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Breastfeeding key to ensuring optimal health, food security

By Tobi Awodipe
05 August 2022   |   2:47 am
Elizabeth Lola Alonge is the founder of the Child Health Advocacy Initiative (CHAI), a healthcare and development non-profit organisation focused on promoting the health and wellbeing

Lola Alonge

Elizabeth Lola Alonge is the founder of the Child Health Advocacy Initiative (CHAI), a healthcare and development non-profit organisation focused on promoting the health and wellbeing of Nigerian children.

In this interview with TOBI AWODIPE to mark World Breastfeeding Week (WBW), August 1 to 7, she said there is a link between malnutrition, poor breastfeeding and food security.

Considering the recent prevalence of viral diseases such as COVID-19 and monkeypox, how important is breastfeeding in fostering wellness, especially for mother and child?
Breastfeeding is important for its inherent nutritional value and cognitive outcomes in children but also for social and emotional development.

Breast milk contains antibodies and protective enzymes that fight infections and now more than ever, babies need to be protected. Exclusive breastfeeding for six months can reduce the risk of a baby contracting an upper respiratory viral infection by 35 per cent.

This year’s WBW theme is Step Up For Breastfeeding: Educate And Support. How best can this be actualised?
Breastfeeding is key to sustainable development strategies post-pandemic, as it improves nutrition, ensures food security and reduces inequalities between and within countries.

The theme is aligned with thematic area 1 of the WBW-Sustainable Development Goal (SDG) 2030 campaign, which highlights the links between breastfeeding and good nutrition, food security and reduction of inequalities. We can step up breastfeeding by the continuous campaign for breastfeeding enabling environment and strengthening the capacity of those that have to protect, promote and support breastfeeding across different levels of society. They include families, governments, health systems, workplaces and communities.

According to the Federal Ministry of Health, the exclusive breastfeeding rate in Nigeria is 29 per cent, indicating that only a small number of infants aged zero to six months are exclusively breastfed. What are the implications of these on society, especially infants?
This means that this small percentage of infants have a very low mortality rate, are less likely to be overweight or obese and less prone to diabetes later in life; infants with better cognitive, social and emotional function unlike the other 71 per cent of children who might face all these challenges later in life.

What are some of the barriers to breastfeeding for Nigerian mothers?
Some of the barriers affecting effective breastfeeding in Nigeria include a lack of knowledge about breastfeeding for women. Women commonly have little or no information about breastfeeding before getting pregnant. Many have had little contact with women who successfully breastfeed and do not know what to expect. Most women know that breast milk provides the right nutrition for babies but are unaware of how important it is for normal infant growth, development and health.

There is a misconception that formula is equivalent to breastfeeding. Many women do not know about the risks associated with formula feeding and the hazards of improper use.
Social norms are also implicated. We live in a culture where breastfeeding is undervalued. In many communities bottle-feeding is viewed as the normal way to feed babies. The use of water and quick introduction of other foods is still practised in many areas of Nigeria.

There is also the issue of a poor family and social support. Lack of support from close family and friends can affect decisions about feeding. Lack of knowledge, negative attitudes and beliefs about breastfeeding by others (partners, family members, support people and the general public) can be unsupportive.

Many women feel embarrassed to breastfeed in public. Many women are still asked to stop breastfeeding or leave public spaces if they wish to breastfeed. Unsupportive attitudes by community members, local services and businesses can lead women to give up breastfeeding and the lack of available facilities for breastfeeding in public places can result in some women restricting their activities to avoid having to breastfeed in public.

Women who have problems breastfeeding in the early weeks are less likely to continue breastfeeding.

More mothers are returning to the workforce while their infants are young and too little assistance is available to help them continue breastfeeding. This includes a lack of on-site childcare, no nursing breaks for mothers or appropriate places to express and store breast milk while at work. Few workplaces have breastfeeding policies or flexible working arrangements.

Policies and practices in health services by health workers: Practices in some health services, such as using displays, posters or pamphlets supplied by formula companies, can influence decisions about infant feeding. Health care providers’ own attitudes and experiences may also influence their recommendations.

Promotion and marketing of infant formula as a suitable alternative undermines breastfeeding. Large advertising budgets are allocated to the promotion of infant feeding products that are widely promoted.

Nigeria has one of the highest rates of malnutrition in the world. Does poor breastfeeding contribute to this statistic?
Yes, studies carried out here have shown that poor breastfeeding impacts a child’s health leading to chronic malnutrition and/or over-nutrition later in life.

Considering that just nine per cent of organisations in Nigeria have a workplace breastfeeding policy, what would you say is the role of employers, government and society in protecting and supporting breastfeeding?
Employers can create a conducive environment for nursing mothers to support breastfeeding through workplace strategies including longer maternity leave; flexible employment practices/part-time work, lactation breaks; private rooms, access to refrigeration and the creation of breastfeeding support programmes in the workplace.

For the government and society, a woman’s ability to initiate and sustain breastfeeding is influenced by a host of factors, including policies that create an enabling environment.

The extent to which the government supports breastfeeding is crucial to the success of breastfeeding in a country and Nigeria can support breastfeeding by reviewing the national guidelines on baby-friendly initiatives, creating sustainable infrastructures for breastfeeding practices, introducing activities to support education in nutrition for breastfeeding mothers including peer support groups, providing financial support to sponsor long-lasting breastfeeding campaigns and initiatives as well as censoring breast milk substitutes campaigns and promotions. Also, establishing a surveillance system to monitor programmers and policies over the years can help to clearly establish progress.

In your opinion, is the global target of at least 50 per cent exclusive breastfeeding rate by 2025 as recommended in the National Policy on Food and Nutrition feasible?
Yes, if more focus is directed on promoting exclusive and continued breastfeeding.

The International Code of Marketing of BMS in Nigeria still lacks enforcement. What is the way forward?
The government needs to act urgently to strengthen the implementation and monitoring of the law to protect and promote the health of Nigerian children and mothers. NAFDAC can step up efforts to ensure that exclusive breastfeeding is protected and all key stakeholders abide by the regulations of the BMS Code.

NAFDAC should conduct regular routine monitoring at health facilities and sales outlets around the country to redress the antics of BMS manufacturers who are exploiting the health system and get health workers to encourage young mothers to choose BMS instead of practising exclusive breastfeeding.

NAFDAC should publish and disseminate the Marketing Of Infant and Young Children Food and Other Designated Products Regulations (2019) and establish its full effect with the stricter regime of sanctions on erring companies and individuals. NAFDAC and other key stakeholders should also work to ensure that there is no cross-promotion of milk-based products aimed at older children with similar branding and packaging thereby subtly marketing breastmilk substitutes to unsuspecting parents of infants.

On the other hand, health workers should be knowledgeable about the benefits of exclusive breastfeeding and support mothers to exclusively breastfeed and more resources should be dedicated to educating mothers and their families, healthcare workers and communities about the value of breastfeeding and the requirements of the code.

Government at all levels has a responsibility to promote, protect and support breastfeeding. There must be adequate investment in the training of healthcare workers across primary and secondary levels of care to promote breastfeeding including supporting mothers to breastfeed optimally and sensitising communities to ensure that BMS do not undermine appropriate breastfeeding practices.

Exclusive breastfeeding has always been encouraged but do you think it is still feasible in today’s fast-paced world?
It is, with aggressive promotion, education and support. Due to urbanisation and financial struggle in Nigeria, women are busier with providing for their families hence having no time for breastfeeding coupled with the lack of flexibility and enabling environment for lactating mothers at workplaces.

How can partners and immediate family offer support and protection for breastfeeding mothers?
Family, friends and relatives exert a great amount of influence on a mother’s choice of infant feeding practice.

Immediate family members can provide support by getting complete information about breastfeeding, committing time, and financial and emotional assistance to support the new mother. Immediate family can take care of the nursing mother (nurturing the nurturer) by taking care of her basic needs and providing practical help.

How can health facilities galvanise action towards promoting breastfeeding?
Health facilities are already promoting breastfeeding through the baby-friendly initiative. However, more effort and resources are needed to increase the promotion of breastfeeding. Health facilities need to look out for more innovative, modern and practical ways of promoting breastfeeding. Emphasis on implementing and promoting of the 10 steps of effective breastfeeding will significantly improve breastfeeding rates.

What are some readily available resources breastfeeding mothers can employ to receive support?
Breastfeeding support is key to successful breastfeeding. Most health facilities give breastfeeding-counselling support during antenatal classes. CHAI also runs a free support group called CHAI NUTRIMUMS. Mothers receive breastfeeding support from professionals on a daily basis. CHAI recently launched a free breastfeeding counselling hotline to support mothers so they can get answers instantly.

In what ways are you personally working to action this year’s theme for breastfeeding mothers?
We intend to visit various communities to educate mothers and young girls of reproductive age on the importance of breastfeeding; health facilities to give gifts to new mothers and encourage them to practice exclusive breastfeeding; media houses to inform and educate the public on the need to protect, promote and support breastfeeding; give awards to ten breastfeeding friendly corporate organisations in Lagos; launch breastfeeding counselling support groups in various communities and erect billboards with key breastfeeding

What are some of the short and long-term benefits of practising exclusive breastfeeding, both for mothers and children?
Short-term benefits for the baby include a reduced risk of illness due to contaminated water, which under some conditions can occur with formula; breast milk is a source of lactose and essential fatty acids that help a baby’s brain grow and develop; breastfeeding saves time and money; breastfed babies have fewer cases of ear infections, gastrointestinal infections, bacterial meningitis, urinary tract infections, late-onset sepsis in pre-term babies, and more. B

breastfeeding also encourages skin-to-skin contact and nurturing, working to soothe and comfort the infant. Colostrum—the first milk produced at birth—contains high amounts of carbohydrates, protein and antibodies, and is yet to be replicated as formula finally, breast milk works as an antibiotic against E. coli and staphylococci, among others.

Long-term benefits for the baby include higher IQ especially if breastfed exclusively and for a longer period of time; lower risk of obesity later in life; lower rate of food allergies, asthma, eczema, celiac disease and Type I/Type II diabetes amongst others. Short-term benefits for the mother include the release of the “love” hormone, oxytocin in the mother, which improves the bond between mother and baby.

Oxytocin also aids in contracting the uterus to prevent postpartum haemorrhage and reduces the uterus to pre-pregnancy size. Women also have a decreased risk of iron-deficiency anaemia while nursing and breastfeeding helps reduce the chances of becoming pregnant in the first six months of exclusive breastfeeding, aiding in family planning.

Milk production also helps with post-partum weight loss. Long-term benefits for the mother include lower rates of ovarian, breast and endometrial cancer as well as higher bone density and lower rates of osteoporosis later in life.