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Thursday, 31 August 2017

Mothers Have no Excuse not to Embrace Exclusive Breastfeeding

Ekoemeye breastfeeding her baby girl
The major reasons nursing mothers in Nigeria give for not embracing exclusive breastfeeding include having no breast milk, weakness while breastfeeding and lack of time among others.  Rebecca Ejifoma spoke to nursing mothers and experts, and writes on the best position and duration for breastfeeding as well as other benefits to mother and child. Excerpts:

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 standards for breastfeeding; hence, introduction of it’s Breastfeeding Collective, a new initiative to increase global breastfeeding rates.

The two global health bodies said that babies and mothers 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% 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% of mothers exclusively breastfeed their babies. Lagos State is 28 per cent; Sokoto state is 8%; Calabar is 22.9%; Edo is 20%; In Ile-Ife, Oyo State, Nigeria, a relatively high rate of exclusive breastfeeding of 61% was reported. However, in Igbo- Ora, Oyo State only 7.5% of them knew any 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 
Adesanya breastfeeding her son
Five nursing mothers spoke to this reporter 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 2nd 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 is straightforward.
“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.

Ekoemeye complained that her breast milk does not flow. “When I give her breast milk she sleeps off. But in 10 minutes time, she wakes up and begins to cry. But 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.”

Just like the other nursing mothers, she complained about the lack of strength. “Ah, 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 2-year-old 

But I can’t breastfeed him till he’s 2. He would be too old,” Adesanya chuckled. “Can you imagine a kindergarten pupil asking for breast milk? Ah! 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 would 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 cholesterol (first milk in the breast after delivery( should not be pressed out or disposed of. “There are some misconceptions that it’s dirt. 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% reduction of infant mortality rates can be achieved with exclusive breastfeeding, Oludara added still that after six months, the mother can start complementary feeding while she continues breast milk. “Introduce complementary meal – that is adult food, the family’s diet – to the child until the child is age two. Do not stop giving him breast still.”

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 of the World Health Organisation (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 with this reporter 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% 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 

Speaking exclusively with (THISDAY where it first appeared), Johnson expressed that there was possibility the women were not positioning their babies properly, proper attachment. “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.”

Avoid infant formula in first six months of life

She, however, warned against baby formula in the first six months. “It is cow milk. Babies exposed quickly to cow milk are prone to allergies. There is difference in the skin of a baby on exclusive and baby on instant formula.”

Most mothers don’t even know how to store baby milk, baby feeders. The bottles are not adequately cleaned and kept. But breast milk flows fresh.

Therefore, it is in line with reducing deaths of infants to preventable diseases that health experts and nutritionists have unanimously called on all mothers and fathers to embrace exclusive breastfeeding and testify about its benefits.