Reframing Prelacteal Norms: An Elder-inclusive and Culturally Sensitive Behavior Change Strategy

Introduction: Exclusive breastfeeding (EBF) for the first 6 months is critical for neonatal health and is recommended by the World Health Organization. Despite national programs promoting EBF, pre-lacteal feeding remains widespread in rural India due to strong cultural traditions and the influence of elder family members. Aims: To understand socio-cultural determinants of pre-lacteal feeding and develop a culturally grounded behaviour change communication (BCC) strategy to support exclusive breastfeeding. Material and Methods: From March 2023 to August 2024, a culturally sensitive behavior change communication approach using mixed-method ethnographic design was conducted across 226 rural households identified with inadequate knowledge of EBF. Accredited Social Health Activists and Female Health Workers accompanied field visits. The approach prioritized respectful engagement with elder family members, particularly those who influenced pre-lacteal feeding, to understand the cultural significance of pre-lacteal feeding. Colostrum was reframed as a culturally appropriate pre-lacteal, preserving the symbolic intent of the tradition while aligning with evidence-based recommendations. Results: The approach resulted in increased acceptance of EBF, improved intergenerational dialogue and greater inclusion of elders in neonatal care decisions. Nearly all participating families expressed willingness to forego traditional prelacteals and initiate breastfeeding immediately after birth. Community health workers, through their involvement, recognized the cultural congruence and effectiveness of the approach; and expressed intent to incorporate it into routine practice, suggesting improved sustainability and potential for wider dissemination. Conclusion: This approach demonstrated that aligning health messages with cultural values rather than opposing them, can foster behavior change, build community trust and enhance program sustainability. Further evaluation is needed to assess the long-term impact on breastfeeding practices.