Improving exclusive breastfeeding rates

*Practice acts as child’s first vaccine by providing antibodies, boosting IQ, school attendance
*Behaviour associated with higher income in adult life, reduces risk of breast cancer in mother
*CHAI introduced ‘Mamajoy breastfeeding suite’ to promote trend in public places, says Alonge

Exclusive breastfeeding means that the infant receives only breast milk. No other liquids or solids are given – not even water – with the exception of oral rehydration solution, or drops/syrups of vitamins, minerals or medicines.

The World Health Organisation (WHO), the United Nations Children Fund (UNICEF) and the Child Health Advocacy Initiative (CHAI) recommend: Infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health; and thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods, while continuing to breastfeed for up to two years or beyond.

Several studies have shown that breastmilk is the only food an infant needs for optimal growth and development.According to CHAI, WHO, and UNICEF, breastfeeding is vital to a child’s lifelong health, and reduces costs for health facilities, families, and governments. Breastfeeding within the first hour of birth protects newborn babies from infections and saves lives. Infants are at greater risk of death due to diarrhoea and other infections when they are only partially breastfed or not breastfed at all. Breastfeeding also improves IQ, school readiness and attendance, and is associated with higher income in adult life. It also reduces the risk of breast cancer in the mother.

Despite all these benefits associated with exclusive breastfeeding, only 23.7 per cent of Nigeria women breastfeed exclusively.As part of efforts to encourage exclusive breastfeeding, improve the health of babies around the world and to celebrate the World Breastfeeding Week (WBW), August 1 to 7, stakeholders including the WHO, UNICEF and CHAI have proffered solutions.

According to Multiple Indicator Cluster Survey, 2017 (MICS, 2017), “95.0 per cent of Nigeria women breastfeed their babies, five per cent of Nigeria women do not breastfeed and 23.7 per cent breastfeed exclusively.”However, presently, Lagos is one of the states with the highest breastfeeding rate of 51.8 per cent in Nigeria.

Anyways, Nigeria is doing better than the United Kingdom (U.K.) and Sweden. Earlier this year, a report revealed that the UK has one of the lowest rates of breastfeeding in the world, with just 34 per cent of babies receiving breast milk at six months of age, compared to 62 per cent in Sweden.But in countries like Norway, where they have a law protecting and supporting breastfeeding, 71 per cent of their babies are exclusively breastfeed at six months.

Why are 76.4 Nigeria women not practicing exclusive breastfeeding despite the huge benefits? Executive Director Child Health Advocacy Initiative (CHAI), Mrs. Elizabeth Lola Alonge, told The Guardian in an exclusive interview ahead of the WBW: “According to Dr. Nigel Rollins, of WHO ‘success in breastfeeding is not the sole responsibility of a woman, the promotion of breastfeeding is a collective societal responsibility.’

“Majority of mothers want to practice exclusive breastfeeding but they don’t have the support needed. About 90 per cent of women in Nigeria start the process but only 23.7 per cent exclusively breastfeed their babies for six months. Limited or non-existent maternity protection policies prevent many women from optimally breastfeeding. Most mothers in Nigeria have to be back at work after three months of delivery and few work places have creches or breastfeeding rooms.

“Family, community and cultural traditions also have a strong influence on women’s breastfeeding decisions. The father is expected to support the breastfeeding mother by providing adequate food for her during the six months of exclusive breastfeeding and also assist her with household chores.

“Mothers need places to breastfeed when they are out of the home. They should not be expected to feed a baby in the toilet. Breastfeeding mothers should not be made to feel uncomfortable about breastfeeding in public. Marketing by the large and growing breastmilk substitute companies also undermines breastfeeding. Mothers are made to believe that formula milk is as good as breast milk.

“Breastfeeding mothers also need counselling and support to overcome challenges. This is not readily available, so most mothers give up easily when there is no professional to encourage and counsel them. We also have few lactation specialists in Nigeria. Healthcare providers often don’t provide mothers with accurate information and support.”

CHAI is an initiative of BASICS 11 United States Agency for International Development (USAID). The focus of the Organization is to promote child survival in Nigeria. It works with the federal, state, and local governments, along with local and international organisations to tackle maternal and child health issues in Nigeria. The Initiative has eight focus areas: nutrition, female genital mutilation, malaria, rights of women and children (girl child education), safe motherhood, child protection, routine immunization, hygiene and safety.

The WBW commemorates the Innocenti Declaration signed in August 1990 by government policymakers, WHO, UNICEF and other organizations to protect, promote and support breastfeeding. The theme of this year’s WBW is “Sustaining Breastfeeding Together,” because all of us – governments, decision-makers, development partners, professional bodies, academia, media, advocates, and other stakeholders – must work together to strengthen existing partnerships and forge new ways to invest in and support breastfeeding for a more sustainable future.

CHAI, WHO and UNICEF insist breastfeeding is the best way to provide infants with the nutrients they need. WHO recommends exclusive breastfeeding starting within one hour after birth until a baby is six months old. Nutritious complementary foods should then be added while continuing to breastfeed for up to two years or beyond. This year, WHO is working with UNICEF and partners such as CHAI to promote the importance of helping mothers breastfeed their babies within that crucial first hour of life. Skin-to-skin contact along with suckling at the breast stimulates the production of breastmilk, including colostrum, also called the baby’s ‘first vaccine’, which is extremely rich in nutrients and antibodies.

What is CHAI doing to address the gaps? Alonge, who is a graduate of the London School of Hygiene and Tropical Medicine where she earned certifications on improving the health of women, children, and adolescents, said: “In order to make exclusive breastfeeding practicable and increase breastfeeding rate in Nigeria, CHAI is putting in place measures to fill the gaps.

“Firstly, CHAI is raising awareness on the importance of exclusive breastfeeding to the mother and baby by using the media to amplify the message and organizing activities at health facilities and community level. Mothers are made to know that 80 per cent of the brain of a child is formed by five years and that breastfeeding can reduce the chances of the mother having ovarian cancer and breast cancer.

“CHAI currently runs a breastfeeding and nutrition helpline, mothers can call in to speak to a lactation expert on any breastfeeding issue and they are advised on how to go about it. CHAI is also working closely with private sector organizations to set up creches or breastfeeding rooms in their work places. We have a target to set up 50 breastfeeding rooms/ creches in companies in the next six months.

“We have an example of a private organization in Nigeria with a creche where their male employees bring their babies under six months to work with an expressed breast milk from the baby’s mother that will last till their work closure time. This is because the mother does not have the same facility at her place of work so the father is supporting the mother to breastfeed exclusively.

“To further promote breastfeeding in public places we have an innovation called ‘Mamajoy breastfeeding suite’ this is a mobile room that can be placed in strategic places so mothers can go there to breastfeed when they are out of the home example Airports, shopping malls, parks, gardens, recreational centres etc.

“CHAI is also working closely with government to have a law protecting and supporting breastfeeding in Nigeria. In order to support less privilege mothers and encourage them to breastfeed, chai is giving out breastfeeding packs to new mothers in public hospitals. The pack contains breastfeeding covers, breastfeeding pillows, breast pump, lactation cookies, diapers and provisions for the new mother. CHAI also has a breastfeeding handbook published by me to help mothers have the accurate information on how to breastfeed successfully.

CHAI is also setting up mother’s support groups in communities to promote exclusive breastfeeding in Nigeria.”Is wet-nursing still applicable? She said: “Wet nursing is the process whereby a woman breastfeeds a child that is not her biological child. Wet nursing is still applicable especially when a mother may need to take a medication that could harm her baby if transferred through her breastmilk or when a child’s mother is late, then the baby can be wet nursed.

What other conditions will make a woman not suppose to breastfeed her child? Alonge explained: “There are few reasons why a mother should not breastfeed her baby. Women who are undergoing medications that can harm their babies if transferred through her breastmilk and women who have infectious diseases like active tuberculosis, infections etc.”

Are there approved alternatives to breastfeeding? “No, breastfeeding is the best. It is the foundation of life and the only sustainable food that can reduce poverty and malnutrition. We need to change the conversation around breastfeeding by telling everyone, not just mothers why breastfeeding is important,” the CHAI executive director said.

Alonge added: “Together, we can create an enabling environment where mothers and families are supported to feed and care optimally for their infants and young children.”Meanwhile, WHO and UNICEF had on April 11, 2018 issued new ten-step guidance to increase support for breastfeeding in health facilities that provide maternity and newborn services. Breastfeeding all babies for the first two years would save the lives of more than 820,000 children under age five annually.

The Ten Steps to Successful Breastfeeding underpin the Baby-friendly Hospital Initiative, which both organizations launched in 1991. The practical guidance encourages new mothers to breastfeed and informs health workers how best to support breastfeeding.

UNICEF Executive Director, Henrietta H. Fore, said: “Breastfeeding saves lives. Its benefits help keep babies healthy in their first days and last will into adulthood. But breastfeeding requires support, encouragement and guidance. With these basic steps, implemented properly, we can significantly improve breastfeeding rates around the world and give children the best possible start in life.”

WHO Director-General, Dr. Tedros Adhanom Ghebreyesus, said that in many hospitals and communities around the world, whether a child can be breastfed or not can make the difference between life and death, and whether a child will develop to reach his or her full potential.Tedros said: “Hospitals are not there just to cure the ill. They are there to promote life and ensure people can thrive and live their lives to their full potential.

“As part of every country’s drive to achieve universal health coverage, there is no better or more crucial place to start than by ensuring the Ten Steps to Successful Breastfeeding are the standard for care of mothers and their babies.”The new guidance describes practical steps countries should take to protect, promote and support breastfeeding in facilities providing maternity and newborn services. They provide the immediate health system platform to help mothers initiate breastfeeding within the first hour and breastfeed exclusively for six months.

It describes how hospitals should have a written breastfeeding policy in place, staff competencies, and antenatal and post-birth care, including breastfeeding support for mothers. It also recommends limited use of breastmilk substitutes, rooming-in, responsive feeding, educating parents on the use of bottles and pacifiers, and support when mothers and babies are discharged from hospital.

According to the WHO, breastfeeding also benefits national economies, by helping to lower health care costs, increase educational attainment and, ultimately, boost productivity. Indeed, breastfeeding is one of the most cost effective investments available. Every US$ 1 invested in supporting breastfeeding generates an estimated US$ 35 dollars in economic returns across lower- and middle-income countries. By contrast, low breastfeeding rates translate into billions of dollars’ worth of lost productivity and health care costs to treat preventable illnesses and chronic diseases.

Recognizing the crucial role of breastfeeding in global health and development, in 2012, the 194 Member States of the World Health Assembly committed to a target of increasing the global rate of exclusive breastfeeding in the first six months of life from a baseline of 37 per cent to 50 per cent by 2025.

Subsequently, the United Nations proclaimed a Decade of Action on Nutrition (2016–2025), inviting countries to implement a Framework for Action that includes a number of measures in support of breastfeeding.Rapid progress is possible with investments in policies and programmes that better support a woman’s decision to breastfeed and ensures that more of the world’s children have the opportunity to thrive.

Consequently, UNICEF and WHO have come together with 20 prominent international agencies and nongovernmental organizations to form the Global Breastfeeding Collective, to launch on August 1, the first day of WBW. The Collective is calling on governments, donors and other stakeholders to advance policies and programmes to enable more mothers to breastfeed.

These policies and programmes include: enforcing the International Code of Marketing of Breast-milk Substitutes so that breast-milk substitute companies cannot mislead women; strengthening policy provisions that support family leave and breastfeeding in the workplace to encourage more working mothers to breastfeed their babies; improving the quality of maternity care to provide new mothers with breastfeeding support; increasing access to skilled breastfeeding counselling in the health system; fostering community networks that support women in breastfeeding; strengthening information systems to track progress towards the global goal of increasing breastfeeding; and increasing funding to protect, promote, and support breastfeeding.

“Breastfeeding is not a one-woman job. Mothers need assistance and support from their health care providers, families, employers, communities, and governments so they can provide their children with the healthiest start to life. Together, we can support women to breastfeed and protect the health and well-being of future generations.”