By Sola Ogundipe
When Janet had her first baby in March 2018, she had no problem with breastfeeding. “My breast-milk flowed normally and my daughter latched on immediately after birth. I always wanted to breastfeed at birth because it is so natural. I read up a lot on the subject and hospital staff gave much enlightenment during antenatal visits. I knew I needed to start immediately after delivery.”
Janet did not lack the self-confidence to breastfeed exclusively since she was already breastfeeding quite well.
“I continued with exclusive breastfeeding until my baby was six months old, when she started complementary feeding. Breastfeeding continued even at night. I expected that it would be hard to breastfeed a baby at night, after a full day of work, but it’s pure joy. Breastfeeding time is the time to nurture and bond.”
Lola’s story is however, different. “When my first child was born, I could not breastfeed him because I didn’t have a single drop of breast milk. I had been placed on some medication during pregnancy and I suspected that it dried up my breast milk.
“The health workers suggested that I give him infant formula, but I said no.” But the baby was hungry and, in the end, she gave in.
“I gave him a small amount of formula. I did not like the idea but was relieved that he was no longer hungry. Later I learned that I wasn’t making much milk because the baby was not suckling. In order to make more milk he needed to be nursing.”
Luckily things slowly changed after a few days. Lola started producing some breastmilk. “My son was happy to suckle my breasts, especially in the middle of the night. I got good advice on how to hold the baby while feeding, how to let him suckle, how to improve my diet, and how to get into a daily routine.”
For Ada, breastfeeding as a new mother was a difficult experience. “I tried day and night to breastfeed my little baby, with support from the nurses. No success. The baby would not latch. He kept crying and I was also crying. I know about breastfeeding because I’m a health worker myself, but it was embarrassing that I couldn’t practice what I preached.
“My dream was to exclusively breastfeed my baby for at least six months. I knew it was the best way to feed newborn babies, for the sake of their nutrition and their psychological bond with their mothers.” Ada was determined, and for several hours continued trying to coax her baby to suckle. “It was a great struggle when it seemed almost impossible but in the end my determination paid off.”
Initiating breastfeeding within the first hour after birth can be lifesaving, yet only 32.8 percent of Nigerian newborns benefit from this practice. Lack of awareness about the benefits of early initiation, is a key barrier.
Exclusive breastfeeding is when an infant takes in breastmilk from with no additional food, water or other fluids with the exception of medicines, vitamins or mineral drops prescribed by a physician.
Breastfeeding is essential because it saves lives, says Dr Sylvester Igbedioh, Nutrition Advisor, Alive and Thrive Nigeria, a project of FHI360. He said early initiation of breastfeeding is essential, but observed that just 20-25 percent of Nigerian mothers breastfeed. Currently, Nigeria’s exclusive breastfeeding rate is much lower than expected.
Recommendations by the World Health Organisation, WHO, say that early and uninterrupted skin-to-skin contact between mothers and infants should be facilitated and encouraged as soon as possible after birth. According to the WHO, infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods, while continuing to breastfeed for up to two years or beyond.
Speaking in Lagos at a workshop on Skills in Utilising Media for Social and Behaviour Change with Focus on Infant and Young Child Feeding Practices (IYCF), Igbedioh, the provision of a mother’s breast milk to the infant within one hour of birth is referred to as “early initiation of breastfeeding” and ensures that the infant receives the colostrum, or “first milk”, which is rich in protective factors.
“All mothers should be supported to initiate breastfeeding as soon as possible after birth, within the first hour after delivery. Through early initiation, infants get the first milk – colostrum, that is rich in antibodies and other important substances important for intestinal growth.
“Early Initiation starts the milk let down reflex, so mature milk can be produced quickly. It provides early stimulation instinctive and provide warmth, love, security and food. It also initiates the process of bonding between baby and mother.”
Igbiedioh said evidence shows that initiation of breastfeeding early after birth and exclusive breastfeeding during the first month is essential in reducing neonatal mortality and morbidity.
“Early initiation of breastfeeding was associated with a reduced risk of neonatal mortality. Initiating breastfeeding after the first hour doubled the risk of neonatal mortality.
“In low-resource, high mortality settings where infection causes a large proportion of newborn deaths, early initiation of exclusive breastfeeding can substantially reduce child mortality. Early initiation of exclusive breastfeeding serves as the starting point for a continuum of care for mother and newborn that can have long-lasting effects on health and development.”
According to the Lancet Child Survival series, exclusive breastfeeding can reduce under-5 child mortality by 13 percent. Exclusive breastfeeding actually has the potential to save more children’s lives than any other preventive intervention.
“If 90 percent of mothers exclusively breastfed their infants for the first six months of life an estimated 13 percent of child deaths could be averted. If the same proportion of mothers provided adequate and timely complementary feeding for their infants from six to 24 months, a further 6 percent of child deaths could be prevented.”
In Nigeria each year, optimal breastfeeding practices have potential to prevent 103,742 child deaths and 10 million cases of childhood diarrhoea and pneumonia and also save N6.93 billion in healthcare system treatment costs related to inadequate breastfeeding and eliminate most of the N11 billion household cost of breastmilk substitutes, reduce out of pocket expenditure to treat diarrhoea and pneumonia
Exclusive breastfeeding for the first six months of life is the safest and healthiest feeding option for children everywhere and has great potential to save lives, impacts positively on the academic performance and long-term earnings as well as reduce the incidence of overweight, obesity and chronic diseases later in life.
The Policy and Advocacy Advisor, Alive and Thrive, Mrs Toyin Adewale – Gabriel, noted that good nutrition in the first 1,000 days, from conception to two years of age is critical to enable all children to lead healthier and more productive lives.
She remarked that as a result of poor nutrition among infants and under 5 children, Nigeria has the second highest stunting burden in the world, with over 11 million stunted children and a prevalence of 42 percent in 2003, 41 percent in 2008, 37 percent in 2013.