“Breastfeeding is a natural safety net against the worst effects of poverty. If a child survives the first month of life…exclusive breastfeeding goes a long way towards cancelling out the health difference between being born into poverty or being born into affluence.” —James P. Grant, former UNICEF Executive Director.
This quote resonates with review of evidence based research which shows that breastfeeding is a sustainable means of ensuring the healthy growth and development of infants as well as the well-being of mothers.
Early initiation of breastfeeding within the first one hour of birth (EIBF) and Exclusive breastfeeding (EBF) are optimal breastfeeding practices. Exclusive Breastfeeding (EBF) is defined as giving an infant only breast milk from birth up to 6 months of age, without other liquids or solids, not even water, with the exception of oral rehydration solution, or drops/syrups of vitamins, minerals or medicines. EBF has been shown to be one of the evidence-based interventions for child survival. This is evident by research based statistics that good breastfeeding practices especially EBF could prevent about 11.6 % of the 6.9 million under five deaths in developing countries. EBF has also been shown to reduce neonatal and child deaths associated with diarrhea and acute respiratory tract infections, two of the leading causes of child deaths.
The nutritional advantage of EBF cannot be overemphasized as it promotes optimal neonate and infant growth by making up to 100 % of daily nutrition requirement of children up to 6 months of age, 50 % of children of 6–12 months and 35 % of nutritional requirement for children aged 12–24 months. These vital advantages of EBF underscore the need for sustained support for the practice.
International health agencies such as United Nations International Children Emergency Fund (UNICEF) and World Health Organization (WHO) have made excellent efforts to ensure optimum breastfeeding by developing pro-EBF strategies such as the Innocenti Declaration, Baby Friendly Hospital initiative (BFHI), The foundation for the BFHI are the Ten Steps to Successful Breastfeeding described in Protecting, Promoting and Supporting Breastfeeding: a Joint WHO/UNICEF Statement. Infant Young Child Feeding policy (IYCF), International Code of Marketing of Breast-Milk Substitutes and breastfeeding recommendation in prevention of mother to child transmission of HIV (PMTCT).
WHO and UNICEF developed the 40-hour Breastfeeding Counselling: A Training Course and more recently the five-day Infant and Young Child Feeding Counselling: An Integrated Course to train a cadre of health workers that can provide skilled support to breastfeeding mothers and help them overcome problems. Basic breastfeeding support skills are also part of the Integrated Management of Childhood Illness training course for first-level health workers.
Exclusive Breastfeeding is not optimally practiced despite its benefits and efforts made to promote it as only 35 % of the infants are exclusively breastfed worldwide and 33% are exclusively breastfed in sub Saharan Africa which has high rates of infants and child mortality. These statistics are staggering and cannot measure up to the recommended EBF coverage of 90 % required to ensure the targeted 11.6 % reduction of child death in low income countries.
Research findings suggest that various factors have been found to be associated with EBF, in developed countries. These factors include:
- Individual level factors such as the mother’s intention to breastfeed, her knowledge, skills and parenting experience, the birth experience, health and risk status of mothers and infants, and the nature of early interaction between mother and infant.
- Group level factors such as an EBF enabling environment which include: The home and peer environment, physical size of household, parity, family circumstances, partner attitudes, the delivery health facilities, postpartum skin-to-skin contact, provision of professional support for breastfeeding technique difficulties and follow-up care and support.
- Societal level factors such as cultural norms regarding breastfeeding, child feeding, and parenting; the role of women in society, including how working outside the home is valued; the extent to which men’s social role includes support for breastfeeding mothers; the extent to which exposing breasts for feeding is complicated by cultural norms regarding sexuality; and the economic importance of products such as breast milk substitutes and complementary foods in the food system.
These factors are pointers to the fact that settings specific and locally adapted strategies should be implemented to support newborn mothers to adopt optimal breastfeeding practices. This further necessitates the need to consider major players in various spheres of the society, prioritize them in line with their relevance to the achievement of optimal breastfeeding and engage them accordingly.
Although breastfeeding is a natural act, it should be learned as an extensive body of research has demonstrated that mothers and other caregivers require active support for establishing and sustaining appropriate breastfeeding practices. Family and community members should increase women’s confidence in their ability to breastfeed. Socio-cultural leanings that subtly manipulate perceptions and behaviour towards breastfeeding should be less emphasized. This requires sensitivity, continued vigilance, and a responsive and comprehensive communications strategy involving all media and addressed to all levels of society. Furthermore, obstacles to breastfeeding within the health system, the workplace and the community must be eliminated. Measures should be taken to ensure that women have access to family planning education and are adequately nourished for their optimal health and that of their families. Emphasis must also be placed on community health services and counselling to improve breastfeeding practices.
Government should; develop and integrate national breastfeeding policies into the health and development system at all levels, set appropriate national breastfeeding targets, institute a national system for monitoring the attainment of their targets, take action to give effect to the principles and aim of all Articles of the International Code of Marketing of Breast-Milk Substitutes, monitor and evaluate breastfeeding policies.
These strategies can protect, promote and support appropriate EBF practices and should be adopted to ensure newborn mothers get necessary support to breastfeed their infants because #Exclusivebreastfeedingisbestforinfants.
Some of the contents of this article are referenced from the links below:
- The Advantages of Breastfeeding Available at https://www.cbhs.com.au/health-well-being-blog/blog-article/2014/11/24/the-advantages-of-breastfeeding Retrieved March 1, 2019
- Protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services Available at https://www.who.int/elena/titles/full_recommendations/breastfeeding-support/en/ Retrieved March 1, 2019
- UNICEF and the Global Strategy on Infant and Young Child Feeding (GSIYCF) Understanding the Past – Planning the Future Available at https://www.unicef.org/nutrition/files/FinalReportonDistribution.pdf Retrieved March 1, 2019
Dr Abayomi Afe contributed this article.
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