September 2025 — Eritrea has become a leading example of how political commitment, health system integration, and Social and Behaviour Change (SBC) strategies can transform child health. By making breastfeeding a national priority, the country has achieved some of the highest rates of early initiation and exclusive breastfeeding in sub-Saharan Africa—contributing to a steep decline in child mortality.

National Commitment and Results

Breastfeeding is not treated as just a health recommendation in Eritrea, it is seen as a national priority.Nearly all Eritrean mothers initiate breastfeeding within the first hour of birth, and a large majority exclusively breastfeed during the first six months of life. These practices have contributed to under-five mortality falling from 130 deaths per 1,000 live births in the 1990s to fewer than 40 today.

SBC at the Core of Progress

Social and Behaviour Change has been central to Eritrea’s success. Rather than focusing solely on information-sharing, SBC strategies have addressed attitudes, norms, and enabling environments that shape family decisions:

• Shifting Norms and Attitudes: National campaigns during World Breastfeeding Week combine radio broadcasts, school competitions, and public rallies. Messages highlight the benefits of exclusive breastfeeding for child growth, bonding, and immunity. Breastfeeding is framed not only as good for health, but also a point of pride and cultural strength.

Behavioural insight: People are more likely to adopt behaviours that are seen as part of their identity and community values.

• Community Mobilization: In rural villages, community health workers conduct home visits to counsel mothers and families on breastfeeding practices. Village elders and religious leaders are often engaged to reinforce the message, ensuring it resonates within traditional structures of authority.

Behavioural insight: This intervention acknowledges that the messenger matters, especially when messages align with cultural traditions.

• Consistent Multichannel Communication: Breastfeeding promotion is embedded in radio dramas, posters in health facilities, and women’s group dialogues. This ensures that mothers receive the same supportive messages whether they are at home, in clinics, or at community gatherings.

Behavioural insight: Repetition across different channels increases salience—making the practice top-of-mind and harder to forget.

• Practical Support: In workplaces and farming communities, SBC interventions encourage husbands and family members to share household responsibilities so that mothers have the time and energy to breastfeed exclusively. In some settings, community dialogues specifically target fathers, shifting social norms to make breastfeeding a shared family responsibility.

Behavioural insight: Behaviour change is easier when the social environment is supportive, reducing the time, energy, and stigma costs mothers may face.

Through these approaches, Eritrea has demonstrated how SBC can go beyond raising awareness to create an enabling environment where positive practices are normalized, supported, and sustained.

Enabling Factors

• Political Leadership: The Government of Eritrea has embedded breastfeeding promotion within maternal and child health policies and international commitments.

• Health System Integration: Breastfeeding counseling and follow-up are part of routine care in maternity wards and community health centers.

• Cultural Reinforcement: With breastfeeding already a social norm, SBC approaches have strengthened and sustained its universal adoption.

Transferable insights

Eritrea demonstrates that investing in SBC, alongside policy and health system support, can generate powerful results. The country’s experience shows that even in resource-limited settings, well-designed SBC strategies can drive long-term improvements in maternal and child health, while strengthening community resilience and trust in health systems.

Eritrea’s experience shows that SBC can help turn simple health practices into sustained social norms when:

• Policies are backed up with community-led action.

• Messages are consistent, repeated, and delivered by trusted voices.

• Cultural values are treated as allies, not obstacles.

• Families—not just mothers—are engaged to share responsibility.

Behavioural science teaches us that people don’t make health decisions in isolation—they follow cues from their culture, peers, leaders, and environments. Eritrea aligned all of these cues toward one goal.

Conclusion

Eritrea’s success story underscores the transformative role of SBC in advancing maternal and child health. By combining political will, strong health systems, and culturally rooted SBC approaches, the country has reduced child mortality and set a compelling example for others. Eritrea proves that with commitment and community engagement, even simple interventions like breastfeeding can deliver extraordinary impact.