The following piece was originally published in the Bill & Melinda Gates Foundation Blog. Written by Ellen Piwoz, Jean Duffy and Gary Darmstadt.
Nicholas Kristof is right. A free treatment, accessible to mothers from all walks of life, that can save millions of newborn lives every year does exist – breast milk.
In his Wednesday op-ed column in the New York Times, Kristof described the surprisingly low rates of exclusive breastfeeding by mothers in the developing world. Exclusive breastfeeding – feeding the child only breast milk, and no other food or liquids, not even water – for the first six months of life is the single most effective way to save a baby’s life. If 90 percent of the world’s mothers followed this practice, an estimated 1.3 million more children could survive every year.
Recent studies have suggested that just the early initiation of breastfeeding in the first hour of life can reduce neonatal mortality in the first month of life by about 20 percent. Despite having this life-saving power at their fingertips mothers are losing children to malnutrition, due in many cases to a misunderstanding about the nourishment a baby needs. Focusing on their own perceptions about hydration in hot climates, many mothers feel the need to give their children water, which unfortunately is often contaminated with life-threatening pathogens, rather than nutrient and antibody-rich breast milk.
In fact, breast milk is 88 percent water, something many mothers are not aware of. Infants do not need other liquids during the first 6 months of life, even in intensely hot and dry climates. Many mothers discard their first milk, a thick yellow substance called colostrum, believing it is “dirty” and not good for the baby.
In fact, colostrum is sometimes termed a child’s ‘first immunization’ due to its vitamin density and immunity-boosting qualities. Small knowledge gaps such as these remain significant barriers to mothers providing their children with sufficient nutrition during the first critical months of life.
Simple techniques, easily taught, can help new mothers overcome nearly every breastfeeding problem they encounter. Issues such as sore nipples or interpreting a baby’s cry as indicating there is too little milk deter mothers and derail their commitment to breastfeeding. Changing the positioning of the baby or adjusting the frequency of feeding offer uncomplicated solutions to these problems. However, health professionals and families commonly overlook these challenges, mistakenly assuming that since all women breastfeed, it is not something that requires support.
To address these misconceptions, it is crucial to approach the problem from the ground up. In order to effectively encourage a family to breastfeed optimally, it is necessary to understand the logic behind their decisions and their aspirations for their children.
In countries as diverse as Vietnam, Bangladesh, and Ethiopia we are supporting a program called Alive & Thrive, which is attempting to appeal to these desires. Alive & Thrive has launched locally tailored campaigns to promote the power of breastfeeding in a way that appeals to local beliefs and circumstances. Radio, video, and television spots link breastfeeding with growth, strength, and the future well-being of families and communities based on the aspirations they hold for their children and their traditional health paradigms.
These media campaigns run in conjunction with other interventions to empower front line health workers to provide breastfeeding support, in the village and at the health clinic, educating them on the advantages of breastfeeding and proper techniques. By working in this way, the program reaches out to those who know traditions, know the families and can bring the message to the community in a relatable way.
In Bihar, India, we are exploring a multi-channel approach to promote early and exclusive breastfeeding. With a focus on reaching communities where low rates of exclusive breastfeeding prevail, we are using mass media campaigns (print and radio), cell phones, and community listening groups, while also providing health workers on the frontlines with the tools and training necessary to effectively deliver the right messages to mothers and families.
Our work looks at all key decision-makers (mothers, fathers, mothers-in-law, health workers, policy makers and others) and attempts to show them small, achievable changes that are within reach and could save their children from disease and death.
Breastfeeding rates will not increase unless we acknowledge the importance of local customs and beliefs. Only by starting there can we address common misconceptions on health and nutrition, and find approaches that will last. In the end, it’s a challenge that needs to be addressed.
To teach a mother the how and why of breastfeeding is to give her the tools to save her child’s life - the ultimate in empowerment.
Jean Duffy is Senior Program Assistant in Family Health at the Bill & Melinda Gates Foundation.
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