Table 2

Newborn care: back to basics

Key messages	Why is it important?	Current challenges	Recommendations
Breast feeding (BF) is an intervention that saves lives, improves health and development of newborns, as well as maternal well-being. BF should be universally and practically achieved with dedicated support in all MSF contexts.	Newborn mortality and morbidities remain high across MSF projects. Essential evidence-based interventions shown to decrease newborn mortality such as exclusive and early BF should be supported and scaled up to save lives across MSF. BF is natural, instinctive, ready made and vastly available. However, many women face different challenges to establish and sustain BF. To overcome those challenges, a coordinated and multidisciplinary support should be available for every woman and their baby.	BF is believed to be intuitive and easy for women. This is globally recognised as a harmful assumption. Essential, evidence-based aspects of BF, such as to starting within the first hour of life and exclusive BF for 6 months, are not always considered. BF is not always recognised as an intervention and therefore there are no allocated resources for BF support. Suboptimal training and preparation lead to varying and even contradictory messages given to the mother and family within MSF projects.	Field Consider BF as an intervention to reduce newborn mortality and allocate space, time and resources in planning for it. Promote BF and essential newborn care champions or focal points. Support and promote early and exclusive BF, including where it seems not easy for newborn or mother. Promote multidisciplinary (midwife, nutritionist, nurses, doctors, logistician) work to support BF, increase awareness and discuss responsibilities and division of tasks. Operations Include essential newborn care interventions (such as BF and Kangaroo Mother Care) into the main/strategic interventions to decrease neonatal mortality at project level and coordinate resources to support it. Promote partnership with other actors involved in essential newborn care, especially at local level. Headquarters Ensure BF policies and guidance are available and harmonised across MSF. Support and encourage access to lactation consultants in telemedicine or other platforms to support field teams. Ensure that training on essential newborn care including BF is available in different languages for frontline staff.
A family-centred approach, which includes an understanding of the community and the context, is needed to ensure successful BF.	To effectively support mothers, we need to understand the barriers and enablers related to a specific context. The mother–baby dyad is at the centre of the process, but all the family and community need to participate, support, encourage.	There is often little understanding about how BF is perceived in different contexts and what are the barriers and enablers in different settings, including the influence of other family members.	Field Include families, caretakers, community health workers in understanding the local influences to support the promotion of BF. Operations Essential newborn care (including BF understanding and support) should be factored into community-level programmes. Research If BF levels are low or poorly understood, consider anthropological studies in different contexts on barriers and enablers for BF. Include male views.

Key messages

Why is it important?

Current challenges

Recommendations

Breast feeding (BF) is an intervention that saves lives, improves health and development of newborns, as well as maternal well-being. BF should be universally and practically achieved with dedicated support in all MSF contexts.

Newborn mortality and morbidities remain high across MSF projects. Essential evidence-based interventions shown to decrease newborn mortality such as exclusive and early BF should be supported and scaled up to save lives across MSF.

BF is natural, instinctive, ready made and vastly available. However, many women face different challenges to establish and sustain BF. To overcome those challenges, a coordinated and multidisciplinary support should be available for every woman and their baby.

BF is believed to be intuitive and easy for women. This is globally recognised as a harmful assumption.
Essential, evidence-based aspects of BF, such as to starting within the first hour of life and exclusive BF for 6 months, are not always considered.
BF is not always recognised as an intervention and therefore there are no allocated resources for BF support.
Suboptimal training and preparation lead to varying and even contradictory messages given to the mother and family within MSF projects.

Field

Consider BF as an intervention to reduce newborn mortality and allocate space, time and resources in planning for it.
Promote BF and essential newborn care champions or focal points.
Support and promote early and exclusive BF, including where it seems not easy for newborn or mother.
Promote multidisciplinary (midwife, nutritionist, nurses, doctors, logistician) work to support BF, increase awareness and discuss responsibilities and division of tasks.

Operations

Include essential newborn care interventions (such as BF and Kangaroo Mother Care) into the main/strategic interventions to decrease neonatal mortality at project level and coordinate resources to support it.
Promote partnership with other actors involved in essential newborn care, especially at local level.

Headquarters

Ensure BF policies and guidance are available and harmonised across MSF.
Support and encourage access to lactation consultants in telemedicine or other platforms to support field teams.
Ensure that training on essential newborn care including BF is available in different languages for frontline staff.

A family-centred approach, which includes an understanding of the community and the context, is needed to ensure successful BF.

To effectively support mothers, we need to understand the barriers and enablers related to a specific context.

The mother–baby dyad is at the centre of the process, but all the family and community need to participate, support, encourage.

There is often little understanding about how BF is perceived in different contexts and what are the barriers and enablers in different settings, including the influence of other family members.

Field

Include families, caretakers, community health workers in understanding the local influences to support the promotion of BF.

Operations

Essential newborn care (including BF understanding and support) should be factored into community-level programmes.

Research

If BF levels are low or poorly understood, consider anthropological studies in different contexts on barriers and enablers for BF. Include male views.

BF, Breastfeeding; MSF, Médecins Sans Frontières.