam, the programs reached between 400,000 to 1.2 million pregnant women, infants, and mothers annually at an average expenditure of USD 0.55–1.90 per woman and infant. These programs focused on strengthening the health system and family/community networks with the understanding that mothers' breastfeeding practices depend upon her motivation, interactions with her infant, her self‐confidence, perception of social norms, and family support.

Expenditures on strengthening existing breastfeeding services ranged from USD 0.55 to USD 0.65 and USD 1.90 per woman and infant for Bangladesh, Ethiopia, and Vietnam respectively. Half to three‐quarters of total expenditures were incurred for training frontline workers and delivering counseling services.Vietnam reached 400,000 women and infants annually through facilities, Ethiopia reached 720,000 women and infants through facilities and community‐based approaches, and Bangladesh reached 1.2 million women and infants through community groups and home visits.If countries use existing delivery systems and reach a large scale, the per participant financial needs of strengthening existing breastfeeding services can be affordable.

Expenditures on strengthening existing breastfeeding services ranged from USD 0.55 to USD 0.65 and USD 1.90 per woman and infant for Bangladesh, Ethiopia, and Vietnam respectively. Half to three‐quarters of total expenditures were incurred for training frontline workers and delivering counseling services.

Vietnam reached 400,000 women and infants annually through facilities, Ethiopia reached 720,000 women and infants through facilities and community‐based approaches, and Bangladesh reached 1.2 million women and infants through community groups and home visits.

If countries use existing delivery systems and reach a large scale, the per participant financial needs of strengthening existing breastfeeding services can be affordable.