It’s breastfeeding week. A time to focus on protecting, promoting and supporting mothers to breastfeed.
Here's what one young mother with two children, Mrs Charity, hsa to say about the challenges women face in breastfeeding and the key role nurses and midwives can play.
“I gave my first child breast milk substitute a few minutes after birth on the advice of the nurses and midwife. I continued giving her water and powdered milk even after my breast milk started flowing.
“I ensured that her feeding utensils were washed properly. Yet she suffered diarrhoea, malaria and pneumonia as an infant. Her weight at birth was 2.5kg but her growth afterwards appears very slow.
“This experience made me to enroll on a Save the Children supported women’s group in Jigawa State, Nigeria. The facilitators provided us with knowledge and information on breastfeeding practices, complementary feeding, dietary diversification, food demonstration and so on. I am happy with the time I participated in the activities of the group.
“I appreciate our group leaders and Save the Children. They thought us how to position the baby and ensure attachment while breastfeeding. This act has bonded me with my second baby.
“Exclusive breastfeeding is better. It enhances child growth. In the case of my second child, I believe it has helped increase her performance in school and reduced the number of times we visited hospital. It has even helped us to save and invest our household income in my petty business.”
Big business
Breastfeeding plays an important role in the health and nutrition of infants and young children. Breast milk stimulates brain development and functions as an infant’s first vaccine. Health experts discourage the practice of giving babies any other foods and water in the first six months, even in addition to breast milk, as it may expose the baby to diseases and hamper their development.
However, policies and interventions to promote and support breastfeeding practices are undermined by powerful multinational formula milk manufacturers. These actors compete for a share of infant feeding using several innovative approaches and technologies to influence the public and boost sales and use of their products.
The Code of Marketing of Breastmilk Substitutes (BMS Code), including subsequent World Health Assembly resolutions, is an attempt to counter harmful marketing of breastmilk substitutes to the public. However, enforcement of the Code is weak and, despite BMS Code-related legislation, marketing continues that does not comply with the Code.
Health workers: time to stand strong
In child health and nutrition, the primary responsibility of health professionals is to safeguard optimal health and development, which includes protection and support of breastfeeding. However, some health workers who stand to benefit from manufacturers of these substitutes encourage nursing mothers to patronise formula milk products.
Inappropriate marketing of breast milk substitutes often negatively affects the mother’s judgement and choices over breastfeeding. Given the special vulnerability of infants and the risks involved in inappropriate feeding practices, usual marketing practices are unsuitable for these products. Yet, the prevalence of inappropriate marketing practices is persistent in many countries, including Nigeria. Increasingly, these practices target new and non-traditional settings, including social media channels and internet sites.
The BMS Code and national regulations remain crucial tools in efforts to reduce and eliminate inappropriate marketing practices, and ensure the effective promotion and protection of breastfeeding.
In Nigeria, the National Agency for Food and Drug Administration and Control’s (NAFDAC) subsidiary legislation on the Marketing of Infant and Young Children Food and Other Designated Products Regulations came into effect in 2019. It seeks to control and regulate the marketing of BMS and complementary foods when marketed or otherwise represented to be suitable as a partial or total replacement of breast milk. Under this legislation, advertising or promoting breast milk substitutes and related products to the public is prohibited. Manufacturers and distributors are prohibited from providing directly or indirectly samples of BMS and related products to pregnant women, mothers or members of their families.
For the Code to be effective in protecting breastfeeding for infants, it is important that public health facilities and health workers ensure compliance with the requirements of the Code and monitor adherence. Where violations are detected, it is the job of the government to impose sanctions, as set out in national legislation. In order to strengthen implementation, monitoring and enforcement of the Code regulations, the Federal Government of Nigeria, through NAFDAC, has developed new regulations and tools for improved implementation of and compliance with the BMS Code.
Challenges mothers face
Some women and their families face challenges that impact on their ability to breastfeed exclusively. These include needing to do household chores, having sore nipples, low breastmilk production, short maternity leave periods and lack of support from health workers. These issues can lead to mothers’ psychological discomfort, and lower their confidence or willingness to breastfeed exclusively their newborn baby.
Within different communities, several myths and beliefs may discourage families from practising exclusive breastfeeding. Grandparents are also known to have considerable influence over their granddaughters nursing and breast-feeding their newborn babie. Rural families may lack knowledge about the importance of dietary diversification for children. Finally, poverty affects the ability of poor households to feed well.
Opportunities on the horizon
There are actions and opportunities for the government – with support from development partners and civil society organisations – to support, promote and protect exclusive breastfeeding in Nigeria. These include the following:
- establishing a technical advisory group (TAG) to support the National Council on Nutrition and the implementation of National Multisectoral Plan of Action for Food and Nutrition and costed plan
- approval by the President Muhammed Buhari of the establishment of a nutrition department in relevant ministries, departments and agencies at national and state levels
- putting in place a National Technical Working Group for the implementation of BMS Code and providing tools to support advocacy and monitoring
- adopting and implementing maternal infant and young child feeding policy
- approval of six months maternity and two weeks paternity leave for government workers
- developing and adopting religious sermon notes for Islamic and Christian faiths.
Finally, advocacy efforts are ongoing for setting up crèches in public offices, for legislation on maternity and paternity leave, for incorporating nutrition into the Medium Term Sector Strategy, annual operational plan and development plans.
Save the Children in Nigeria is part of these efforts. We signed a commitment with the Federal Government to help create an enabling environment for breastfeeding, especially in the workplace.
photo: Sister Hadiza with a newborn baby at a hospital in Katsina, Nigeria (Pep Bonet/NOOR)
