Strengthening breastfeeding counseling through a scaled-up intervention implemented within Ecuador’s local healthcare system

Background: Breastfeeding counseling plays a key role in promoting optimal infant feeding, particularly when delivered individually and in person. Its effectiveness relies on the quality of healthcare training, which remains highly variable. In Ecuador, however, public health services mainly rely on group-based strategies with limited access to individualized support. This gap reinforces existing inequalities as private counseling services remain costly. This article aims to document an intervention co-developed with the local health system to strengthen healthcare capacity and implement a model of individualized counseling in a rural area of the country. Methods: This practice-based case study was implemented in two phases between 2023 and 2024. In phase I, 32 primary-level healthcare professionals participated in a training consisting of 80 hours (40 theoretical, 40 practical), focused on technical content, affective communication, and supportive counseling strategies. Focus group discussions conducted at the beginning and end of the training informed the curriculum design and evaluated changes in knowledge and attitudes. In phase II, a breastfeeding counseling room was established at the Tabacundo Healthcare Center, staffed by ten certified counselors. Standardized digital records were used to document user profiles and counseling topics. Data were analyzed descriptively with Stata and thematically with MAXQDA. Results: Ten of 32 providers (31%) completed the full training and certification process. A total of 305 counseling sessions were conducted with 247 women, most of whom were lactating (74%), aged 18–29 (68%) and resided in the immediate catchment area (87.9%). Key consultation topics included latch difficulties, nipple pain, perceived low milk supply, and the need to express and store milk. Sessions averaged 36 minutes. Adolescents and primiparous women represented a significant proportion of users, reinforcing the need for differentiated approaches. The counseling model emphasized active listening, personalized support, and emotional containment. Conclusions: This study demonstrates the feasibility of designing and implementing a breastfeeding counseling model tailored to local healthcare system resources and user needs. The model proved technically sound, contextually appropriate, and responsive to maternal trajectories. The findings offer valuable insights for scaling similar interventions in other low-resource settings and support future research into their effects on breastfeeding outcomes and maternal–infant health.