By Jamila Akweley Okertchiri

Thirty-five-year old Alima Yakubu is a mother of six. When she gave birth to her first five children, she did not practise exclusively breastfeeding.

“After breastfeeding them for a month, what I do is to add water and other baby foods to the breast milk I gave them. I wanted them to be satisfied and grow healthy,” she said

However, Alima added that the childhood of her first five children was characterised with frequent sicknesses which left her spending most of her time at the hospital because they often had diarrhoea and vomited. “I was a frequent visitor to the clinic because they easily got sick some to the point of losing their lives,” she said.

But things changed when she gave birth to her sixth child. Her neighbour was practising exclusive breastfeeding prior to her delivery and she had noticed that her neighbour did not go to the hospital as often as she did when she delivered.

“My neighbour did it with her child, so I decided to try it too,” Alima said while nursing her seven-month-old son.

“I’ve noticed a big difference. He has never been sick and I’ve never had to take him to the clinic,” she added.

Alima and all the mothers in her community have been encouraged to practise exclusive breastfeeding as part of Ghana Health Service Baby Friendly Health Initiative.

Health workers and midwives in rural health posts, as well as community activists in villages and communities are helping to educate women on the benefits of breast milk in order to increase its practice in the country. “Breastfeeding is the single most effective strategy for child survival due to its numerous advantages. It protects the child from many of the dangers that a baby and a young child face,” Eunice Sackey, National Coordinator of the BFHI said.

Dr Pricilla Wobil, Health Specialist, MNH UNICEF, quoting from the LiST analysis, disclosed that exclusive breastfeeding can save over 800,000 under five deaths (more than any other single intervention) and 20,000 breast cancer deaths every year.

She indicated that, however, in low and middle income countries, only 37 percent of children younger than six months are exclusively breastfed. “The rate of prolonged breastfeeding in the poor populations is decreasing,” she said sadly.

Ghana’s 21st Century Breastfeeding Trend

Giving a national picture of the situation, Dr Wobil said that early initiation of breastfeeding in the country has been wobbling since 2003. She indicated that in 2003, it was 52 percent, it came down to 35 percent in 2006, and stabilised at 46 percent from 2008 to 2011 and then went up to 56 percent in 2014.

“The trends in exclusive breastfeeding is not different, the country started on a good note from seven percent in 1993 to 31 percent in 1998, 53 percent in 2003, 54 percent in 2006 hitting its highest percentage of 63 percent in 2008. But, then again, it dropped to 46 percent in 2011 and gradually rose to 52 percent,” Dr Wobil said.

The UNICEF health specialist said while 52 percent of babies breastfeed exclusively in the country, 19 were given complementary foods in addition to breast milk while, 28 percent were given breast milk plus other milk or other non-milk liquids and one percent not breastfeed at all.

WHY EXCLUSIVE BEASTFEEDING IS IMPORTANT

Dr Wobil stated that the benefits of exclusive breastfeeding span populations living in high-income, middle-income, and low-income countries. “It saves women’s lives and contributes to human capital development through improving the survival, health, and development of all children,” she said. “First, the little money I get from selling my ‘koko’, I used it to buy medicine for my children but with this my son I do not buy medicine because he does not often get sick,” Alima stated.

Alima added that exclusively breastfeeding her son has helped her increase her income from selling porridge because she hardly spends on clinic bills.

Dr Wobil said there is 88 percent chance of survival among children who exclusively breastfeed, according to the 2016 Lancet Series On Breastfeeding, adding that scaling up breastfeeding universally will substantially contribute to the attainment of the newborn targets by 2018 and the SDGs by 2030.

“Exclusive breastfeeding for the first six months results in a seven times lower mortality than those not breastfed, it also has a 44 percent reduction in neonatal mortality with early initiation, according to the 2016 Lancet Series,” she said.

Apart from the health benefits of breastfeeding, the 2016 Lancet Breastfeeding Series also found that breastfeeding consistently has been associated with higher performance in intelligence tests in children and adolescents with a pooled increase of 3.4 IQ points.

Dr Wobil explained that according to the paper, 72 percent of the effect of breastfeeding on income is explained by the increased in IQ.

“Prolonged breastfeeding duration increases intelligence resulting in higher educational attainments and higher incomes,” she said.

On the other hand, she said increasing delay in initiation of breastfeeding after day one was associated with a 2.6 fold increase in infection-specific mortality, while partial breastfeeding was associated with a 5.7 fold increase in mortality.

Dr Gyikua Plange-Rhule, Paediatrician at the School of Medical Science, Kwame Nkrumah University of Science and Technology (KNUST), disclosed that despite the benefits of breastfeeding, funding for breastfeeding campaign was decreasing.

“One analysis showed that USAID funding for breastfeeding promotion increased from $8•3 million in 1989 to $16•6 million in 1999, and subsequently decreased to $13•3 million in 2003 and $2•3 million in 2005,” she said.

Challenges and bottlenecks

Alima said practising exclusive breastfeeding “was not easy for me in the first month. When he cried, I thought he was hungry and I was tempted to give him additional food like I did with his older brothers and sisters because I thought that my breast milk was not enough for him. But following the advice of the health workers and putting him to my breast anytime he cried, I got used to it.”

Alima said by the second month she began seeing the improvement in her son’s development as compared to his older brothers and sister when they were his age and that encouraged her to continue breastfeeding despite pressure from her family to add supplementary foods.

Dr Plange-Rhule said nearly all women are biologically capable of breastfeeding. She said at the personal level, breastfeeding intentions are generally established by the third trimester.

However, the practices, she said, may be affected by a wide range of historical, socio-economic, cultural, and individual factors “Within families, the practices, attitudes and experience of female relatives affect the incidence and duration of breastfeeding, including the work the women do,” she mentioned.

Dr Plange-Rhule also mentioned that poor breastfeeding positioning and latching as well as inadequate support, especially in the first weeks after birth, and anticipation of breastfeeding difficulties are common reasons for abandoning breastfeeding.

“Mothers who do not successfully breastfeed are less likely to attempt breastfeeding in subsequent pregnancies. Infant crying or fussiness, perceived hunger, and the inability to settle her infant often cause a mother to assume that she has insufficient milk and to introduce breast milk substitutes,” she stated.

Compounding the already fragile situation is the formula advertisements portray formula milk to be as good as or better than breast milk or a lifestyle choice rather than a decision with health and economic consequences.

“Promotion and marketing have turned infant formula, which should be seen as a specialised food that is vitally important for those babies who cannot be breastfed, into a normal food for any infant,” she said.

Call for action

Dr Plange-Rhule proposed a six-point action for addressing the challenges of breastfeeding. Top among the suggestions is the recognition of breastfeeding as a powerful intervention for health and development that benefits children and women alike.

The second action point she said is the fostering of a positive societal attitudes towards breastfeeding. Negative societal attitudes—as shown by inadequate maternity leave, lack of opportunity to breastfeed or express milk at the workplace, and restrictions on breastfeeding in public are all too common.

“Paid-break guarantees for at least six months were associated with an 8•9 percent point increase in exclusive breastfeeding.

Maternity leave and provisions at the workplace for nursing mothers may improve breastfeeding rates but do not cover women in the informal sector who may need to be targeted differently,” she highlighted.

The third action is to show political will. She said politicians need to demonstrate they appreciate that breastfeeding promotion saves lives and money. Democratic governments are entrusted to protect and promote well-being in the communities that elect them—“this includes breastfeeding,” she stressed.

The fourth is to regulate the breast milk-substitute industry. Breast milk substitutes are a multi-billion-dollar industry, the marketing of which undermines breastfeeding as the best feeding practice in early life.

“The fifth action point is to scale up and monitor breastfeeding interventions and trends in breastfeeding practices.

The sixth and final action point is for political institutions to exercise their authority and remove structural and societal barriers that hinder women’s ability to breastfeed,” she stressed.