Boosting breastfeeding in Nigeria

Breastfeeding especially exclusively for the first six months of life has been shown to prevent diseases such as diarrhoea and respiratory infections in the baby and breast and ovarian cancers in the mother. It also boosts the child’s Intelligent Quotient (IQ) and lowers his or her tendency of developing into a violent adult. Despite all these benefits, only about 17 per cent of nursing mothers in Nigeria practise exclusive breastfeeding and about 70 per cent breastfeed for up to 12 months. As humanity marks World Breastfeeding Week, August 1 – 7, CHUKWUMA MUANYA and RUTH ADEKUNLE write on why most Nigerian women are not practising exclusive breastfeeding and efforts to improve rates.

Activities are rife as World Breastfeeding Week is celebrated, August 1 to 7, to encourage breastfeeding and improve the health of babies around the world.

It commemorates the Innocenti Declaration signed in August 1990 by government policymakers, World Health Organisation (WHO), United Nations Children Fund (UNICEF) and other organizations to protect, promote and support breastfeeding.

Several studies have shown that 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 and nutritious complementary foods should then be added while continuing to breastfeed for up to two years or beyond.

This year, WHO is encouraging people to “Support mums to breastfeed anytime, anywhere,” as all of society has a role to play in making our communities more breastfeeding-friendly.

Now, evidence is stronger than ever that breastfeeding has substantial benefits for women and children in rich and poor countries alike.

A major new Series on breastfeeding, published in The Lancet, found that despite strong health and economic benefits from breastfeeding, few children are exclusively breastfed until six months, as recommended by WHO. Globally, an estimated one in infants under-six months is exclusively breastfed – a rate that has not improved in two decades.

New WHO estimates published in The Lancet reveal that increasing breastfeeding to near-universal levels could save more than 800 000 lives every year, the majority being children under six months. In addition, nearly half of all diarrhoeal diseases and one-third of all respiratory infections in children in low- and middle-income countries could be prevented with increased rates of breastfeeding.

According to the report, children who are breastfeed perform better in intelligence tests, are less likely to be overweight or obese, and less prone to diabetes later in life. Mothers who breastfeed also reduce their risk of developing breast and ovarian cancers. At current breastfeeding rates, an estimated 20 000 deaths from breast cancer are prevented and an additional 20 000 could be saved if rates improved.

Beyond health, the new Series presents a strong economic case for investing in promoting and protecting breastfeeding worldwide. The findings from WHO and partners estimate that global economic losses from lower cognition associated with not breastfeeding reached more than US$ 300 billion in 2012, equivalent to 0.49 per cent of the world’s gross national income.

Boosting breastfeeding rates for infants below six months of age to 90 per cent in Brazil, China, and the United States of America, and to 45 per cent in the United Kingdom would cut treatment costs of common childhood illnesses, such as pneumonia, diarrhoea and asthma, and save healthcare systems at least US$ 2.45 billion in the United States, US$ 29.5 million in the United Kingdom, US$ 223.6 million in China, and US$ 6.0 million in Brazil.

Yet, worldwide low levels of optimal breastfeeding affect both high- and low-income countries. Fewer than one in five infants are breastfed for 12 months in high-income countries and only two out of three children between six months and two years receive any breast milk in low- and middle-income countries.

But despite these evidence-based and celebrated benefits of exclusive breastfeeding, only about 17 per cent of nursing mothers in Nigeria observe this practice.
The Guardian investigations revealed factors that hinder exclusive breastfeeding by mothers in Nigeria

Top on the findings is that women in the workplace often did not have enough maternal protection from their employers and not all health workers were convinced of breast milk’s nutritional benefits.

According to a Registered Dietician Nutritionist (RDN), 68 Nigeria Army Reference Hospital, Yaba (NARHY), Lagos, Mrs. Ede-Osondu, the factors that could hinder exclusive breastfeeding by nursing mothers could be as a result of hormonal challenges, lack of family support, societal influence, influence of extended families and social status.

“In my own opinion just as there are different types of skins so are there different types of breast. For a woman who has a pendulum breast, is she saying that you will not breastfeed the baby because she does not want the breast to grow longer?

“If women are saying that exclusive breastfeeding causes sagging of the breast, for me it is not true. The men for me even sucks more than the babies, the strength of a man is even more than that of the baby even the grip of the man is stronger than the grip of a baby so what makes women feel that it is not the grip of the man that causes the sagging of the breast.”

Ede-Osondu maintained that exclusive breastfeeding does not in any way cause sagging of the breasts as some mothers claimed, she said the reason why most women have sagged breast is because at the time of breastfeeding, most of them do not use firm bras to help give the breast support especially the time that the breast is engaged with breast milk.

When asked if exclusive breastfeeding is scientifically proven as a reason for sagging of the breast, Ede-Osondu said: “There is no scientific reason to back up the saying that says exclusive breastfeeding causes sagging of the breast as some mothers claimed. For her sagging of the breast is as a result weakening of the muscles.

“As a woman ages, her muscles equally ages and weakens which is the major cause of a sagged breast, just as the muscles weakens the skin also slackens so the same way you find the skin having wrinkles that’s the same thing that happens to a woman’s breast and every parts of her body when she grows older.”

Ede-Osondu added: “Really for me I think in Nigeria the major challenge why most mothers don’t do exclusive breastfeeding is water and societal influence it’s not just about the sagging of the thing. They feel the baby needs water to quench their taste and when a mother who is doing exclusive gives water to her baby, it is no longer called exclusive.”

When asked of the health implication and health benefits exclusive breastfeeding has on a child and the mother, the dietician said: “Exclusive breastfeeding reduces the risk of ovarian cancer in mothers, retained gestational weight gain, type two diabetes and also aids the prevention on the development of childhood obesity and diabetes in the later years of children lives and may be associated with decreased cholesterol concentrations. Exclusive breastfeeding also has maternal benefits, including the delayed resumption of menstruation and subsequent reduced risk of anaemia, as well as substantial association with bonding of mother and the child.”

She continued: “Exclusive breastfed children have higher scores of mental-cognitive capability than children who were not exclusively breastfed. Exclusive breastfeeding helps protect babies from many diseases and reduces the severity of their systems. So far no replacement has been proposed for breastfeeding.
“The view that many Nigerian’s have is that if a baby is not looking so chubby, that baby is not healthy they believe that chubby babies are healthy babies which is wrong and because of that most of them choose to do baby formula believing it will make the baby add some weight, forgetting the health implication the formula will do to the baby later in the future.”

Ede-Osondu advised that mothers who cannot be near their children at all times for any reason can extract their breast milk and freeze the milk, so that other family members can feed the child whenever the child needs to be fed.

Another health implication of children who were not exclusively breastfed is associated with an increased in communicable disease, as well as higher risks of childhood obesity, type one and type two diabetes and sudden infant death syndrome (SIDS).
Nigerian mothers speak

For Mrs. Ngozi Opara, the reason why I did not practice exclusive breastfeeding for my two children is that, “Babies need water to quench taste when tasty and breast milk alone cannot satisfy my baby and also the baby needs herbs that will help prevent them from ela (rashes) according to my mother in-law.

Another basic reason is that exclusive breastfeeding is time consuming and disrupts the mother’s sleep at night when the baby needs breast milk at night and the night sleep for me is very important.

For Mrs. James Etti, a teacher at Ibuolu International College, Lagos, I actually practiced exclusive for my first child for three months but when my mother in-law visited for Omugwo (a practice among the Ibos where the mother comes to take care of her daughter and her new born baby), she was always insisting that I give the baby real food that am punishing my own child by giving him only breast milk and when I tried to make her see reasons with me, we had a very serious fight that I had no other choice than to do what she wants.

“I am learned and as such know the health benefits and health implications of not doing exclusive breastfeeding for my children because whenever I visit the hospital during pregnancy I was always told but when I saw that the pressure coming from my mother in-law was unbearable and didn’t want trouble in my marriage I had no other choice than doing what mama wants, she said.”

For a gynaecologist at NARHY, Lagos, Dr. Ofu Nkem, the reason why some mothers don’t practice exclusive breastfeeding is that, “Mothers who have breast cancers, societal influence and social status. Even if a woman breastfeed or not when it is time for that breast to sag it will still sag because of age.

“An exclusive breastfed baby enjoys quite a lot from the breast milk for instance: the exclusive breastfed babies have a high advantage to all the nutrition’s contained in the breast milk. All the baby requires are contained in the breast milk compared to the baby that was fed with baby formula.”

A representative of WHO, Mr. Nigel Rollins, said: “Nigeria had become s driver of growing breast-milk substitute industries to the detriment of their children.”

Although the World Health Assembly adopted the International Code of Marketing of Breast milk Substitutes in 1981 to protect the public from inappropriate marketing strategies, it has been has been weakly enforced by countries. As a result, aggressive marketing of breast-milk substitutes is undermining efforts to improve breastfeeding rates, with global sales expected to reach US$ 70.6 billion by 2019.
Studies

Also, a new study found that preterm infants fed breast milk within the first 28 days of life have better brain development and neurocognitive outcomes.

Study findings support current suggested guidelines for using breast milk to feed preterm babies during hospitalization.

The study, led by Brigham and Women’s Hospital, followed 180 preterm infants from birth to seven years old.

The results showed that the preterm babies that received more breast milk within the first 28 days of life had larger deep nuclear gray matter volume at full term and better IQs, academic achievements, memory, and motor function by age

Also observed by the team were cognitive measures of IQ, reading, mathematics, attention, working memory, language, visual perception, and motor testing at the age of seven.

Infants who were fed mostly breast milk on more days during Neonatal Intensive Care Unit (NICU) hospitalization had more nuclear gray matter volume – an area that processes and transmits neural signals to other brain areas – at term age equivalent.

By the age of seven, these same children were able to perform better in IQ, working memory, and motor function tests.

Findings from the study revealed that ingesting more breast milk correlated with better outcomes for preterm babies, larger regional brain volumes at full term, and improved cognitive ability at seven years old.

Recommendations to boost exclusive breastfeeding
To address this issue, the Global Breastfeeding Advocacy Initiative, led by UNICEF and WHO in collaboration with international partners, will be providing leadership to improve breastfeeding rates. As a first step, WHO and UNICEF have created a Network for Global Monitoring and Support for Implementation of the International Code (NetCode) with the purpose of strengthening capacity for Code monitoring, adherence and implementation.

Beyond combating marketing of breast-milk substitutes, countries need to invest in policies and programmes that support women’s breastfeeding. Supportive health-care systems, adequate maternity leave entitlements, workplace interventions, counselling and educational programmes can all help to improve breastfeeding rates.

Breastfeeding has also been identified as a high-impact intervention to achieve the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030), which was launched alongside the Sustainable Development Goals (SDGs) as a roadmap for ending preventable deaths in a generation. Breastfeeding is important to child survival in all settings, but also to ensuring that children can thrive and reach their full cognitive and developmental potentials throughout their lives.

Nkem urged the federal government to extend the period of maternity leave to six months for the working class mothers to enable them practice exclusive breastfeeding and possibly make sure that there is a Crèches close to the place of the mother so that the mothers can always have access breast fed her baby.

In Viet Nam, breastfeeding campaign has helped to normalise practice, improves rates.

WHO Assistant Director-General, Family, Women’s and Children’s Health, Flavia Bustreo, said: “Exclusive breastfeeding is the best way to give your child a great start in life. We all need to do everything in our power to support women who want to breastfeed at any time and in any place.

“A child’s brain undergoes some remarkable changes in the first three years of life. Neural connections form more quickly than at any other stage as speech and language develops and the architecture and functionality of the brain are established.

“That’s why the sight of a mother breastfeeding her child always warms my heart. In addition to providing the perfect source of early nutrition, by breastfeeding she is also providing love and security. I know she’s giving her child the best start at life.”