Quality Improvement Initiative to Promote Exclusive Breastfeeding Through Antenatal Counseling and Structured Follow-Up Until 6 Months: A Tertiary Hospital Based and Community Follow-Up Study.

INTRODUCTION: Exclusive breastfeeding (EBF) is essential for infant survival and optimal growth; however, rates remain suboptimal due to sociocultural and health system barriers. The antenatal period offers a critical opportunity for structured education and behavioral reinforcement. OBJECTIVE: To evaluate the impact of a structured Quality Improvement (QI) intervention, incorporating antenatal counseling and scheduled postpartum follow-up, on EBF rates up to 6 months. METHODS: This QI study used a Plan-Do-Study-Act (PDSA) framework in a tertiary care hospital. A total of 70 antenatal mothers (≥ 34 weeks gestation) were enrolled. Participants received structured breastfeeding counseling and postpartum reinforcement via telephonic follow-up and clinic visits at predefined intervals (birth, postnatal Day (PND) 3/5, PND 7, 6 weeks, 10 weeks, 14 weeks, and 6 months). Exclusive breastfeeding status was recorded at each contact. RESULTS: Of 70 enrolled mothers, 64 completed the 6-month follow-up. The baseline EBF rate in the study setting was 58.8%. Following the intervention, EBF was sustained in 52/64 (81.5%) infants at 6 months, reflecting an absolute increase of 22.7%. EBF rates were 64/64 (100%) at birth, 51/64 (80.0%) at PND 3/5, 58/64 (90.8%) at PND 7, 59/64 (92.3%) at 6 and 10 weeks, 55/64 (86.2%) at 14 weeks, and 52/64 (81.5%) at 6 months. Two attrition phases were identified: early postpartum (PND 3/5) and after 10 weeks. CONCLUSION: A structured antenatal counseling program combined with systematic postpartum follow-up was associated with improved EBF rates, achieving sustained EBF of 81.5% at 6 months. Continued engagement during early postpartum and later infancy appears important for breastfeeding sustainability.