Breastfeeding in Lebanon: barriers and policy dynamics

Breastfeeding practices in Lebanon fall short of international recommendations: despite high breastfeeding initiation, exclusive breastfeeding (EBF) rates are almost nil at 4-5 months. In the Lebanese context, health services are expected to have a large contributing role on early breastfeeding practices. This research aimed at identifying Lebanese stakeholders’ perceptions of barriers to recommended early breastfeeding initiation and EBF till 6 months in the context of health services as well as the political dynamics around existing policies that if implemented would address these health system barriers. A review of systematic reviews of the effectiveness of health services interventions to promote and support breastfeeding initiation and exclusivity revealed that a package of complementary interventions would be most effective. It would include applying maternity ward changes according to the Baby-Friendly Hospital Initiative, facilitating the formation of lay support groups, and tailoring education and support to the setting and needs of the population. Semi-structured interviews were conducted with a purposeful sample of 59 Lebanese stakeholders in early breastfeeding. The framework approach was used for analysing data. Health services barriers included suboptimal antenatal preparedness to breastfeeding, detrimental hospital practices, medicalisation of childbirth, health professionals’ knowledge and attitudes towards breastfeeding and aggressive marketing by breast milk substitutes companies. The socio-cultural context was depreciative of breastfeeding. Using the principles of stakeholder analysis, implementation of key policies endorsed by the Lebanese government was found to be hindered by the Ministry of Public Health’s weak governance and commitment, the weak engagement of key international organisations and professional associations compounded by the financial interests of strong stakeholders in the health care system offered by breast milk substitute companies. Key recommendations include the need for further commitment from government, grassroots advocacy to shift the culture towards demanding appropriate early breastfeeding practices, and implementation of several health services related programmes.