‘With six years to go, Nigeria still far from reaching the world health assembly 70% breastfeeding target’

Elizabeth Ololade Alonge is the Founder and Executive Director, Child Health Advocacy Initiative (CHAI), a healthcare and development non-profit focused on promoting the health and well-being of babies and children. Speaking extensively on the theme for this year’s World Breastfeeding Week (WBW), she tells TOBI AWODIPE why healthcare workers and employers need to encourage breastfeeding to stem malnutrition, early childhood feeding-related diseases and infant mortality.

What would you say are some of the most common barriers to breastfeeding for Nigerian mothers and how can they be addressed?
We have many barriers, including cultural beliefs and practices. Some cultures believe colostrum is not good for the baby and should be discarded; others are stigma and social pressure. Breastfeeding in public is seen as shameful or embarrassing. Also, lack of access to accurate information and support from the community, spouse and family. Many Nigerian mothers return to work soon after childbirth and face challenges in expressing and storing breastmilk. Some Nigerian cultures have traditional practices that hinder breastfeeding, such as giving water or other fluids to baby in the first few days. Finally, mothers lack access to lactation consultants, breastfeeding support groups, and other resources.

These barriers can be addressed by carrying out education and awareness campaigns to dispel this myth and promote the importance of colostrum for the baby’s health; encouraging community leaders and influencers to promote breastfeeding as a natural and essential part of motherhood, train more lactation consultants and peer counselors, and establish breastfeeding support groups and hotlines. We must also encourage employers to provide lactation rooms and flexible work arrangements to support breastfeeding mothers, engage husbands and family members in breastfeeding education and support and encourage them to be involved in caring for the baby.

The theme for this year is Closing the gap: Breastfeeding support for all, how best can we drive advocacy and support to practicalise this in Nigeria?
We can drive advocacy and support by engaging stakeholders, including policymakers, healthcare providers and community leaders, to raise awareness and build support for breastfeeding; develop and implement policies that support breastfeeding, such as paid maternity leave and breastfeeding-friendly environments; provide education and training for healthcare providers and community health workers on breastfeeding support and counseling and support the establishment of breastfeeding-friendly environments in healthcare facilities, workplaces, and communities. We can also drive advocacy and support by engaging the media to raise awareness and promote breastfeeding support among the general public; collaborate with non-governmental organisations to promote breastfeeding support and advocacy; develop and implement breastfeeding support programmes, such as peer support groups and lactation consultants and finally, monitor and evaluate the progress of breastfeeding support and advocacy efforts to identify gaps and areas for improvement.

How best can we promote and encourage a culture of breastfeeding support in communities?
By promoting breastfeeding education and awareness, organising community outreach programmes and workshops to educate mothers and families about the importance of breastfeeding and this should be done using local languages and contexts to communicate the benefits of breastfeeding. Engage community leaders and influencers, support breastfeeding-friendly environments by encouraging employers to provide lactation rooms and flexible work arrangements for breastfeeding mothers. We can also leverage on traditional media and social media, organise community events to celebrate World Breastfeeding Week (WBW) and other breastfeeding-related milestones, recogniSe and reward breastfeeding mothers and work with healthcare providers to promote breastfeeding and provide support.

In your opinion, do you think healthcare providers need to play a stronger role in promoting and supporting breastfeeding?
Yes, healthcare providers need to play a stronger role in promoting and supporting breastfeeding. Healthcare providers are seen as authorities and credible sources of information by mothers and families. Their support and encouragement can go a long way in promoting breastfeeding. They can educate mothers about the importance of breastfeeding during prenatal visits, setting the stage for a successful breastfeeding experience, ensure mothers receive proper support and guidance in the immediate postpartum period, when breastfeeding is established. They offer ongoing support and guidance to mothers throughout the breastfeeding journey, helping to address any challenges or concerns that may arise and can role-model breastfeeding support by promoting a culture of breastfeeding within their own practices and institutions.

Healthcare providers can be sensitive to the cultural beliefs and practices of mothers and families, providing support that is tailored to their unique needs and preferences. By playing a stronger role in promoting and supporting breastfeeding, healthcare providers can help increase breastfeeding rates and improve the health and well-being of mothers and babies in Nigeria.

What are some local practices/beliefs that support or hinder breastfeeding?
In some Nigerian cultures, breastfeeding is seen as a natural and essential part of motherhood, grandmothers and older women play a significant role in supporting and encouraging breastfeeding and it is seen as a way to bond with the baby and promote spiritual growth. They also believe breast milk is the best nutrition for babies and a way to promote child’s growth and connection. Some cultures believe that colostrum is harmful to the baby and is discarded, breastfeeding will cause their breasts to sag or lose their shape, breast milk is not enough for the baby. Formula feeding is more convenient or modern.

How can we offer better support for breastfeeding mothers in the workplace or for women in unstable situations?
We can support breastfeeding mothers by establishing lactation rooms or breastfeeding-friendly areas in the workplace, provide flexible work arrangements or flexible hours to support breastfeeding mothers, offer breastfeeding education and support programmes in the workplace, develop policies and laws that support breastfeeding in the workplace and provide access to lactation consultants and breastfeeding support groups. We can also implement the World Health Organisation’s (WHO) Breastfeeding Friendly Workplace Initiative; provide paid family leave and flexible work arrangements to support breastfeeding mothers and encourage policymakers to develop and implement policies that support breastfeeding.

What are the benefits of breastfeeding for mothers and babies and how can we amplify these benefit all?
Benefits of breastfeeding for mothers include the promotion of uterine contraction and helps the uterus return to its pre-pregnancy size, it helps with weight loss and reduces the risk of postpartum depression, lowers the risk of breast and ovarian cancer, supports bonding and attachment with the baby and delays the return of menstruation, which can help with family planning.

Benefits of breastfeeding for babies are that it provides optimal nutrition and promotes healthy growth and development, supports their immune system development and reduces the risk of infections, lowers the risk of sudden infant death syndrome (SIDS); promotes their brain development and cognitive function; supports healthy digestion and reduces the risk of constipation as well as promotes bonding and attachment with the mother. We can amplify the benefits of breastfeeding carrying out education and awareness campaigns to promote the importance of breastfeeding, plan community-based breastfeeding support programmes, social media campaigns and online resources to promote breastfeeding and collaboration with other healthcare professionals to provide comprehensive support.

What is the current state of breastfeeding policies and legislation in Nigeria, and how can we advocate for stronger support?
The Nigerian government has established policies and programmes to promote and support infant and young child feeding practices including, the Baby Friendly Hospital Initiative (BFHI) introduced in 1992, the National Breastfeeding Policy introduced in 1998, the National Policy on Food and Nutrition introduced in 2001 and the National Policy on Infant and Young Child Feeding introduced in 2005. Despite these initiatives, malnutrition and early childhood feeding-related diseases and mortality remain significant public health concerns in Nigeria. Only seven out of 36 states provide six months fully paid maternity leave and only 34 per cent of children between zero to six months are exclusively breastfed. Nigeria is still far from reaching the World Health Assembly 70 per cent target by 2030 and women in the informal sector have nearly no support for breastfeeding. However, currently, the Ministry of Health in collaboration with the World Bank and others are advocating for stronger support by training stakeholders on Maternal and Infant and Young Child Nutrition (MIYCN) which they will step down to heath workers at local Government level.

How can we engage Nigerian fathers and families to support and promote the culture of breastfeeding?
Fathers and families can be educated on the importance of breastfeeding and their roles in supporting it, by encouraging their involvement in antenatal care and role modeling breastfeeding support. We can also implement community-based initiatives to promote breastfeeding and engage fathers and families, utilise media campaigns to promote breastfeeding and engage fathers and families and offer incentives to encourage fathers and families to support breastfeeding.

How can we address the impact of infant formula marketing on breastfeeding rates in Nigeria?
We must implement and enforce the International Code of Marketing of Breast-milk substitutes in Nigeria to restrict the marketing of infant formula, regulate the marketing practices of infant formula companies in Nigeria to prevent unethical marketing. We can also monitor and evaluate the impact of infant formula marketing on breastfeeding rates in Nigeria and take corrective action, engage with healthcare providers to promote breastfeeding and counteract the impact of infant formula marketing as well as develop and implement policies that support breastfeeding and restrict the marketing of infant formula.

What role can traditional birth attendants and community health workers play in supporting breastfeeding in Nigeria?
They can provide breastfeeding education and support to mothers in their communities, promote early initiation of breastfeeding and support mothers in establishing a good breastfeeding routine, help address common breastfeeding challenges such as latching difficulties and nipple soreness; promote and support exclusive breastfeeding for the first six months of life. They can also provide ongoing support and encouragement to mothers to continue breastfeeding beyond the initial weeks; facilitate referrals to healthcare facilities or lactation consultants when necessary; promote breastfeeding-friendly environments in communities and healthcare facilities and provide support and guidance on breastfeeding in emergency situations such as natural disasters or conflicts.