Addressing Obstacles to Exclusive Breastfeeding in Yemen

Photo: Dr. Ali Assabri

This blog was originally published by MCHIP. Written by Rae Galloway. 

If exclusive breastfeeding in the first six months of life prevents malnutrition, a subsequent pregnancy (as long as menses has not returned), and potential death from infections, why aren’t more women worldwide choosing to do so? Babies who are not exclusively breastfed have a one- to two-fold greater risk of dying than breastfed babies (with the risk varying by the type of illness). And the risk of mortality is even greater (a two- to four-fold increase) when children receive food and other liquids in addition to breast milk, or are not breastfed at all (a two- to 14-fold increased risk of dying).  

While rates are higher in some countries than others, the unfortunate truth is that fewer than half of children are exclusively breastfed in most countries. In Yemen—which has one of the lowest rates of exclusive breastfeeding in the world—preliminary results from a recent national survey found that only 10% of infants are exclusively breastfed in their first six months. 

To uncover the factors impeding optimal maternal, infant and young child nutrition and family planning practices, including exclusive breastfeeding, USAID’s flagship Maternal and Child Health Integrated Program (MCHIP) in partnership with the Ministry of Public Health and Population conducted formative research on the subject in two ecological zones of Dhamar Governorate. The study results illuminated a clear need among mothers, fathers and other family members for accurate information on how best to feed young children, as well as what women should eat during pregnancy and lactation. 

For example, within the study sample: 

  • Not one child under six months was being exclusively breastfed.
  • Not one child 6-23 months had been exclusively breastfed.
  • One infant had received only water, which the mother had provided to promote speech development, believing that “water lubricates the jaw to make speech easier.”
  • Most mothers had introduced food or animal milk prior to six months, feeling their breast milk was “not enough.” Mothers often made the decision that their breast milk was insufficient because their baby cried after nursing, or other family members advised them that their baby needed additional food. 
  • All infants received liquids before six months—with animal or powdered milk, water and juice being the most common liquids given.
  • More than half of babies younger than six months received food with crushed, sugary biscuits made into a paste with water or milk being a popular food to give to babies, even as young as one month of age.
  • Some mothers gave food because it filled their baby’s stomach, reportedly making them cry less and easier to manage.

In reality, breastfeeding practices in the sample were not optimal, which contributed to inadequate breast milk supply and hungry, unhappy babies. Sub-optimal practices included infrequent feedings, short duration of feedings, feeding from only one breast, and not feeding babies at night time. These practices led to decreased breast milk supply and the introduction of liquids and food, which further reduced breast milk production. Introduction of liquids and foods increases risk of infection, which in turn increases risk of malnutrition and mortality. Half of the women reported some problem with breastfeeding—such as pain, redness, engorgement and cracked nipples—but women were able to manage these problems themselves or seek treatment for them.

To improve infant and young child feeding, including exclusive breastfeeding, MCHIP is developing a package for health facility and community workers to use when counseling mothers. Because of the importance of family planning to the health, nutritional status, and survival of women and children, this package also will include messages about using the lactational amenorrhea method (LAM) in the first six months and transitioning to modern methods of family planning thereafter.

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