title: A Qualitative Analysis of Barriers and Facilitators to Optimal Breastfeeding and Complementary Feeding Practices in South Kivu, Democratic Republic of Congo.
abstract: Suboptimal infant and young child feeding (IYCF) practices are determinants of poor child nutritional status. In the Democratic Republic of Congo, few children are fed according to international guidelines; this combined with endemic poverty and food insecurity have contributed to the high prevalence of child undernutrition.
  
  
  
  To characterize IYCF practices and barriers and enablers to optimal child feeding in South Kivu.
  
  
  
  Focus group discussions, structured and in-depth interviews with women of reproductive age, mothers of children <2 years, and health workers were conducted in 2012 as part of formative research for the US Agency for International Development (USAID)-funded Jenga Jamaa II multiyear assistance program.
  
  
  
  Although breastfeeding was prevalent, few mothers engaged in optimal feeding practices. Barriers included poverty, high work burden, lack of decision-making power in the household, and perceived milk insufficiency. Health provider guidance and mothers' motivation to breastfeed and feed nutrient-dense foods emerged as facilitators to optimal practices.
  
  
  
  Structural factors, especially long hours working in agricultural fields, impeded mothers' ability to feed their children optimally. Interventions to address child nutrition and improve IYCF practices should take into account these factors, in addition to food access, nutrition education, and behavior change.
authors.affiliation: International Medical Corps, Washington, DC, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Burns
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Jillian A
authors.initials: JA
authors.lastname: Emerson
authors.affiliation: PATH, Seattle, WA, USA Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Amundson
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Shannon
authors.initials: S
authors.lastname: Doocy
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Caulfield
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Helen Keller International, Washington, DC, USA rklemm@hki.org.
authors.forename: Rolf D W
authors.initials: RD
authors.lastname: Klemm
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000706:statistics & numerical data*; D015023:Democratic Republic of the Congo; D005069:Evaluation Studies as Topic; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007407:Interviews as Topic; D008297:Male
keywords: DRC; breastfeeding; complementary feeding; nutrition