KIBS: KwaZulu-Natal Initiative for Breastfeeding Support

Overview of the KIBS project for the website

Breastfeeding provides the best nutrition to ensure child health, growth and development and offers lifelong benefits for the mother and her child. The World Health Organisation recommends that all infants be breastfed exclusively for the first six months of the baby’s life. This should be followed by the addition of nutritious complementary feeds and continued breastfeeding to two years of age and beyond.

Breastfeeding saves lives.

Optimal breastfeeding is the most important determinant of child survival. Its benefits include protecting the child against diarrhoeal disease, pneumonia and ear infections, and evidence suggests that breastfed children score higher on IQ testing, and are higher achievers overall. Breastfeeding not only provides nutritional and psychosocial benefits, but also lifelong health and socioeconomic benefits for both mother and child.

Despite strong evidence of the importance of breastfeeding for maternal and child health breastfeeding rates, particularly exclusive breastfeeding rates, remain low in many settings globally. This includes in South Africa where, despite the availability of effective interventions to promote breastfeeding, rates of breastfeeding have been low. A number of initiatives to promote breastfeeding were introduced by the KwaZulu-Natal Department of Health in recent years but could not be evaluated because of the lack of accurate national and provincial data on breastfeeding rates.

The KwaZulu- Natal Initiative for Breastfeeding support or KIBS was a three-year partnership between the Centre for Rural Health (CRH) and the KwaZulu-Natal (KZN) Department of Health (DoH). Funded by the ELMA Foundation, the aim of KIBS was to  improve breastfeeding practices in KZN. The CRH team provided technical and logistical support for the DoH to implement existing and proposed interventions to support breastfeeding in the province.

There were four main components to KIBS:

  • Establishment of Human Milk Banks
  • Training and mentoring health workers
  • Media campaign
  • Cross sectional surveys

Support for the DoH’s establishment of Human Milk Banks in one facility in each of the 11 districts in KZN. This process included the development of standard operating procedures, training materials, technical support and training for staff teams responsible for the Human Milk Banks in each designated health facility.

Achievement: On completion of the project there were functioning Human Milk Banks in nine of 11 districts in KZN.  Two further banks were in the planning and set up stage.

KIBS provided training and mentoring for skills development and support of new cadres of health workers deployed to support infant feeding, particularly breastfeeding, in clinics, hospitals and communities. Among the health workers were nutritional advisors, lay health workers recently deployed in all PHC clinics; lactation advisors, enrolled nurses who were deployed in all hospitals to support breastfeeding, particularly in the labour ward and postnatal ward and community caregivers (CCGs) who work at household level and whose roles include visiting pregnant women and new mothers in their homes.

Achievement: On completion of the project, 58 lactation advisors, 555 nutrition advisors and 115 community health facilitators received training and mentoring over the three-year period of the KIBS intervention.

The funding for the KIBS project supported a media campaign to share key community messages related to the establishment of Human Milk Banks. This consisted of the development of a ‘Made-by-Mom’ logo, and a supporting blog, a documentary about Human Milk Banking, and a series of video and radio dramas promoting the importance of breastfeeding.


  • The “Made-by-Mom” logo was handed over to the KZN Department of Health.
  • Radio dramas were broadcast on local radio stations in rural districts.
  • Each of the newly established milk banks had a community launch supported by promotional material.

The project team embarked on a research study using cross sectional surveys at baseline and endpoint to establish a robust estimate of feeding practises at 14 weeks in every district of KZN at the beginning (KIBS1) and at the end of the project (KIBS2). Using the same methodology in both surveys allowed a robust comparison of feeding. Click here to read the Baseline Report and the Endpoint Report.


Results from the baseline study showed an estimated exclusive breastfeeding rate in KZN of 45.1% (95% CI: 40.3-50.0) with significant differences in the rates of exclusive breastfeeding between the districts and a high overall rate of breastfeeding, with 73.9% of infants still being breastfed at 14 weeks.  (Horwood C, Haskins L, Engebretsen IM, Phakathi S, Connolly C, Coutsoudis A, and Spies L. Improved rates of exclusive breastfeeding at 14 weeks of age in KwaZulu Natal, South Africa: what are the challenges now? BMC Public Health (2018) 18:757  18:757)

The endpoint report showed a huge improvement in rates of exclusive breastfeeding at 14 weeks over a short period of time. A 9,4% improvement rate – from 49.9% at baseline in 2014 to 59.3% at endpoint in 2017 – was found. There was also a significant reduction in mixed breastfeeding over the same time period.

Furthermore, results from the endpoint report showed an estimated exclusive breastfeeding rate among all carers (mothers and caregivers) of 50.5%  – an improvement of 4.7% over the 3-year period. Statistically, this was not significant, however.  (Horwood C, Haskins L, Engebretsen IM, Phakathi S, Connolly C, Coutsoudis A, and Spies L. Are we doing enough? Improved breastfeeding practices at 14 weeks but challenges of non-initiation and early cessation of breastfeeding remain: findings of two consecutive cross-sectional surveys in KwaZulu-Natal, South Africa. BMC Public Health (2020) 20:440)

In recognition of the complex nature of mothers’ decisions about whether to breastfeed or not, a longitudinal qualitative study was undertaken to explore individual mothers’ narratives about infant feeding choices and practices from birth to six months . This allowed researchers to prospectively capture critical moments and processes involved in participants’ infant feeding choices.  Mothers were recruited to provide critical insights from the perspective of HIV positive mothers, teenage mothers, working mothers and mothers who did not work. (Click here to read the Cohort Report).   

Multiple factors hindered mothers’ decisions to breastfeed exclusively for six months but most mothers had the same reasons for introducing other food or fluids before 6 months: Health system factors and mother-baby factors.

This was followed by social factors such as pressure from the family or returning to work or school.   Jama NA, Wilford A, Masango Z, Haskins L, Coutsoudis A, Spies L and Horwood C. Enablers and barriers to success among mothers planning to exclusively breastfeed for six months: a qualitative prospective cohort study in KwaZulu-Natal, South Africa. International Breastfeeding Journal (2017) 12:43 

Although teenage mothers were knowledgeable about the benefits of exclusively and planned to initiate breastfeeding, they were unable to sustain it for the full 6 months. Once teenage mothers returned home, the responsibility of caring for the child was handed over to older members of the family who were not supportive of EBF and suggested starting complementary feeds within the first month Jama NA, Wilford A, Haskins L, Coutsoudis A, Spies L and Horwood C. Autonomy and infant feeding decision- making among teenage mothers in a rural and urban setting in KwaZulu-Natal, South Africa. BMC Pregnancy and Childbirth (2018) 18:52.

HIV‐infected women were strongly motivated to comply with infant feeding counselling messages from HWs, and resisted contrary messages from friends and family to prevent their infants acquiring HIV infection.  However, the infant feeding counselling messages HWs shared with HIV positive mothers were often outdated, confused and prescriptive, and failed to provide individual support. Ultimately, this led to inappropriate infant feeding decisions. Horwood C, Jama NA, Haskins L, Coutsoudis A, Spies L.  A qualitative study exploring infant feeding decision‐making between birth and 6 months among HIV‐positive mothers. Maternal and Child Nutrition. 2018;e12726.