Exclusive breast feeding: Whither Nigeria in the campaign?

BY SOLA OGUNDIPE & CHIOMA OBINNA

The young lady, from the look of things, could be in her early 20s. She sat quietly in the bus, her baby fast asleep on her back.  Obviously, it was  probably her first child. The bus which was headed for Mile 2 from Oshodi, was full of passengers many of who were on their way home after a hard day’s work. Somewhere along the journey, the sleeping baby was suddenly jolted awake due to the dangerous potholes all over the Oshodi-Apapa expressway. Immediately, the baby  let out a loud cry.

All attempts by the young mother to pacify the child proved abortive as the little creature continued to yell The mother tried all she could to make the baby comfortable and even checked the baby’s diaper to find out if it was wet but none of these pacified the baby. This continued for a while until an elderly man in the bus who had been observing the situation now shouted at the woman saying: “This baby is hungry!  By this time,  all eyes were on this woman.

But she was not moved until another man shouted in Yoruba language and said “efun omoyi loyan” (meaning  breastfeed this child). “Why are you trying to deny this child what is naturally his? He remarked. Before she could respond, another male passenger seated at the back noted. “What is in that your breast that no eyes have seen? I beg breastfeed that child!”

This outburst generated a heated debate amongst other passengers in the bus, especially from the male passengers many of who descended very heavily on the woman, accusing her of being insensitive to the needs of the child. After much pressure, the woman reluctantly complied with the wishes of the child.

This particular scenario highlights the common trend nowadays among Nigerian women, especially the educated ones. Before now, breastfeeding was the only culturally acceptable mode of feeding babies in Africa and specifically in Nigeria within the first two years of life.
Breastfeeding is encouraged at any point in time be it, in the open / public or in isolation. The belief of Africans is that breastfeeding is an ingredient of promotion of closeness to mothers and a concept of bringing the mother and child closer to one another. It is even seen as taboo for a mother not to breasfeed her child.
Since the advent of Western education and introduction of feeding formula, many Nigerian women have practically  discarded what is culturally sees as a child’s right.

Breastfeeding in the African setting used to be a thing to be proud of.  But today, the reverse is the case.

Over the years breast milk has been known to be uniquely superior for infant feeding. Breast-feeding helps in infant growth, health development and all other short and long term outcomes.

According to experts, medically, breast feeding, should serve as the only food for babies under six months. Unfortunately, getting mothers to do it the right way is the problem. Up till now some people still have challenges with the issue of not giving water and herbs at all during the first six months of life.

In the past, every culture in Nigeria every mother is expected to breastfeed her child except for some serious reasons. In fact, in some societies, even neonates who lost their mothers during birth are usually breast fed by relations who re-lactate to do so, some are even breastfed by their grand mothers.

Then, mothers, breastfeed anytime and anywhere even in public places. Some even breastfed while working on the farms, for example while planting crops and baby who is strapped to the back is hungry, what the mother does is shift the baby to the side, still strapped to the mother, she brings out the breast, then sticks it in the baby’s mouth and continues her planting. Unfortunately, the educated women usually try to stay in secluded places to breastfeed not minding the right of the baby.
Critical observers are of the view that the situation is the major factor contributing to the drop in breast feeding in Nigeria.
According to the National Demographic Health Survey (NDHS) 2003,  the rate of exclusive breastfeeding was put at 17 percent . Unfortunately, the rate dropped from 17 per cent to 13 per cent in the 2008 NDHS.
This is a  situation that experts say could be fuelling child mortality in the country.  Confirming the situation, Health Minister Prof. Christian Onyebuchi Chukwu, said the rate of women who breast feed their babies has decreased drastically, which does not augur well for the health of the baby.
Research shows that the significant drop in Nigeria’s exclusive breast feeding rate from 17 percent in 2003 to 13 percent due to reasons ranging from ignorance to traditional beliefs one of which has to do with water. Even scientific evidence has shown that a child who is exclusively breastfed does not need additional water because breast milk itself contains 90 per cent of  water.
In the views of the Special Adviser to the Governor on Public Health, Dr. Yewande Adeshina, breast feeding is the most cost effective public health intervention for a child’s survival, yet many women do not breastfeed exclusively for six months.
In a study on the Determinants of exclusive breastfeeding in Nigeria by  Kingsley E. Agho and colleagues from School of Medicine, the University of Western Sydney, NSW, Australia, Sydney School of Public Health, the University of Sydney, NSW, Australia and Department of Mathematics, the University of Benin, Benin, Nigeria, “Exclusive breast feeding (EBF) has important protective effects on the survival of infants and decreases risk for many early-life diseases.
The EBF rate in Nigeria is low and falls well short of the expected levels needed to achieve a substantial reduction in child mortality. Also, the study found that antenatal care was strongly associated with an increased rate of EBF.
They also stressed that appropriate infant feeding practises are needed if Nigeria is to reach the child survival Millennium Development Goal of reducing infant mortality from about 100 deaths per 1000 live births to a target of 35 deaths per 1000 live births by the year 2015.
It is also an established fact that EBF for the first six months of life improves the growth, health and survival status of newborns and is one of the most natural and best forms of preventive medicine.
It  plays a pivotal role in determining the optimal health and development of infants, and is associated with a decreased risk for many early-life diseases and conditions, including otitis media, respiratory tract infection, diarrhoea and early childhood obesity.
It has been estimated that EBF reduces infant mortality rates by up to 13 per cent in low-income countries It also could be recalled that in response to the importance of exclusive breast feeding, the Nigerian government established the Baby-Friendly Hospital Initiative (BFHI) in Benin, Enugu, Maiduguri, Lagos, Jos and Port Harcourt with the aim of providing mothers and their infants a supportive environment for breastfeeding and to promote appropriate breastfeeding practices , thus helping to reduce infant morbidity and mortality rates.
Despite these efforts, child and infant mortality continue to be major health issues affecting Nigeria. The infant mortality rate for the most recent five-year period (1999-2003) is about 100 deaths per 1,000 live births and EBF rates in Nigeria continue to fall well below the WHO/UNICEF recommendation of 90 per cent EBF in children less than six months in developing countries.
According to Kingsley E Agho and colleagues, EBF rates in Nigeria are amongst the lowest in the world, and even compare poorly with other neighbouring countries in the region.
On the nutritional value of breast feeding, Deputy Director on Nutrition, Lagos State Ministry of Health Dr. Abimbola Ajayi, said the breast milk contains every thing nutritionally that the baby needs for growth.  According to her, all the vitamins, the minerals, protein, fats and carbohydrate including all the water that the child will need to survive for six months is fully and complete in the breastmilk.
“The only problem is the fact that the stomach size of the child is small. So the child cannot take all that he or she needs at once that is why we talk about feeding the child on demand. You may feed the child now within the next minute the child will be hungry. This is because most of the breast milk is water.  Again, nature knows that the child needs water to satisfy his or her taste.  Almost 90 per cent of water in the breast milk. So the water will come then the nutrient will follow.”
Ajayi who advised on ways to get the best from exclusive breastfeeding explained that when a mother breast feed from one breast, that one breast will give the complete breast milk if she continued to breastfeed that child on that one breast until there is no more water or milk coming out from that one breast.
She explained “It is because once you put the child to the breast the first thing that will come is water.  That water is meant to satisfy the taste, it is assumed by nature that, that child will be taste first. then if you continue to breast feed and if you don’t change that breast at the end of that water, the next thing that will come out will be what we call the nutrient.
So those nutrients will enter into that baby’s mouth before breast feeding is concluded.  So when that is done that child is satisfied with subsidy and then within 10 minutes they urinate the water has gone out flushing and cleaning up the system of the child but the nutrient will stay. But because the stomach of that child is small, the child will be hungry again or cry. The next thing is to put that child to the second breast. The second breast will now give another set of water then the nutrients at the end. This is how you must continue for the first six month of that  child’s life so that the child will grow in his own capacity until he reach optimal development. So breast milk is enough and it has complete nutrients and it can satisfy any child that is under six months as far as the mother si doing it well.
HIV and breast feeding
In the wake of the HIV and AIDS epidemic, scientific findings show that HIV can be transmitted through breast milk, Ajayi counselled that exclusive breastfeeding hardly transmits the virus.
“By exclusively, we mean to breastfeed without adding water, no infant formula, herbal medicine or whatever; and also to initiate breastfeeding within the first hour of birth is critical. Immediately after delivery, the baby should be put to breast, even before the mother is cleaned because that has other effects on the release of the placenta.
“The fluid of every human being that is HIV positive contains the virus but the thing is that it has been discovered that for a breast feeding mother, it is safer to still give the breast milk only to the child for the first six months positive or negative because the antibodies in the body of the mother  will protect that child
Ajayi stated that if breastfeeding is mixed with other modes of feeding, it create a lot of problems for the child. According to her,  it would not only dilute the nutrient value it would also create a problem for the child by making sure that the virus penetrate into the body of the child easier”.
“So the safest thing, she advised for an HIV mothers is to breastfeed exclusively for six months and after six months, she can use the various family foods to supplement whatever foods the child may need. The chances of the child getting HIV is so limited it is probably about 1 in 12 to get HIV virus if the child does not have it from the process of delivery.  If the child is still negative,  the likely hood that the child will have it is very slim. But the benefit of breast milk is so strong that it will also protect the child from other infections through the use of any other type of foods that may be given to the child, she concluded.
Benefits of breast feeding at a glance
*Breastfeeding helps protect your baby from gastrointestinal trouble, respiratory problems, and ear infections.
*Researchers have found that immune factors that are present in colostrum (the first milk your body produces) guard against invading germs by forming a protective layer on your baby’s mucous membranes in his intestines, nose, and throat.
*Breastfeeding may also protect your baby from developing inflammatory bowel disease later in life.
*Breastfeeding can also help protect your baby from developing allergies
*Breastfeeding may boost your child’s learning ability
*Breastfeeding may protect against Obesity later in your childs life
*Breastfeeding may protect against your child developing leukemia
*Breastfeeding may protect against type 1 diabetes in children
*Breastfeeding may protect against high blood pressure later in life
*Breastfeeding is also thought to reduce SIDS
*Breastfeeding can help the mother lose weight
*Breastfeeding can also help with the mothers stress levels
*Breastfeeding may reduce the risk of some types of cancer

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