Date of Award


Document Type


Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Rafael Pérez-Escamilla



Background: Exclusive breastfeeding rates in Lao People’s Democratic Republic (Lao PDR) remain at 44% against a global goal of at least 50%, partly due to a weak understanding of the multifactorial and multilevel determinants of breastfeeding (UNICEF, 2021). Therefore, evidence-based advocacy efforts call for a systems approach to improve the enabling environment around breastfeeding. Aim: This study aims to stitch together the comprehensive patchwork of actors and dynamic ‘gears’ in the socio-ecological environment that came together to develop a much more enabling environment to improve child nutrition through breastfeeding promotion and protection in Lao PDR. Further, it aims to tease out the specific strategies used in Lao PDR to develop a sound evidence-based advocacy approach to improve breastfeeding protection through multisectoral political will; increased investment; research, monitoring and evaluation; and stakeholder coordination. Methods: A literature review of peer-reviewed evidence and gray literature on the breastfeeding protective landscape in South-East Asia was conducted to contextualize progress in Laos. In addition, a qualitative study was conducted using semi-structured, in-depth interviews with six key informants guided by the COM-B (Capability, Opportunity, Motivation) model to identify the motivators, barriers, and facilitators of Code implementation. The Breastfeeding Gear Model (BFGM) and stakeholder mapping were used to illustrate key ‘gears’ in the environment. Qualitative coding was conducted, leading to the development of generalizable strategies and recommendations for other countries. Results: The three main themes identified were 1) Political will, 2) Multisectoral collaboration and Advocacy, and 3) Flexible funding. The key lessons and main enabling factors of the Lao PDR story were identified to be cross-sectional advocacy and partnerships between the development partners and the Lao government. Conclusion: A multisectoral approach to bring together the collaborative network of stakeholders is essential to create an overall conducive and enabling environment for breastfeeding protection. Countries with a similar socio-economic makeup may consider Lao PDR’s strategies to support child nutrition along global WHO goals.


This thesis is restricted to Yale network users only. It will be made publicly available on 05/10/2025