Strengthening breastfeeding counseling through a two-phase training and implementation intervention in Ecuador's local healthcare system.

backgroundBreastfeeding counseling is a key intervention to promote optimal infant feeding, particularly when delivered individually and in person. Its effectiveness depends on the quality of healthcare training, which remains variable. In Ecuador, public services primarily rely on group-based strategies with limited access to individualized support, reinforcing inequalities given the high cost of private services. This study describes an intervention co-developed with the local health system to strengthen provider capacity and implement an individualized counseling model in a rural setting.

methodsThis practice-based case study was conducted in two phases between 2023 and 2024. In Phase I, 32 primary-level healthcare professionals participated in an 80-hour training program combining theoretical and practical components focused on technical skills, communication, and supportive counseling. Focus group discussions informed curriculum adjustments and explored changes in perceptions and competencies. In Phase II, a breastfeeding counseling room was established and staffed by ten trained healthcare professionals. Standardized digital records were used to document user characteristics and consultation topics. Data were analyzed descriptively using Stata and thematically using MAXQDA.

resultsTen of 32 providers (31%) completed the training. A total of 305 counseling sessions were conducted with 247 women, most of whom were lactating (76.5%), aged 18-29 years (68%), and residing in the local catchment area (87.9%). The most frequent consultation topics included breastfeeding technique, nipple pain, perceived low milk supply, and milk expression and storage. Sessions averaged 36 min. Users included adolescents and women with varying levels of maternal experience, highlighting diverse counseling needs. The intervention emphasized individualized, empathetic, and context-sensitive support.

conclusionsThe intervention was feasible within a public primary healthcare setting and addressed key gaps in access to individualized breastfeeding support. It demonstrated the relevance of combining technical and relational competencies in counseling and the importance of integrating such services within existing health systems. These findings provide practical insights for the implementation of similar models in resource-constrained settings. CLINICAL TRIAL NUMBER: Not applicable.