Exclusive Breastfeeding Within a Social Context - Reflecting on Africa

Wednesday, 16 September, 2009 - 13:20

Exclusive breastfeeding for the first six months of a child’s life is not only a matter of concern for those working in the HIV and AIDS sector. While the benefits of breastfeeding are known, for many women this is simply not an option. Social norms and practices, programmes which ‘dump’ milk formulae in poor communities to relieve poverty and hunger and other factors all contribute to a complex social environment which affects women’s choice to breastfeed or not

The importance of breastfeeding is easily overlooked or argued away by non-scientific arguments. The fact is, however, that breastfeeding is intimately related to our present and future, through its vital connection to the state of the continent’s health. The breastfeeding of infants not only holds several health benefits to the infants themselves, but is also an important variable to consider from a long-term perspective. The practice is vital to the future of the continent, notably because it has been shown that exclusive breastfeeding for the first six months of a baby’s life can protect the baby from contracting HIV.

Most health centres and clinics recommend to new mothers that they practice exclusive breastfeeding for at least the first six months of infants’ lives in order to maximise the infants’ immune systems. This instruction seems easy enough to follow, but the social context in which these mothers live often deviates significantly from the clinical setting. The general upbringing of infants, including breastfeeding and other health concerns, are not issues simply and single-handedly determined by mothers. This month’s newsletter argues that against the background of Augusts World Breastfeeding Week, breastfeeding is not only a health and HIV and AIDS related issue, but also a gender issue insofar as it concerns mothers, the role played by families and surrounding environments and circumstances in mother’s decision making.

World Breastfeeding Week is celebrated annually from 1 - 7 August and serves as a period during which organisations and Governments work to create awareness about the importance of breastfeeding. The celebration commemorates the Innocenti Declaration made by the World Health Organisation (WHO) and the United Nations Children’s Fund (UNICEF) policy makers in August 1990 to protect, promote and support breastfeeding. Yet, despite almost 20 years of promotion and awareness, less than 50 percent of African mothers practice potentially lifesaving exclusive breastfeeding. In Cameroon, for example, the current breastfeeding rate is a meagre 24 percent (Cameroon Tribune, 18 August 2009).

The benefits of breastfeeding

So, why is breastfeeding so important when a variety of formulae exist that can perform a seemingly identical function? According to the WHO, there are several important reasons for a mother to breastfeed for at least the first six months of her infant’s life. First, mother’s milk contains all the nutrients the infant needs. Particularly in resource-limited settings, powdered formula is often diluted too much in order to ‘stretch’ supplies, a strategy that sadly reduces the nutrients the infant receives. Formula may also contain contaminations present in the water used. Mother’s milk is usually readily available and safe for infants to drink, and obviously far more affordable than formula. “Besides being clean and hygienic, mother's milk is ready for consumption and at the right temperature, the mother does not need to buy it, and the more she breast-feeds the more milk she will produce,” explains Mozambique’s Lidia Chongo, Head of the Women and Child Health Department. She launched a year-long ‘National Campaign to Promote Breast-Feeding’ in August as part of the Government’s efforts to promote exclusive breastfeeding. Against the background of worldwide increasing poverty and famine, breastfeeding is certainly a viable alternative to formula milk.

Besides these benefits, the fact that breast milk boosts infant immune systems also means that it protects babies from contracting HIV, if practiced exclusively. If mothers breastfeed in addition to feeding their baby’s formula and/or solid foods, the babies are at a far higher risk of contracting HIV. Thus, although many African mothers breastfeed their infants, the fact that so few exclusively practice this feeding method puts thousands of infants at risk of contracting HIV from their mothers. The consequences are not only reduced quality of life for mother and child, but also reduced wellbeing of the African continent as a whole. Why do so few mothers practice exclusive breastfeeding?

Breastfeeding in the social context
As noted, clinics and health centres advise mothers to breastfeed exclusively for at least the first six months of their babies’ lives. However, when mothers arrive home, several other factors come into play. First, in the African context, mothers are usually not the sole decision-makers when it comes to their children. Grandmothers play an important role in the mothers’ and infants’ lives and are said to have a strong influence over what mothers feed their babies. In Burkina Faso, for example, grandmothers are reported not to approve of exclusive breastfeeding (‘The path to mother's milk is paved with kola nuts’ Irin News, 4 August 2009).

According to D. Marc Sawoudogo, a nurse and director of the village clinic in Zincko, Kaya health district, 100 km northeast of the capital, Ouagadougou, grandparents are the “real” decision makers when it comes to child care. “Children do not belong to only their parents in African society,” she told IRIN. “Here, the grandparents take the babies as soon as they get home and dismiss the parents as if to say, 'Who do you think you are?' It is the old ladies who block exclusive breastfeeding from taking root,” she stated. It is not clear why grandparents disapprove of exclusive breastfeeding, and programmes to address this issue have not been as effective as hoped.

Low levels of involvement by fathers and other community members in infant care is another reason why the advice of health centres is discarded. The absence of men and youth groups from the issue of caring for infants has been identified as a contributing factor to the low numbers of women who breastfeed. In Cameroon, the Minister of Public Health, André Mama Fouda, launched a campaign to promote breastfeeding during last month’s World Breastfeeding Week. Fouda’s campaign urged men and youth groups to become more involved in raising infants in their communities. It is hoped that more involvement of these groups will help to spread the message of the importance of exclusive breastfeeding.

Supporting mothers

Breastfeeding is not a miracle solution to poverty and famine. Hunger and poor nutrition affects mothers and in turn, their milk and their babies. Programmes that empower women financially and generate incomes for communities thus remain absolutely essential, not only for the mothers, but for the children they are raising, too. However, many programmes reportedly ‘dump’ formula on communities in efforts to relieve their poverty and hunger, but experts have warned that formula is a bad substitution for breast milk. Providing famine communities with formula discourages exclusive breastfeeding, and therefore can technically worsen the situation, without the correct information.

Mothers need healthcare support, too. The WHO describes breastfeeding as something that needs to be learnt. New mothers need proper instruction from healthcare workers as well as family encouragement, as they have to deal with nipple pain, tiredness and fears that they will not produce enough milk for the baby. If mothers do not feel that the way their infant is fed is an important health and community matter, they may see no reason to breastfeed their babies exclusively for six months or longer.

While breastfeeding is vital to the future of Africa, both in terms of coping with food shortages and building healthy, HIV-free generations, the practice should not be conceptualised as existing independently of women’s social contexts. Welfare dumping of formula milk, cultural and communal beliefs and healthcare shortcomings may all contribute to maternal reluctance to practice exclusive breastfeeding. In light of the urgency that underlies the promotion of exclusive breastfeeding, campaigns need to take note of the influence of women’s social contexts so that programme efficiency can be significantly improved.

- Charlotte Sutherland is Research Manager: Gender Issues in Africa at Consultancy Africa Intelligence (charlotte.sutherland@consultancyafrica.com). The September edition of the Gender Issues in Africa Newsletter is republished here with permission from Consultancy Africa Intelligence (CAI), a South African-based research and strategy firm with a focus on social, health, political, and economic happenings in Africa. For more information see http://www.consultancyafrica.com or http://www.ngopulse.org/press-release/consultancy-africa-intelligence. Alternatively, visit http://www.consultancyafrica.com/promo2 to take advantage of CAI’s free, no obligation, three-month trial to the company’s Standard Report Series.

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