Improving Exclusive Breastfeeding Among Nursing Mothers In Nigeria

Poor exclusive breastfeeding habit in the country has become a growing concern especially among career mothers. As the country joins the rest of the world to commemorate the world breastfeeding week, SOLOMON ODENIYI takes a look at the causes of the habit and how to encourage mothers to change the trend.

The World Breastfeeding Week is coordinated by the World Alliance for Breastfeeding Action (WABA), a global network of individuals and organisations concerned with the protection, promotion and support of breastfeeding worldwide based on the Innocenti Declarations made by WHO and UNICEF in August 1990.

The declaration is part of an efforts being geared towards the promotion of exclusive breastfeeding for the first six months of life and then supplemented same for at least one year and up to two years or more.  The world breastfeeding Week, August 1 to 7 is being observed by countries of the world since 1992 with this year’s theme, “BREASTFEEDING: Foundation of Life”

However, it is estimated that Nigeria loses about 2,300 under-five year-old children daily and this ranks the country as the second largest contributor to under five mortality rate in the world. However, over two-third of the deaths is associated with inappropriate feeding/poor practices.

Consequently, a review of clinical trials and observational studies from some developing countries, including Nigeria by WHO strongly states that Exclusive Breastfeeding (EBF) for up to six months offers significant health benefits to both mothers and babies. UNICEF also, in one of its reports said, EBF comes at no cost, fulfilling the nutritional requirements of infants which protect them from childhood infections including diarrhea, and pneumonia.  These imply that the death could not have been high in the country if EBF is being religiously practiced in Nigeria.

Conversely, mothers who do not breastfeed are more likely to develop post-partum depression, obesity, type 2 Diabetes Mellitus, breast cancer and hypertension.

Aside the health benefit derived from EBF for both mothers and babies, it also has in human capital development that can benefit a country’s economy. A 2017 report by the WHO and UNICEF in collaboration with the Global Breastfeeding Collective, shows that in  five  world’s largest emerging economies including Nigeria, lack of investment in breastfeeding results in estimated 236,000 child deaths per year and US$119 billion in economic losses.

The Director-General of WHO, Dr Tedros Ghebresyesu corroborated this by saying that EBF could potentially generate US$300 billion in economic gains over 10 years as a result of reduced illnesses, health care costs and increased productivity.

Despite its enormous benefits, nursing mothers in Nigeria still do not exclusively breastfeed. The fifth round Multiple Indicator Cluster Survey (MICS5)  which was carried out in 2016/2017 by the National Bureau of Statistics (NBS) in collaboration with the National Primary Health Care Development Agency (NPHCDA) and National Agency for the Control of Aids (NACA), as part of the global MICS programme revealed that  23.7 per cent women breastfeed exclusively.

Although, 95.0 per cent of Nigerian women breastfeed their babies, while five per cent of Nigeria women do not breastfeed, this is against the exclusive breastfeeding recommended by the world health organization.

Also in the report, Osun State tops the list of states where breastfeeding is practiced with 55.3 per cent, followed by Abuja 52.0 per cent, Lagos tanked third with 51.8 per cent, Oyo 49.5, Rivers 49.1 per cent, Ebonyi 43.9 and Benue 40.9 per cent among others.

The least ranked states are; Yobe with 4.9, Niger 6.2, Katsina 6.7 and Kebbi with 9.5 per cent.

However, in the middle income countries like Nigeria, one of the reasons factored in the low practice of EBF is the rising number of women within the reproductive range working to sustain the family income due to the economic situation of the country.

A general health practitioner at the State Hospital, Asubiaro in Osun state, Dr Segun Ajayi said, illiteracy or cultural beliefs represent a low percentage of the reasons women are not exclusively breastfeeding their children.

He added that the major challenge affecting proper EBF is the situation of the country where the woman has to work to support her family.

Such woman, he said would have to go back to work after 3months and most of them see it as a cumbersome task to combine.

He said, “As it is, 76.4 per cent Nigerian women are not practicing exclusive breastfeeding despite the huge benefits. Most of them are the working mothers. With the situation of the country, it is an established fact that the income from the husband alone cannot meet the needs of the family. This has led women to work in order to help their families. How many of the establishments where these women work have a crèche? How many do give maternity leave? Even those who give, gives three months and exclusive breastfeeding last for 6months. Illiteracy, culture and those not wanting their breast to sag represent a few per cent combined.

A grandmother and a retired civil servant, Mrs. Felicia Oludare lamented the rising rate of poor compliance with breastfeeding exclusively among mothers nowadays.

According to her, work should not stop a mother from exclusively breastfeeding her children for the first six months of birth, saying though difficult, but blamed mother of today for always finding an easier route to child rearing.

She said: “I grew up seeing mothers adequately breastfeeding their child; then, it was a thing of pride for any woman to do. It was done for as long as they could bear. When I started bearing my children, I also followed that step. During those years, the supplement we have scattered all over the place now are not as pronounced as we have now.

“Where was even the money then? Well, you may say because I work with the government, that was why I was able to do EBF but I still know some of my colleagues who didn’t engage in EBF. Even now, I can still count those who are with the government and are still not practicing EBF.

“Work or not, our ladies are lazy, and have been beclouded by the western culture. These days, our ladies do not back their children with wrappers that we used. They are now in the habit of using shack to hang their children around their shoulders like a school bag.

Olufemi-Mathews Odunayo argued that career mothers inability to breastfeed exclusively is beyond laziness or maintaining the architecture of their breasts, but because of time and stress involved.

The mother of two admitted that not practicing EBF cost her much as she spends minimum of 6000 every two week on formula, but she was left with no choice in order to keep her job.

“I only did exclusive when I gave birth to my first child, then I was not working. For the second, I had to resume work two months after I gave birth, hence there was no way I could practice the EBF with this. I recall resuming work from 7am to 4pm; I get home 6pm or 7pm.

“In my case, we had an emergency and I was asked to resume work. It was not easy for me.

However, at 23.7 per cent, Nigeria is still far from the World Health Assembly’s target for countries in the world to increase to at least 50 per cent, the number of children under 6 months of age who are exclusively breastfed by 2025.

Dr. Segun doubts if the country can meet up with the 50 per cent benchmark set by the world health assembly with the increasing rate of working mothers in the country.

He added: “Except there are aggressive enlightenment programmes where working nursing mothers are informed about the law of use and disuse and also clamp down on the infiltration of breast milk supplement and encourage the 50 per cent, I doubt if we can meet up”.

If Nigeria is to attain the 50 per cent target by 2025 as set by the World Health Assembly, Mrs. Odunayo said the country must put in place a friendly working policy that will encourage EBF practice in the country.

She said: “Except Nigeria can improve on some things, I doubt if we will be able to improve on the percentage, let alone the 50 per cent target. If a woman works for a private firm especially a demanding one like a bank, will she be allowed to stay away from work for long so as to exclusively breastfeed for the stipulated 6months? If she tries it, she would have been replaced before she resumes.

“Except maternity leave is made compulsory especially for non government workers with stiff punishment for defaulters, and extended to 6months with weekends excluded from it, this feat looks unattainable among other policies for a nursing mother to exclusively breastfeed”.

Mrs Idowu, a NAFDAC official is also of the view of having a law in place to protect and encourage EBF just like it is done in Norway where 71 per cent of their babies are exclusively breastfeed for six months. She advocated that the maternity leave be extended to a year and stipends be paid to all nursing mothers.

Mrs Temitope Oluwadare on her part recommended that mothers should not be discouraged to bring their child to work, and they should be given less work to do immediately they resume from the maternity leave until it is six months. This, she said would improve the practice of EBF among working women and the country at large.

Seen attending to work while her child lies in an open baby court by her side, Mrs. Adeniyi Tolu confessed to how tasking it could be combining the two, but she said exclusive breastfeeding is a sacrifice all mothers must make for proper development of their babies.

The mother of four who revealed how she has been religiously practicing EBF from her first to fourth child averred that the results have been evident in her children’s level of intellect as well as the sound health they are enjoying.

She said, “By August 22, my baby will clock 5month and I have been exclusively breastfeeding my child. It has never come in between my work. It is not that he takes it every second, I only breastfeed him anytime he cries, then l put him back in the court then afterwards I go back to my work. I just came back from an official assignment that took me from Osogbo to Benin. EBF saved me from the stress of packing flask, looking for where to boil the water to prepare supplements; I only went with my bags. Also, it has saved me cost”.

Mrs. Adeniyi noted that she wouldn’t have practiced EBF but for the overwhelming supports she has been receiving from her husband, urging husbands to always show compassion on their wives by stretching a hand of help to them.

The Osun state nutritionist, James Olubode said all that is needed to increase the rate of exclusive breastfeeding is the political will by the government to support nutrition in the country.

He added that government must see to the elongation of the maternity leave, active promotion of crèches in places and breastfeeding rooms in places, as well as enforcement to put measures in place to ensure that private firms do not go contrary to any of the set policies. He also called for the regulations of breast milk substitute which has been an affront on EBF.

Suggesting some of the steps embarked upon which have made the state the highest in the percentage of breastfeeding in the country, Olubode said, “The state with the support of UNICEF carried out advocacy visits to all the local governments and telling the community leaders the importance of breastfeeding and exclusive breastfeeding.

“We did community sensitization where we asked the leaders to select some members of their communities and they were sensitized on the importance of breastfeeding. Beyond this, in some community, we came up with a community support group for infant and young child feeding which deals with breastfeeding. We are doing regular media sensitization. Twice a year, we carry out maternal new born week which is centered on breastfeeding and with these, we have been able to raise the awareness of mothers and caregivers on breastfeeding.

“The state has a working maternity leave for mothers. We have a daycare center at government establishments where mothers can bring their babies during working hours and go there from hour to hour to breastfeed their child. We have a working arrangement that does not allow them to be exposed to too much stress”, he added.