In Sri Lanka, as in many other countries, the number of mothers who continue to exclusively breastfeed their child once they leave the hospital drops. Realizing the critical need for breastfeeding support and outreach outside of the delivery ward, Sri Lanka created Lactation Management Centers (LMCs) beginning in 2000 in order to assist mothers who need breastfeeding support. The LMCs, funded by the Ministry of Health, are located in every specialist hospital that provides maternity services and newborn care. They work with in-hospital patients and have a significant outreach component. The 2012 WBTi report on Sri Lanka cited the LMCs as contributing to high exclusive rates of breastfeeding as mothers receive support on an out-patient basis. Today, Sri Lanka has one of the top breastfeeding outcomes in the world with 99% of children ever-breastfed and 82% breastfed exclusively in the first six months in 2016.
In Sri Lanka, as in many other countries, the number of mothers who continue to exclusively breastfeed their child once they leave the hospital drops. In 2007, 85% of mothers breastfed within the first hour of birth and 53.5% were still exclusively breastfeeding four-five months later (1). Many times, this is due to a lack of education and knowledge of how to breastfeed properly and the importance of breastfeeding, as well as the easy alternative infant formula provides when a mother encounters trouble (1,2). Realizing the critical need for breastfeeding support and outreach outside of the delivery ward, Sri Lanka created Lactation Management Centers (LMCs) in order to assist mothers in need of support (1,3). These LMCs are located in every specialist hospital that provides maternity services and newborn care (1). While there is supervision by a consultant neonatologist or pediatrician, day-to-day operations are performed by Nursing Officers, who have significant breastfeeding training (1). Any mother with problems breastfeeding may use the center for free, without referral letters or appointments (1).
LMCs have a significant outreach component: in addition to looking after any in-hospital patients, Nursing Officers advise through a dedicated phone line in the center, attend to out-patients, present antenatal health educational classes, take part in special day/half-day programmes organized to educate nursing officers staff in other wards, and run sessions for nursing students and midwifery students (1,4).
Guidelines on the construction on Lactation Management Centers are stipulated by the Family Health Bureau (1,7):
Common Procedures Performed at LMC include (1):
Monthly feedback forms are returned to the Family Health Bureau from LMCs all over the country to ensure quantity and quality assurance (1).
From 884 admissions to LMCs in 2007, Sri Lanka reported the rate of admissions more than doubled by 2011 (1). In 2012, the WBTi report on Sri Lanka cited the LMCs as contributing to high exclusive rates of breastfeeding as mothers could now receive support on an out-patient basis (5). This report also cites an improvement in Mother Support and Community Outreach, receiving full marks on the criteria, “all women have access to community-based support systems and services on infant and young child feeding” (5).
In addition, LMCs have been reported to significantly reduce the burden on Special Care Baby Units by taking admissions for problems with breastfeeding (8). This can lower costs because Special Care Baby Units have higher costs per cot per day than a normal ward (1). This frees up staff time in the Special Care Baby Unit to focus on immediate life-threatening conditions (8).
Today, Sri Lanka has one of the top breastfeeding outcomes in the world with 99% of children ever-breastfed and 82% breastfed exclusively in the first six months in 2016 (6). It is important to note that there are claims that 82% is an inflated estimate because it is from a 24-hour recall method, where surveyors ask mothers with infants of varying age whether they have breastfed in the last 24 hours (11).
LMCs are included in universal healthcare system in Sri Lanka. The Ministry of Health (MoH) finances the LMCs through the Family Health Bureau. The MoH has a recurrent budget of approximately 140,000,000 Rupees (USD $910,000) (9). LMCs costs include operating and facility costs, Nurse Officer salaries, and materials needed to encourage breastfeeding and provide for the mother/child (1).
LMCs have been reported to be cost effective by reducing admissions and staffing burdens at the costlier Special Care Baby Units (8).
The WHO and WBTi have praised Sri Lanka in its recent gains in breastfeeding practices, citing LMCs as a contributing factor (5). In-country residents also praise the centers; a daily business paper in Sri Lanka, published an article on the opening of a new LMC in 2015, and quoted the Sri Lanka College of Pediatricians President as stating, “…we know those mothers who fail to breastfeed at the very inception fail to initiate and sustain breastfeeding within the first week itself. LMCs are manned by trained staff that will help those mothers who have genuine problems in initiating and maintaining breastfeeding” (4).
Furthermore, a study on LMCs in India says that constant reinforcement and support for all mothers is essential to maintain breastfeeding (2). While this role can be filled by mother support groups in the community, in situations these groups are not available or mothers need specially trained help, hospital-based support services, such as LMCs, are a proven method to help mothers (2).
Ensuring that LMCs reach the whole population, especially rural, poor mothers, should be considered with this intervention.
Sri Lanka has a health care system with universal coverage of population and 90% of deliveries occur in a health facility. The Lactation Management Centers (LMCs) represent a significant cost for a free health care system and required the political desire to implement. They provide a special place for mothers who need breastfeeding support to go and receive help from well trained staff is an innovative model to deliver lactation support. The intervention does not seem to have been applied to private hospitals so adaptations would be needed for countries with more mixed private and public health care provision. However, this intervention is replicable in any hospital with the space and funding available.
There are costs associated with this intervention for staff, training, facilities and equipment. Although, in Sri Lanka this cost was offset by the LMCs reducing the high running costs of specialist baby units and postnatal wards by taking in-hospital admissions related to feeding problems (prior to the introduction of LMCs, one study found that 58% of admissions to specialist baby units were feeding issues, this dropped to 43% in two years). A key aspect identified is the need for a neonatologist or pediatrician to ensure the efficiency and effectiveness of LMCs.
Increasing access to health workers trained in breastfeeding skills is critical to improving breastfeeding rates. Governments and international organizations struggle to find reasonably low-cost, viable solutions to the high rates of maternal and newborn mortality in many low and middle income countries. This innovative approach has helped to make Sri Lanka achieve some of the best breastfeeding rates globally.
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