Health  

‘Why only 27% of Nigerian women practice exclusive breastfeeding’ CHAI

Elizabeth Lola Alonge

Mrs. Elizabeth Lola Alonge is the Executive Director of Child Health Advocacy Initiative (CHAI). The nutrition expert and child rights advocate in this interview with The Guardian ahead of the World Breastfeeding Week (WBW), August 1-8, gave reasons why only 17 per cent of Nigerian women practice exclusive breastfeeding. She, however, outlined what CHAI is doing to improve the situation, among other things. CHUKWUMA MUANYA writes.

What are the latest figures on breastfeeding and exclusive breastfeeding rates in Nigeria?
According to the National Demographic Health Survey (NDHS) 2018, which is the most recent survey, in Nigeria, only 27 per cent of children less than two years are exclusively breastfed but this is an improvement from the 17 per cent in 2013. However in Lagos state 52 per cent of babies are exclusively breastfed at six months.

What have been the challenges towards ensuring exclusive breastfeeding for the first six months of life in Nigeria?
Different studies have researched this and found that short maternity leave, perceived beliefs that breast milk alone is not sufficient in meeting baby’s nutritional needs, baby will become addicted to breast milk and socio-cultural pressure to add water and artificial feeds. Maternal health problems such as pain in the breast, and lack of quality support from the nurses, rising rates of female participation in the labor force, urbanisation and increasing incomes and aspirations, that have encouraged the adoption of convenience-oriented lifestyles and made baby formula more desirable, have all contributed to the declining Exclusive Breastfeeding (EBF) in Nigeria.

How could these challenges be addressed to improve exclusive breastfeeding rates in Nigeria?
We recently launched a free online breastfeeding support group known as ‘Nutrimums”. Mothers receive daily support through counselling on breastfeeding from professionals. Many mothers all over Nigeria have the opportunity to get answers instantly to their breastfeeding challenges. There is also a helpline for mothers to call on any issue bothering them and also get referred to our partner Primary Health Care (PHC) facilities for free support and treatment if necessary.

CHAI developed an innovation called “Mamajoy Breastfeeding Suite” this is a mobile room placed in strategic places so mothers can go there to breastfeed when they are out of the home, they are located at shopping malls, religious centres, recreation centres among others.

CHAI is setting up breastfeeding support groups manned by trained experts in various Local Government Areas (LGAs) in Lagos state. This is to facilitate door-to-door counselling and support in communities.

In order to support the less privileged mothers to breastfeed CHAI donates breastfeeding/nutrition packs to new mothers in public hospitals. The pack contains breastfeeding covers, breastfeeding pillows, Lactation cookies, diapers and provisions for the new mother.

We are working closely with private sector organisations to encourage them to set up creches or breastfeeding rooms in work places and we are also working closely with government to enact a law protecting and promoting breastfeeding in Nigeria.

The initiative is using notable personalities and the media to raise awareness and amplify breastfeeding messages. A new video with key messages on exclusive breastfeeding by influential personalities was recently launched to commemorate the 2019 World breastfeeding week in Nigeria.

How far with the Code on marketing of breastmilk substitutes? It seems producers of baby formula are having a field day.
The code was enacted to protect and promote breastfeeding, through the provision of adequate information on appropriate infant feeding and the regulation of the marketing of breastmilk substitutes, bottles and teats. The code stipulates that there should be absolutely no promotion of breastmilk substitutes, bottles and teats to the general public; that neither health facilities nor health professionals should have a role in promoting breastmilk substitutes; and that free samples should not be provided to pregnant women, new mothers or families. All governments should adopt the Code into national legislation.

However, there are various challenges hampering its actualisation. One of such challenges is the continued violation of the International Code of Marketing of Breastmilk Substitutes (BMS) and violation of the national regulations by manufacturers of BMS products. “The knowledge and lack of awareness of stakeholders has contributed to the gravity of violations currently being practiced in Nigeria. Thus necessitating the need for relevant partners to aggressively address this unpleasant situation through interventions including effective sensitization of all stakeholders. In addition, there are stipulated penalties for violation of this code however this needs to be made effective.

According to the World Health Organisation (WHO), three in five babies are not breastfed in the first hour of life. Why? What can be done to reverse this trend?
Not breastfeeding within the first hour of life puts the babies at higher risk of death and less likely to continue breastfeeding as skin-to-skin contact along with suckling at the breast stimulate the mother’s production of breastmilk, including colostrum, also called the baby’s ‘first vaccine’, which is extremely rich in nutrients and antibodies. Mothers simply don’t receive enough support to breastfeed within those crucial minutes after birth, even from medical personnel at health facilities, thus to change this, WHO ten steps to successful breastfeeding must be strictly adhered to buy health facilities in Nigeria.

Health workers need to be sensitized and a continuous capacity development for health workers to be able to provide qualitative support to the mothers to breastfeed within the 1st hour of birth. Also, in some health facilities the neonatal ward is separate from the postnatal ward, thus mother and child are separated after delivery, this should also be discouraged.

Rise in elective C-sections has been associated with drop in breastfeeding. How true is this and what is the situation in Nigeria and proffer solutions?
Studies have shown that C-section (elective or emergency) does adversely affect breastfeeding initiation, milk supply, and infant breastfeeding receptivity when compared to vaginal deliveries If a woman delivers by caesarean section, medical staff may be reluctant to allow her to engage in skin-to-skin contact with her baby or to breastfeed, out of concern for possible infection and wanting to make the mother stable and fit. But even with C-section deliveries, there are safe methods a woman can use to breastfeed her child during that first hour. Also, studies have shown that women who deliver with C-section have higher proportion of breastfeeding difficulties such as lack of the natural surge of oxytocin that can help with her milk supply. While elective C-section should not be discouraged, strategies to improve breastfeeding initiation within 1hour should be implemented such as; starting breastfeeding as soon as possible after C-section surgery, getting help with positioning the baby to breast, breastfeed very frequently every one-three hours and keeping baby with the mother as much as possible.

What strong legal measures are adopted or can be adopted in Nigeria to restrict the marketing of infant formula and other breastmilk substitutes?
According to the National Agency for Food and Drug Administration and Control (NAFDAC) there were penalties to the violation of the code in line with a reviewed Resolution by the world Health Assembly (WHA). It says that a person who contravenes any provision of these Regulations is guilty of an offence and liable of conviction with warning letters for first offenders. Some other fines include seizure of offending articles for destruction, administrative fines, closure of business premises, prosecution of recalcitrant offenders, leading to fines from N150,000 – N2,000,000 and jail term not exceeding six months, as appropriate. In addition to this, instituting an independent monitoring and enforcement team has proven valuable in many other countries.

Has Nigeria made progress on implementing breastfeeding policies and programmes?
Yes. Some states in the country like Lagos state has institutionalized the extension of the maternity leave to six months and also introduced two weeks’ paternity leave for the first two children of Lagos state workers. However, the labor law of the country has not enforced this thus not practised throughout the country and in private sectors, hence the current policies are not in accordance with the contemporary international standards for the protection of pregnancy and maternity. It does not guarantee and protect the freedom of the nursing mother to exclusively breastfeed the child for at least the six months as stipulated by WHO and the National Breastfeeding Policy. Moreover, there is no enabling law to back up the National Policy as it affects employer and employee relations. In addition, there is a need to institutionalize having a crèche in every organization to promote breastfeeding and to have places to breastfeed in public example airports, shopping malls and so on.

A new trial shows that breast milk chemical dissolves tumours so cancer patients can pass them in urine. What is your take on this? Is this possible?
A research showed that a chemical called alpha-1H, found only in breast milk which is essential to a baby’s development, has been shown to help break down tumors into fragments in the body, thus passing out the cancer cells in urine. However, there is a need for more evidence as the study was conducted in only 40 patients thus not sufficient to show a drug’s effectiveness. Also, no measure of statistical significance for the difference between treated and control is given and no actual clinical outcomes are presented such as improved survival or time in remission. Thus information available is not sufficient to prove it.

Does breastfeeding have any disadvantage?
No, breastfeeding is the foundation to good nutrition but it has some constraints which includes: less freedom- you always have to be available to feed every time which can be exhausting as you have to breastfeed every two-three hours, it can be very painful as it causes mastitis, breast engorgement, plugged milk ducts and sore nipples but all these resolve with continuous feeding. Your partner cannot feed the baby and could feel left out of the feeding relationship. If you are a modest individual, it could be difficult breastfeeding in public and finally the need to lead a healthy lifestyle if you choose to breastfeed, need to stay off substance that might affect the baby for example caffeine, alcohol and nicotine. However the benefits of breastfeeding far outweighs the consequences

Should all women breastfeed their babies including those with HIV, cancer, Lassa fever, hepatitis?
The Ribo Nucleic Acid (RNA)/genetic material retroviruses including Human Immuno-deficiency Virus Type 1 (HIV-1), HTLV-1, and HTLV-2 are all transmitted by this route. It has been recorded that HIV-2 is not transmitted by breast milk, but it is probable that there is a relatively lower risk in this less virulent retrovirus as well as fewer data to assess infectivity. Rubella, herpes simplex, and rarely hepatitis B can be passed on to the infant too if mothers have an active infection. Hepatitis C RNA has not been detected in milk in one series, and the infection rate by this route is probably low unless the maternal viral load is high. The challenge to clinicians is therefore to determine the risk to any particular infant of milk borne infection. Given the volume of milk consumed daily by an infant it is surprising that milk is not more infectious, thus there are clearly strong protective factors at work. What is most important is that for viral infections EBF should be practiced because adding formula feeding to breastfeeding increases the risk of infection.

For tuberculosis (TB) it is safe to breastfeed if currently on TB medications for at least two weeks. For cancer, if you have been diagnosed with breast cancer in the past and have been treated for it, you may be concerned about the effects of breastfeeding on you and your baby. Previous breast cancer does not mean that you cannot breastfeed your baby. If you have had a mastectomy, you can feed from the remaining breast. If you have had a tumor removed from your breast or radiation treatments, you can still try feeding from that breast. You may find that your milk production is less.

For Lassa fever, the virus presence in breastmilk has not been extensively reported in literatures, however it has been found to be present in breast milk and breastfeeding is discouraged.

When is it not safe to breastfeed?
When you are on some medications. Cancer chemotherapy drugs, illegal drugs, some drugs for migraine such as ergot alkaloids, mood stabilizers such as lithium and lamotrigine (anticonvulsant or antiepileptic drug), sleep aid medications, radiation therapy, untreated TB and herpes on the breast.

With the rise in plastic pollution and the environmental and health consequences, what happen to plastic bottle-feeding of infants?
A chemical called Bisphenol (BPA) used in polycarbonate plastic products and epoxy resin-based food can liners are however no longer used in the production of baby bottles, thus the baby bottles are safe but we as members of the society should take precautions as oral exposure is the primary concern right now. We all should avoid unnecessary exposures to chemicals in our food and water. However, if you bottle-feed your baby avoid bottles with recycling codes 3,6,7 and do not use abrasive sponge. Don’t put your baby’s bottle in the microwave.

Is expression of breastmilk by working mothers a good option? If yes or no, why?
Of course it is, as it still affords the baby the benefit of receiving breast milk. It may be easier for people to split caregiving duties if they choose pumping over breastfeeding. It allows for the baby to have sufficient supply of milk while the mum is away at work and allows for recovery from sore, cracked or even infected nipples, although it does have its consequences like reduced bonding time and storage concerns, it cannot be stored for an extended period of time.

What is the relevance of the World Breastfeeding Week (WBW) in improving the lives of infants and nursing mothers?
This year’s WBW Theme, “Empower parents, enable breastfeeding” focuses on empowering parents to promote the importance of family-friendly policies to enable breastfeeding and help parents nurture and bond with their children in early life, when it matters most. It includes enacting paid maternity leave and paid paternity leave to encourage shared responsibility of caring for their children on an equal basis. Mothers also need access to a parent friendly workplace to protect and support their ability to continue breastfeeding upon return to work by having access to breastfeeding breaks; a safe, private, and hygienic space for expressing and storing breastmilk; and affordable childcare.

According to the Executive Director, United Nations Children Fund (UNICEF), Henrietta H. Fore, “Breastfeeding saves lives and its benefits help keep babies healthy in their first days and last well into adulthood.”

The WHO Director-General, Dr. Tedros Adhanom Ghebreyesus, said “We must urgently scale up support for mothers so they can give their children the best start in life.”

Movement coordinator, Scaling Up Nutrition (SUN), Gerda Verburg, said: “Nutrition is not only a matter of people, it is a matter of economic development.”

Breastfeeding is the key to achieving the sustainable development goals and a collective responsibility. Mothers need support from their health care provider, families, employers, communities and government so they can provide their children with the healthiest start to life.

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