Evaluating the role that Care Groups play in providing breastfeeding and infant feeding support at community level: a qualitative study in Dedza district in Malawi

Abstract

Background: Promoting exclusive breastfeeding is a key nutrition policy objective in Malawi. This study assesses the role that care group volunteers (CGVs) play in providing breastfeeding and infant feeding support at community level. Care groups are a peer-to-peer learning approach, which has been part of Malawi’s nutrition policy since 2012, yet its efficacy and its role within community-level nutrition support remains under-researched. Methods: In July 2021, we conducted 60 qualitative semi structured interviews in Dedza District with village leaders, Health Surveillance Assistants (HSAs), CGVs and district health officials, mothers with at least one child under two (n=36) who were randomly selected, and (purposively selected) mothers who had a child who was born prematurely or with low birthweight. The research was conducted in one of two care group programme implementation areas, or in several villages where care group interventions had not taken off.  All interviews were recorded, transcribed and translated into English and then analysed using qualitative data analysis software. Thematic analysis was used to elicit key themes. Results: Only eight out of 26 women in locations where care groups were active reported receiving breastfeeding support from care groups. All mothers reported receiving breastfeeding support at the health facility where they delivered their baby(ies) (n=36) and some (n=24) also at ante-natal care clinics. Where care groups were active, 18 out of 26 interviewees reported interacting with them, mostly during cooking demonstrations or receiving home visits. Little interaction was observed by interviewees between HSAs and CGVs (n=1) and no evidence suggested coordination between HSAs and CGVs around (vulnerable) newborn baby visits, as described by one HSA. Conclusions: This research shows that care groups, despite being well-known, remain an under-appreciated and un-integrated volunteer cadre. Policy reform in relation to care groups in Malawi could improve care group efficacy.