Pro­mot­ing Ex­clu­sive Breast­feed­ing

While some women be­lieve ex­clu­sive breast­feed­ing could sap their time and strength, ex­perts say in­fants should not be de­nied the enor­mous ben­e­fits as­so­ci­ated with the prac­tice. Re­becca Eji­forma writes

THISDAY - - HEALTH & LIFESTYLE | HEALTH -

The United Na­tions Chil­dren’s Fund (UNICEF) and World Health Or­gan­i­sa­tion (WHO) in a new re­port, ob­served that no coun­try in the world fully meets rec­om­mended stan­dard for breast­feed­ing; hence, in­tro­duc­tion of it’s Breast­feed­ing Col­lec­tive, a new ini­tia­tive to in­crease global breast­feed­ing rates.

The two global health bod­ies said ba­bies world­wide have been failed by lack of in­vest­ment in breast­feed­ing, ac­cord­ing to facts re­leased on World Breast­feed­ing Day 2017. They ar­gued that ex­clu­sive breast­feed­ing will help all coun­tries achieve Sus­tain­able De­vel­op­ment Goals (SDGs) 2, 3 and 4.

The Global Breast­feed­ing Score­card that eval­u­ated 194 na­tions found that only 40 per cent of chil­dren younger than six months are breast­fed ex­clu­sively (given noth­ing but breast­milk) and only 23 coun­tries have ex­clu­sive breast­feed­ing rates above 60 per cent, ex­clud­ing Nige­ria.

Ac­cord­ing to re­search, ex­clu­sive breast­feed­ing for the first six months can re­duce child deaths by at least 800,000 each year, al­most 15 per cent of the to­tal 6.3 mil­lion an­nual child deaths in Nige­ria. Un­for­tu­nately, ba­bies – who are not breast­fed – are par­tic­u­larly vul­ner­a­ble to the lead­ing killers of small chil­dren and are more likely to die from pneu­mo­nia and di­ar­rhea, com­pared to ba­bies who are ex­clu­sively breast­fed.

Ex­clu­sive breast­feed­ing rates in some states In Nige­ria to­day, 17 per cent of nurs­ing moth­ers give their chil­dren ex­clu­sive breast­feed­ing for the first six months of life, while only 11 per cent breast­feed ex­clu­sively be­yond the sixth month. States like Abia have at least 36 per cent of moth­ers ex­clu­sively breast­feed their ba­bies. La­gos State is 28 per cent; Sokoto State is 8 per cent; Cal­abar is 22.9 per cent; Edo is 20 per cent. In Ile-Ife, Oyo State, Nige­ria, a rel­a­tively high rate of ex­clu­sive breast­feed­ing of 61 per cent was re­ported. How­ever, in Igbo- Ora, Oyo State only 7.5 per cent of them knows at least a mother who was prac­tic­ing ex­clu­sive breast­feed­ing.

It was in line with this that sev­eral or­gan­i­sa­tions and health ex­perts took to the streets to de­mand for ex­clu­sive breast­feed­ing dur­ing the World Breast­feed­ing Week 2017, en­light­en­ing moth­ers that breast­feed­ing is the first im­mu­ni­sa­tion of new ba­bies and an aca­demic am­pli­fier to ba­bies breast­fed ex­clu­sively for six months and com­ple­men­tar­ily for two years.

Nurs­ing moth­ers speak out Five nurs­ing moth­ers spoke to THISDAY about rea­sons they could not breast­feed ex­clu­sively for at least six months. For Toyin Ade­sanya, 32, re­sid­ing at Magodo in La­gos her main rea­son for be­ing un­able to breast­feed ex­clu­sively for at least six months is that her breast milk does not flow de­spite her drink­ing enough wa­ter.

Ade­sanya’s first child is two years old and the sec­ond is two weeks old. She started the baby off with in­fant for­mula and wa­ter plus breast milk from day one.

“I breast­fed my first child – a girl – ex­clu­sive for two months only and weaned her at one year and two months. For my new baby – a boy – he wasn’t get­ting sat­is­fac­tion from my breast milk at all. He was al­ways cry­ing, so I had to switch to in­fant for­mula while I con­tin­ued breast­feed­ing as com­ple­ment,” she ex­pressed.

A Mar­ket­ing In­sur­ance Per­son­nel, Ade­sanya started her baby on in­fant for­mula and wa­ter from day one fol­low­ing ad­vice from her friend and mother of three against at­tempt­ing to breast­feed ex­clu­sively.

“My friend has two boys al­ready. She just had a girl now. She told me how she did six months ex­clu­sive for her first two chil­dren but said she would not dare it again be­cause it is tir­ing and that the baby girl feeds more than the boys.”

Be­ing more ex­pe­ri­enced, Ade­sanya fol­lowed suite on her baby with for­mula to date. “When she ad­vised me, I didn’t bother do­ing any ex­clu­sive. But sur­pris­ingly, my hus­band called me on Au­gust 2 to in­struct me to stop all the in­fant for­mula with im­me­di­ate ef­fect. He pleaded that I do ex­clu­sive for six months. He said he had a talk with a nu­tri­tion­ist who listed the many ben­e­fits. So, since Au­gust 3, I’ve not mixed any other food.”

Mother of a month-old baby girl, 29-year-old Ekoe­m­eye Agnes is a mar­keter in a cor­po­rate out­fit, hence, her rea­son against ex­clu­sive was given as lack of time

“I started giv­ing her in­fant for­mula, wa­ter and breast milk after birth al­though only breast milk on the first day. I don’t even have enough milk flow­ing from my breasts. More­over, I will re­sume work on the third month.”

Asked if her hus­band was com­fort­able with her not feed­ing her baby ex­clu­sively, she ex­claimed: “Ah, he is not at all. He told me to do ex­clu­sive, but I don’t have the strength. After all when he goes to work, I stay with the baby alone.”

No sat­is­fac­tion from breast milk Ade­sanya and Ekoe­m­eye have sim­i­lar com­plaints. The for­mer said her baby al­ways cried even after tak­ing breast milk. “As a woman you will know when you feed a child. The milk wasn’t com­ing out as much as in­fant for­mula would. It’s ob­vi­ous. Al­though my gy­nae­col­o­gist told me to breast­feed for three years, what you see on the field of breast­feed­ing is prac­ti­cal. He told me to drink enough wa­ter and all that. I did it all but still no milk enough to feed the baby.”

Ekoe­m­eye shared her own ex­pe­ri­ence. “My baby suck­les then falls asleep. Within 10 min­utes she cries again. I had to in­tro­duce in­fant for­mula. Once I give her for­mula, she doesn’t cry. And I give her for­mula twice a day. I don’t have strength for that only breast milk ex­er­cise. It’s too much for me.”

She com­plained about the lack of strength. “For six months? Do you want to kill me?! I am sapped of strength al­ways. I can’t do ex­clu­sive. I don’t have the strength. More­over, I will re­sume of­fice in the third month.”

Em­bar­rassed breast­feed­ing a two-year-old But I can’t breast­feed him till he’s two. He would be too old,” Ade­sanya chuck­led. “Can you imag­ine a kinder­garten pupil ask­ing for breast milk? I can’t. That will be em­bar­rass­ing. I will wean him at a year plus. I stopped my first child be­cause she could pro­nounce breast clearly even in pub­lic.

“He would al­ready be in the crèche and would be too old. I can’t breast­feed him un­til he’s two. I can’t take that em­bar­rass­ment of my child say­ing in pub­lic: ‘mummy, breast.”

A Fam­ily Pub­lic Health and Nu­tri­tion­ist, Dr. Fo­lashade Olu­dara, told THISDAY that it is wrong to deny the child his right and im­mu­nity.

“It is for rea­sons like this that we are con­duct­ing pub­lic sen­si­ti­sa­tion that ev­ery nurs­ing mother should ex­clu­sively breast­feed for the first six months. And colostrum is the first milk that comes out of the mother’s breast im­me­di­ately after de­liv­ery of the baby. It must be given to the child be­cause it is the first im­mu­nity the child takes.”

She fur­ther warned that the colostrum (first milk in the breast after de­liv­ery) should not be pressed out or dis­posed of. “There are some mis­con­cep­tions that it’s dirty. It’s God’s-given im­mu­nity to the baby. Once it’s pressed out, you have pressed out the im­mu­nity of the child. And that is wrong.”

With re­search show­ing that an es­ti­mated 13 per cent re­duc­tion of in­fant mor­tal­ity rates can be achieved with ex­clu­sive breast­feed­ing, Olu­dara added that after six months, the mother can start com­ple­men­tary feed­ing while she con­tin­ues breast milk.

Ben­e­fits of breast milk to the child Ac­cord­ing to Olu­dara, breast milk, es­pe­cially ex­clu­sive breast­feed­ing, fights dis­eases like pneu­mo­nia and di­ar­rhoea – two ma­jor causes of death in in­fants. “It im­mu­nises the child. It makes the child’s cog­ni­tive de­vel­op­ment to be per­fect, the child will ma­ture well and cope well aca­dem­i­cally once he starts school. It in­creases mother to child bond­ing. There are many ben­e­fits for the child.”

She em­pha­sised on ex­clu­sive for six months – no wa­ter or com­ple­men­tary. “For the first six months, all moth­ers are ad­vised to do ex­clu­sive. God has given the mother ev­ery­thing for the child in her breast.”

The Di­rec­tor Gen­eral, WHO, Dr Te­dros Ad­hanom Ghe­breye­sus, said breast­feed­ing gives ba­bies the best pos­si­ble start in life. “It works like a baby’s first vac­cine, pro­tect­ing in­fants from po­ten­tially deadly dis­eases and giv­ing them all the nour­ish­ment they need to sur­vive and thrive.”

He de­scribes breast­feed­ing as the best panacea against breast and ovar­ian can­cer – two ma­jor causes of deaths in women. “It cre­ates a last­ing bond be­tween you and your baby,” he re­marked.

“Breast­feed­ing is one of the most ef­fec­tive— and cost ef­fec­tive—in­vest­ments na­tions can make in the health of their youngest mem­bers and the fu­ture health of their economies and so­ci­eties,” UNICEF Ex­ec­u­tive Di­rec­tor, An­thony Lake, ex­pressed. “By fail­ing to in­vest in breast­feed­ing, we are fail­ing moth­ers and their ba­bies—and pay­ing a dou­ble price: in lost lives and in lost op­por­tu­nity.”

How to breast­feed Many women don’t know how to breast­feed. This is Olu­dara’s con­clu­sion. “A child must stay within 30 to 45 min­utes on one breast be­fore he can be moved to the other one. Breast milk is like eat­ing. You start with wa­ter fol­lowed by the main course then fin­ish with wa­ter for di­ges­tion. “The milk that comes out in the first 15 min­utes is wa­ter. But if you re­move that child within that pe­riod and change to the other breast, you are in­vari­ably giv­ing that child just wa­ter. So, once that child uri­nates, the wa­ter is gone.”

There­fore, she urged that even if the child un­latches from the breast within 15 - 20 min­utes, moth­ers should re­turn the child to that same breast un­til 45 min­utes is com­plete. “Make the child take the main course. That is how to breast­feed.”

The As­sis­tant Di­rec­tor on Fam­ily Health, La­gos, Dr. Taiwo John­son, shared tips about how nurs­ing moth­ers can pro­duce more breast milk.

Eat bal­anced diet for breast milk “When a woman is breast­feed­ing, she needs to eat ad­e­quate or bal­anced diet – tak­ing the right amount of car­bo­hy­drate, pro­tein and lots of fluid. You know that breast milk is fluid-based. Breast milk con­tains 70 to 75 per cent of wa­ter and the baby is tak­ing that. So, we en­cour­age women to take lots of wa­ter to pre­vent de­hy­dra­tion. In Nige­ria we tend to eat move car­bo­hy­drates. As a mother of three, I took enough wa­ter rather than eat­ing too much. Ex­clu­sive breast­feed­ing is lots of wa­ter and lots of Nu­tri­ents.”

Right po­si­tion­ing John­son said there was pos­si­bil­ity the women were not po­si­tion­ing their ba­bies prop­erly. “We tell the women, put the baby to the breast not to take the breast to the baby. Sit right then lift the baby to your breast. “You must learn proper po­si­tion­ing of the baby. Breast­feed­ing is not a chore. Don’t bend your back. Sit up and put the baby to the breast, lest, you com­plain of back pain and tired­ness. Sit well and be com­fort­able.”

Prof­fer­ing more so­lu­tions to en­hance ex­clu­sive breast­feed­ing, she said, “Baby is tak­ing flu­ids and nu­tri­ent from your breast. So take enough wa­ter for strength. The wa­ter you drink will re­place it. Eat ad­e­quate por­tion of pro­tein, car­bo­hy­drate.

Truly, work­ing class nurs­ing moth­ers will re­sume work from third month to fourth. La­gos State has con­trib­uted to breast­feed­ing and en­cour­ages it. “Hence, it has raised ma­ter­nity leave to six months for first and sec­ond time moth­ers in the state.”

How to breast­feed when you re­sume work “Al­though we un­der­stand what small and medium com­pa­nies might be fac­ing – to give a staffer six months, the com­pany may lose. But we en­cour­age them.”

As the Co­or­di­na­tor of Ma­ter­nal and Peri­na­tal Death Sur­veil­lance and Re­sponse Pro­gramme, John­son urged moth­ers to ex­press breast milk and store in con­tain­ers in the re­frig­er­a­tor. “Moth­ers do it when they re­sume work or go out so that the breast­feed­ing can con­tinue,” she said.

Mrs Ade­sanya breast­feed­ing her baby

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