Researchers in rural Ethiopia are testing whether teaching pregnant women about breastfeeding works better when their mothers-in-law learn alongside them. Many Ethiopian mothers struggle with breastfeeding because of cultural beliefs and lack of information. Since first-time moms have never breastfed before, they’re easily influenced by family members. This study will teach 510 pregnant women in three different ways: some alone, some with their mothers-in-law together, and some with regular care only. Researchers will check how well babies are fed after birth. The results could help doctors and health workers decide the best way to teach families about breastfeeding to keep babies healthy.

The Quick Take

  • What they studied: Whether teaching pregnant women about breastfeeding works better when their mothers-in-law learn the same information at the same time, compared to teaching just the pregnant woman alone or giving regular care.
  • Who participated: 510 first-time pregnant women in rural South Ethiopia who are less than 16 weeks pregnant. The study includes women from 51 different rural communities, with some women learning alone, some learning with their mothers-in-law, and some receiving regular care.
  • Key finding: This is a study plan, not yet completed results. Researchers expect to finish testing in May 2025. They predict that including mothers-in-law in breastfeeding education may help more babies get breast milk, especially in the first months of life.
  • What it means for you: If results show that teaching mothers-in-law helps, health workers in rural areas could involve family members in breastfeeding classes. This might be especially helpful in cultures where mothers-in-law have strong influence on family decisions. However, wait for final results before making decisions based on this research.

The Research Details

Researchers are conducting a cluster randomized controlled trial, which is a strong type of study design. They divided 51 rural communities into three groups. One group of pregnant women will receive breastfeeding education alone. A second group will receive the same education, but their mothers-in-law will attend and learn together. A third group will receive routine care without special breastfeeding education. This design helps researchers see if having mothers-in-law involved makes a real difference.

The study separates the communities geographically to prevent information from spreading between groups. Pregnant women will receive education starting in their fourth month of pregnancy through their ninth month, with two more sessions after the baby is born. This timing allows researchers to teach women before and after delivery when they’re most likely to need the information.

Researchers chose this approach because in rural Ethiopia, mothers-in-law often have significant influence over family decisions, including how babies are fed. First-time mothers have never breastfed before, so they may listen more to experienced family members than to health workers.

This research design is important because it tests a practical solution to a real problem. Many studies teach only the mother, but this study recognizes that family relationships matter in rural communities. By comparing three groups, researchers can see if involving mothers-in-law actually improves breastfeeding. The study also uses a strong method (randomized controlled trial) that helps prove cause and effect, not just coincidence.

This is a well-designed study with several strengths: it uses randomization to fairly assign communities to groups, it includes a large number of participants (510 women), it separates communities to prevent information mixing, and it measures specific breastfeeding practices rather than just asking general questions. The study is registered publicly (NCT06236412), which means researchers committed to their plan before starting. However, this is a protocol paper describing the plan, not the final results, so we don’t yet know if the intervention actually works.

What the Results Show

This paper describes the study plan rather than final results. The research is still ongoing and expected to be completed in May 2025. Researchers will measure four main breastfeeding practices: whether babies receive food or water before breast milk (pre-lacteal feeding), whether babies receive colostrum (the first milk), whether breastfeeding starts within the first hour after birth, and whether babies receive only breast milk for the first six months.

When results are published, researchers will compare these practices between the three groups: women who learned alone, women who learned with their mothers-in-law, and women who received routine care. They will use statistical methods to determine if differences between groups are real or just due to chance.

The study is designed to detect meaningful differences in breastfeeding practices. For example, if the mother-in-law group has significantly higher rates of exclusive breastfeeding compared to the control group, that would suggest the intervention works. The researchers will also look at whether the paired education (mother plus mother-in-law) works better than educating the pregnant woman alone.

Beyond the main breastfeeding measures, researchers will likely examine how many women complete the education program, whether women report the education was helpful, and whether there are differences between communities. They may also look at whether certain types of women (younger, older, more educated, less educated) benefit more from the intervention. These secondary findings could help health workers understand who benefits most from family-based education.

Previous research shows that breastfeeding education helps improve feeding practices, but most studies have focused on teaching mothers alone. This study builds on that knowledge by testing whether adding family members increases the benefit. In Ethiopia specifically, cultural practices and family influence are known to affect breastfeeding, so this study addresses a gap in research by testing a culturally appropriate approach. The results will help determine if family-centered education is better than individual education in rural settings.

This is a protocol paper, so the main limitation is that we don’t yet have results. When results are published, potential limitations may include: women in the education groups might share information with women in the control group (though the study tries to prevent this), some women might drop out before completing the program, and results from rural Ethiopia may not apply to urban areas or other countries. Additionally, the study measures what women report about breastfeeding rather than directly observing feeding practices, which could introduce bias.

The Bottom Line

This study is still in progress, so no final recommendations can be made yet. However, based on the study design and existing evidence, health workers in rural areas may consider involving mothers-in-law in breastfeeding education programs when culturally appropriate. Current evidence suggests breastfeeding education helps, and this study will test whether family involvement increases that benefit. Confidence level: Wait for final results (expected May 2025) before implementing widespread changes.

First-time pregnant women in rural areas where mothers-in-law have influence over family decisions should pay attention to these results. Health workers, midwives, and public health officials in rural Ethiopia and similar settings should monitor this research. Women in urban areas or countries with different family structures may find the results less directly applicable. Mothers-in-law who want to support their daughters-in-law’s breastfeeding success should also be interested in these findings.

The study will be completed in May 2025. Once published, results should be available within 6-12 months. If the intervention is effective, it could take 1-2 years for health programs to adopt and implement family-based breastfeeding education. Pregnant women who receive the education might see benefits immediately after birth, with the most significant improvements in exclusive breastfeeding visible by 3-6 months postpartum.

Want to Apply This Research?

  • Track breastfeeding initiation time (how soon after birth breastfeeding started), exclusive breastfeeding days (days when baby receives only breast milk), and any pre-lacteal feeds (other foods or water given before breastfeeding). Users can log these daily to see patterns over the first 6 months.
  • If using a breastfeeding app, invite a trusted family member (mother-in-law, mother, or partner) to view your progress and receive educational notifications alongside you. This mimics the paired education approach tested in this study. Set reminders for monthly education sessions during pregnancy and two sessions after delivery.
  • Create a long-term tracking dashboard showing exclusive breastfeeding percentage over time, number of breastfeeding sessions per day, and any challenges encountered. Share progress reports with family members involved in your breastfeeding education to maintain engagement and support throughout the first 6 months postpartum.

This article describes a research study that is still in progress. The findings presented are based on the study protocol, not final results. This information is for educational purposes only and should not replace advice from your healthcare provider, midwife, or lactation consultant. Breastfeeding decisions should be made in consultation with qualified health professionals who understand your individual circumstances. If you are pregnant or planning to breastfeed, speak with your doctor or local health worker about the best feeding approach for you and your baby. Results from this Ethiopian study may not apply to all populations or settings.