1. This poster is a publication developed by LINKAGES: Breastfeeding, LAM, Related Complementary Feeding, and Maternal Nutrition Program, and was made possible through funding from the United States Agency for International Development (USAID) provided to the Academy for Educational Development (AED) under the terms of Cooperative Agreement No. HRN-A-00-97-00007-00. View expressed herein are those of the authors and do not necessarily represent views of LINKAGES, AED or USAID. Methodology. The USAID-funded LINKAGES project, managed by the Academy for Educational Development, worked with many partners in Bolivia, Ghana and Madagascar to implement large-scale breastfeeding programs from 1997 to 2004. In Bolivia over 17 partner government and NGO groups were involved reaching a coverage of 1 million, in Ghana over 14 partner groups reached a coverage of 3.5 million, and in Madagascar over 45 partner groups reached a coverage of over 6.3 million. Each country program was different; however, common strategic elements included i.) partnerships, ii.) training, iii.) behavior change, and iv.) community support. IMPROVING BREASTFEEDING AT SCALE IS POSSIBLE: EXPERIENCES FROM AFRICA AND LATIN AMERICA V.J. Quinn, PhD, A.B. Guyon, MD MPH, C. Acquah, M.A., M.D. Hainsworth, MPH, P. Raoelina, MD, V. Ravelojaona, M.D., J. W. Schubert, A. Torrez, M.A. and M.A. Stone-Jimenez MS, The LINKAGES Project, Academy for Educational Development, 1825 Connecticut Ave NW, Washington D.C., 20019, USA Background. Improvements in breastfeeding can avert upwards to 13-15% of child deaths, the largest contribution of any preventative intervention (Jones et. al., Lancet 2003; 362:65–71). The recent Lancet Neonatal series further highlighted the importance of early and exclusive breastfeeding for neonatal outcomes. Objective. Rapidly improve breastfeeding practices in a number of countries at broad scale at the community level using existing systems & multiple program opportunities. Figure 1: Comparison over time and by country of infants less than 12 months old who were reported to have been breastfed within 1 hour of birth in intervention areas. Two data points in Madagascar in 2000 represent February and October of that year. *p<0.001, change from first data point vs. last data point, chi-square analysis. †p<0.05, change from first data point vs. last data point, chi-square analysis. Figure 2: Comparison over time and by country of infants less than 6 months old exclusively breastfed based on 24 hour dietary recall in intervention areas. Two data points in Madagascar in 2000 represent February and October of that year. *p<0.001, change from first data point vs. last data point, chi-square analysis. Conclusions  Behavior change approach should build on partnerships, integration, and harmonization  Addressing breastfeeding in an integrative manner using multiple program opportunities, rather than a separate vertical program, extends its appeal to other health and non-health programs, and increases program reach to more of the primary audience— pregnant women and mothers with young infants. Policy Implications  Broad scale programs to improve breastfeeding practices are feasible and should be included as a central component of child survival strategies.  To avert upwards to 25% of all child deaths each year, a similar integrated approach based on multiple program opportunities should be used to implement a package of ‘essential nutrition actions’ similar to that recommended by Jones et. al.2003, which includes improved breastfeeding and complementary feeding, vitamin A, and zinc. Results In all three countries statistically significant improvements were seen in Timely Initiation of Breastfeeding within 1 hour of birth, as well as in Exclusive Breastfeeding 0-6 months (see Figs 1 and 2 below). In both Ghana and Madagascar significant results were seen within one year of community interventions. Breastfeeding within 1 hour of birth Exclusive breastfeeding 0-6 months