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How to ensure women exclusively breastfeed their babies

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Stakeholders seek law to mandate six months maternity leave with pay,
establishment of crèche, lactating rooms in working places
• Say avoidable morbidity, mortality resulting from not breastfeeding
incurs global costs as high as N550b yearly to treat

Despite the many benefits of exclusive breastfeeding, for mother and child, only about 29 per cent of Nigerian women adhere to the practice.

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To ensure women exclusively breastfeed their babies for six months, stakeholders have called on the government at all levels to enact laws that would make it mandatory for six months maternity leave with pay and establishment of crèche and lactating rooms in working places for nursing mothers.

The stakeholders at a virtual Nigeria Health Watch 2021 Nutrition Policy Dialogue titled, “Strengthening Workplace Policies for Exclusive Breastfeeding: A Shared Responsibility” were unanimous that breastfeeding provides essential nutrients to newborns and infants, which translate to proper growth and development from childhood to adulthood.

They said there are many benefits of breastfeeding to infants (reduced risk of infections, heart disease, obesity, etc.) and mothers (reduced risk of breast and ovarian cancers, heart disease). They said it also has future economic benefits for countries; avoidable morbidity and mortality resulting from not breastfeeding incurs global costs as high as $1.1 billion (N550 billion) yearly to treat.

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They said the policy dialogue was to explore ways of leveraging on this important nutrition tool to improve outcomes for households and the country by extension, especially as the World Breastfeeding Week was marked globally.

The Zoom dialogue, organised by the Nigeria Health Watch, brought together stakeholders in government, academia, research, development, civil society, nutrition commodities manufacturing and marketing, relevant groups and associations, and healthcare providers. The theme of the policy dialogue highlighted the importance of multi-stakeholder and multi-sectoral collaboration to the advancement of workplace policies for nutrition.

Nigeria Health Watch is a health communication and advocacy organisation.

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The stakeholders include Permanent Secretary, Federal Ministry of Labour and Productivity, Dr. Yerima P. Tarfa, who was represented by Kehinde Facunle; Chief of Section, Nutrition, United Nations Children’s Fund (UNICEF) Nigeria Office, Nemat Hajeebhoy; Managing Director of Nigeria Health Watch, Vivianne Ihekweazu; Director of Public Health, Kaduna State Ministry of Health, Dr. Hajara Ni’ima Kera; and public health officer and Head of Nutrition, Federal Ministry of Finance Budget and National Planning, Mrs. Chito Nduka Nelson.

Ihekweazu, in her opening remarks, said: “Breastfeeding costs $4 billion (N200 billion) in household cost annually and $22 billion (N11 trillion) in health system cost. The legal instrument, to ensure exclusive breastfeeding for the first six months and continue breastfeeding with complementary food for up to two years, is lacking. There was a national policy on infant and young child feeding in 2010. The Nigeria Labour Act provides for three months of maternity leave but it is only adhered to in the public sector, there is variation in the private sector. There is no uniformity. There is a lack of workplace policies like establishing a crèche. There is no law to encourage exclusive breastfeeding for six months.”

Kera said there is a novel policy in Kaduna institutionalising an executive bill for presentation at the state House of Assembly. Kera said the state ministry of health is providing technical support for the policy to succeed. She said there is an executive bill to establish six months maternity leave in Kaduna state. “The bill is with the ministry of justice and they are reviewing it to make sure mothers are given six months paid maternity leave,” Kera said.

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Kera said for organisation that is struggling, there is fear that breastfeeding will affect their bottom line. “In Kaduna State, we have extended leave from three to six months, and leave is paid for. We have established crèche and lactating rooms for women to go and breastfeed their babies. It makes the woman more relaxed and more productive. We are still pushing forward for other ministries to establish these lactating rooms and see that women are more when their babies are with them. We are also doing sensitisation that it is not a loss but credit to the bottom line. We are working towards making workplaces mother and baby-friendly,” she said.

Kera added: “We have the support in paid leave, crèche, and a place to lactate the child. There is also an exclusive bill. We are looking across the multi-sectoral response. Where and whenever we have the opportunity, we push forward exclusive breastfeeding. You can just give lactating mothers an office to accommodate our mothers and future leaders. There is something everyone can do to support breastfeeding.”

Nelson said there is a national policy for food and nutrition that provides a framework for the first 1,000 days and there is also the national committee on food and nutrition. “We tried to address exclusive breastfeeding and first 1,000 days and the national multi-plan of action 2021 to 2025. We have a very strong platform- National Committee on Food and Nutrition and National Council chaired by the Vice President. We have very strong synergy, learning and supporting each other,” she said.

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Nelson said it is not just about having the policies but implementing the policies. She said if women were determined to exclusively breastfeed the employer needs to encourage them. “It will make the woman more productive. There is a need to extend the lactating leave for women from 12 weeks to six months,” Nelson said. “We have state committees on food and nutrition at the state level. I urge all of us to ensure full implementation at all levels especially at the state level.”

Hajeebhoy said UNICEF is proposing increasing maternity leave from three to six months. She said there are challenges and opportunities but there should be a protective policy for the woman to effectively play her roles in society. “It is not just the question of six months leave but paid leave. Women make up to 40 per cent of the workforce. We are advocating for long paid leave and workplace intervention to continue for 24 months. There is a belief that taking maternity leave affects the career of women. It is not a barrier and should not be a barrier. 75 per cent of women interviewed said they would like to have six months of paid leave. There is no correlation between six months’ leave and job protection. The burden is falling on the private sector to comply. Breastfeeding women do better at work,” she said.

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Hajeebhoy said the recommendation is workable because breastmilk is the only food the child needs for the first six months. She further explained: “When a child is born, the neural and gut are not well developed. So they need breastmilk as sufficient for the first six months and with complementary feeding till 24 months. Breastmilk still provides 70 per cent of child needs for the first nine months. It is critical for brain development, gut, and immune system development.”

The UNICEF nutrition chief said there are small things employers can do to make the job flexible. “We need to make breastfeeding a new normal. In Nigeria, one in three children are exclusively breastfed and this is unacceptable. Just allocate a small space in your office. You don’t expect the women to go into the toilet to express breastmilk,” she said.

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Tarfa disagrees with the notion that some nursing mothers in some government establishments were asked to resume work after three months. “It is strange to me that somebody was asked to resume work after three months. We have maternity protection policies to support exclusive breastfeeding in the workplace. The Labour Act does not say that,” he said.

The stakeholders’ assertions were supported by several studies which showed that the workplace plays a critical role in supporting breastfeeding practices. According to the International Labour Organisation (ILO), lack of support at the workplace is one of the major reasons why women stop breastfeeding before the recommended time. Women tend to stay longer at their jobs if they can breastfeed at work –skill retention is good for business.

Section 54 of Nigeria Labour Act lays stipulates 12 weeks of maternity leave; six weeks before and six weeks after delivery−Pay of not less than 50 per cent of her previous wages during this time−Half an hour breaks twice daily for breastfeeding.

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The first objective of the National Policy on Infant and Young Child Feeding in Nigeria published in 2010 is “to protect, promote and support exclusive breastfeeding in the first six months of life”. There is no enabling law to back up this policy in employer-employee relations. Sustained breastfeeding is facilitated by a longer duration of maternity leave, but inconsistent maternity leave policies and lack of enforcement of existing policies are deterrents.

According to the Nigerian Labour Act, women are entitled to three months of maternity leave which falls short of the six months recommended period for exclusive breastfeeding and largely only applies to public sector workers. “Given the obvious benefits of breastfeeding, there is a clear need to strengthen workplace policies for exclusive breastfeeding both in public and private organizations, and to ensure that these policies become consistent across all sectors,” Ihekweazu.

UNICEF Executive Director, Henrietta Fore and World Health Organisation (WHO) Director-General, Dr. Tedros Adhanom Ghebreyesus, in a joint statement released on the occasion of World Breastfeeding Week, August 1 to 8, 2021, said: “Initiation of breastfeeding within the first hour of birth, followed by exclusive breastfeeding for six months and continued breastfeeding for up to two years or beyond offer a powerful line of defence against all forms of child malnutrition, including wasting and obesity. Breastfeeding also acts as babies’ first vaccine, protecting them against many common childhood illnesses.

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“While there has been progressing in breastfeeding rates in the last four decades – with a 50 per cent increase in the prevalence of exclusive breastfeeding globally – the COVID-19 pandemic highlights the fragility of those gains.

“In many countries, the pandemic has caused significant disruptions in breastfeeding support services, while increasing the risk of food insecurity and malnutrition. Several countries have reported that producers of baby foods have compounded these risks by invoking unfounded fears that breastfeeding can transmit COVID-19 and marketing their products as a safer alternative to breastfeeding.”

They said this year’s World Breastfeeding Week, under its theme “Protect Breastfeeding: A Shared Responsibility” is a time to revisit the commitments made at the start of this year by prioritising breastfeeding-friendly environments for mothers and babies. This includes:
•Ensuring the International Code of Marketing of Breastmilk Substitutes – established to protect mothers from aggressive marketing practices by the baby food industry – is fully implemented by governments, health workers, and the industry.

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•Ensuring health care workers have the resources and information they need to effectively support mothers to breastfeed, including through global efforts such as the Baby-friendly Hospital Initiative, and guidelines on breastfeeding counselling.

•Ensuring employers allow women the time and space they need to breastfeed; including paid parental leave with longer maternity leave; safe places for breastfeeding in the workplace; access to affordable and good-quality childcare; and universal child benefits and adequate wages.

They said as the world approach the United Nations (UN) Food Systems Summit in September and the Tokyo Nutrition for Growth Summit in December, governments, donors, civil society and the private sector all have an opportunity to make smart investments and commitments to tackle the global malnutrition crisis – including protecting, promoting and supporting breastfeeding – through stronger policies, programmes and actions.

UNICEF and WHO added: “Now is not the time to lower our ambitions. Now is the time to aim high. We are committed to making the Nutrition for Growth Year of Action a success by ensuring that every child’s right to nutritious, safe, and affordable food and adequate nutrition is realized from the beginning of life, starting with breastfeeding.”

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