Total country population (2001): 8 million

Project population and area: 1 million in 149 municipalities in all 9 departments of Bolivia

Project Duration:1998 to 2003

• Download a complete copy of World LINKAGES/Bolivia
• Download a summary in Spanish of program activities and results
• Download Journal of Human Lactation article on "Improving Breastfeeding Practices on a Broad Scale at the Community Level: Success Stories From Africa and Latin America"
• Download counseling cards developed by LINKAGES and its country program partner

Background
Twenty-eight percent of all Bolivian children under three years of age suffer from chronic malnutrition. Sub-optimal breastfeeding practices and inappropriate complementary feeding account for high rates of infection, malnutrition, and an estimated 4,500 infant deaths each year (Profiles 2000). Approximately 50 percent of infants less than six months of age are not exclusively breastfed. Other detrimental feeding practices include postponed initiation of breastfeeding (62 percent initiation after the first day), early introduction of liquids and/or other foods (31 percent introduction within the first month), and infrequent feedings (1998 DHS).

Program Design and Implementation
In 1998 COTALMA (the Technical Breastfeeding Support Committee) conducted a needs and resource assessment of PROCOSI, a network of Bolivian and international nongovernmental organizations involved in integrated and reproductive health programs members. After analysis of the assessment, regional behavior change communication (BCC) workshops were held for NGO technical staff to reach consensus on priority behaviors, analyze factors that influence them, and develop behavior change strategies to achieve measurable change.

PROCOSI member partners and LINKAGES designed a program focusing on five key infant feeding behaviors: (1) initiate breastfeeding within the first half hour after birth; (2) exclusively breastfeed until the baby is six months old; (3) start giving foods at six months, giving mashed foods in the soup, not just soup broth; (4) increase the density, frequency, and quantity of complementary foods as the baby gets older; and (5) increase breastfeeding and complementary feeding during and after the illness of mother or child. PROCOSI members participating in the program included APSAR, APROSAR, CARE, Caritas, CEPAC, Consejo de Salud Rural Andino, Esperanza, Freedom from Hunger/Crecer, PLAN Internacional, PROSALUD, Project Concern International, SACOA, Save the Children/Canada, Save the Children/US, Servir, and Universidad Nur.

PROCOSI and LINKAGES, working in close collaboration with the Ministry of Health, outlined strategies for improving infant feeding behaviors and for offering LAM. The strategies included community mobilization and behavior change communications, training of community workers and service providers, policy and advocacy initiatives, and monitoring and evaluation. The training involved discussions of key messages, role plays, demonstrations, and practice in the use of IEC materials in individual counseling and group sessions. The training also focused on practice in negotiating behaviors with mothers through trials of improved practices and implementation of the mother-to-mother support group strategy.

Results
To assess changes in infant and young child feeding practices, LINKAGES conducted a baseline survey in 2000, annual rapid assessment procedures, and an endline survey in 2003. These demonstrated how quickly breastfeeding practices can be changed.