Health workers help to bust breast-feeding myths

When Annette Mumo Mulolo gave birth to her daughter last October, everyone around her was worried.

In her humble 10 by 10 house in Gitathuro in Nairobi’s Korogocho slum, she tells of how her Blessing Kavae was just about the size of her palm with her weight barely hitting two kilogrammes.

What followed was pressure from both sides of the family urging that in order to improve Kavae’s weight, she would need more than breast milk.

“Before I had given birth, I decided that I was going to breastfeed for six months as it is required, but it was not easy. When my mum saw the baby, she was so worried and insisted that she stay to help make porridge for the baby but I refused,” explained Ms Mulolo.

Ms Mulolo stood her ground, did odd jobs to supplement her husband’s income while breastfeeding. Today, the vibrant little one has just started to learn how to walk and at ten months she is healthy and weighs 10kg.

Ms Mulolo is among many women living in informal settlements around the country who are now adopting the World Health Organisation (WHO) regulations on six months exclusive breastfeeding for infants and complementary feeding until the child is two years to reduce underweight and stunted children.

Health workers say that most mothers opt out of exclusive breastfeeding because of poverty and as they seek jobs.

DEBUNKING MYTHS

Debunking breastfeeding myths has now become a full-time job for health officials.

A study published in the open access, peer-reviewed journal BMC Public Health in 2011, which highlighted the breastfeeding trends in informal settlements in Nairobi, showed that more than 37 per cent of the children were not breastfed in the first hour following delivery.

According to the survey carried out in Korogocho and Viwandani slums, two in five of the children were given something to drink other than the mothers’ breast milk within three days following delivery.

The most common complementary foods given to children before the age of six months was plain water with most children on it having been given within the first month. A majority of children who were fed on porridge were introduced to it between the second and third months.

Fresh or powdered milk was also given to some children by their third month while some mothers and caregivers gave children sweetened or flavoured milk within their first month.

Dr Elizabeth Kimani-Murage an associate research scientist at African Population and Health Research Centre and one of the authors of the research, proposes a multi-sectorial approach of talking to the whole community and other opinion leaders who influence the mother’s feeding practices.

The APHRC study showed that poverty was a key determinant of the length of time a mother breastfeeds.

This is because most slum mothers work as casual labourers in the informal sector and go back almost immediately after delivery to fend for the rest of the family.

According to the researcher, one of the main myths that emerged during the research was that colostrum was dirty and not good for the baby because of its consistency and some mothers give their children pre-lacteal feeds like water, cow milk and porridge in the first days of life before the mother’s milk “starts to flow”.
“Others believe that women should not eat a lot while pregnant as the baby will grow too big and require a caesarean section leading their husbands to starve them. There are those who believe that the unborn child will become stupid or deformed because the breastfeeding child is depleting their food,” she added.
“While some mothers may want to express breast milk so as to leave it behind when they go to work, there is concern regarding preservation as most households do not own refrigerators in these slum settings, and also concern on how to warm it. The only viable option for working mothers seems to be leaving breast milk substitutes, especially cow milk and porridge for their babies regardless of their age because formula milk was considered too expensive,” the report says.

EXTREMELY COMPLEX SITUATION

The study shows that women in urban poor settings face an extremely complex situation with regards to breastfeeding due to multiple challenges and risk behaviour often dictated to them by their circumstances and recommends macro-level policies and interventions.

“Such macro-level policies and interventions may include revision of labour laws regarding maternity leave in favour of casual labourers, provision of social protection measures for urban poor breastfeeding mothers, adequate childcare facilities, and support for mothers expressing breast milk,” the report says.

Every day, Joyce Kanyoisya, a community health worker, visits at least three women to educate them on the importance of breastfeeding.

She says the greatest challenge for mothers is the influence of the mother- in-laws, who she says have more power than parents to dictate what the child is fed.

The Ministry of Health estimates women delivering at health facilities nationally has increased to 66 per cent over the last year with the introduction of free maternity services in public hospitals.

According to Ms Terrie Wefwafwa, the head of the department of nutrition in the ministry, early initiation of breastfeeding within the first hour of birth is part of the standard package that a midwife provides to a mother during the prenatal visits.

“We have been promoting breastfeeding for all women. There are no specific interventions for slums. Women living in informal settlements are also counselled to breastfeed throughout the night and leave behind expressed breast milk which can be fed to the baby while they are at work,” she said.

The establishment of Baby Friendly Community Initiative, an adaptation of the global Baby Friendly Hospital by the government, mobilises community health workers and facilitates the formation of support groups for mothers and links them with lower level health facilities for additional support in optimal breastfeeding practices.

“We try and provide information and education talks through clinics and at times target key opinion leaders, traditional birth attendants, elders and mothers-in law as a way of dispelling some of the myths around breastfeeding,” said Ms Wefwafwa.

This article was first published in the Business Daily