The Biggest Missed Opportunity in Child Survival…Breastfeeding

This newborn baby boy in Northern Nigeria was put to his mother’s breast within 30 minutes of delivery to make sure he received the colostrum, the first milk a mother produces. It provides a newborn with important protection from bateria and infections. Photo: Lucia Zoro/Save the Children

We have known for a long time that breastfeeding can prevent the deaths of many babies.

Exclusive breastfeeding for the first 6 months can reduce child deaths by at least 800,000 each year – almost 15% of the total 6.3 million annual child deaths.

Breastfeeding within the first hour of birth has the potential to reduce newborn deaths by up to 560,000 – 20% of the total 2.8 million annual newborn deaths.

Babies who are not breastfed are particularly vulnerable to the leading killers of small children and are 15 times more likely to die from pneumonia and 11 times more likely to die from diarrhea, compared to babies who are exclusively breastfed.

But despite this evidence rates of early and exclusive breastfeeding are very low (around 40%) and haven’t improved much since the early 1990s, despite more than 15 years of advocacy and investment.

It’s not that women don’t understand the value of breastfeeding. Surveys repeatedly show that new mothers across many countries know that breast is best for babies.

It’s not that we aren’t aware of the reasons that mothers don’t breastfeed. Surveys repeatedly show that new mothers are concerned that they don’t have enough milk or time; that they experience pain, exhaustion and rejection from their babies; that they feel awkward breastfeeding in public; that spouses are often unsupportive and that it’s just too hard to breastfeed and work. And don’t forget that although world health authorities recommend exclusive breast-feeding for 6 months most countries don’t offer maternity leave beyond three, and typically without pay.

It’s not that new mothers are hard to reach. With more women delivering their babies in facilities than ever before it has never been so easy to reach millions of mothers in the critical hours after delivery to help them initiate breastfeeding.

Our collective failure to do so has led to a realization that we need a new approach.

UNICEF’s landmark 2013 report, Breastfeeding on the Worldwide Agenda, outlines a powerful argument for change describing the current environment as “policy rich” but “implementation poor”.

At the same time, the Bill and Melinda Gates Foundation’s flagship breastfeeding investment – Alive & Thrive – is demonstrating that large increases in breastfeeding are possible with multi-sector action to shift attitudes among new mothers, the behavior of employers and the policies of governments. With this approach, the exclusive breastfeeding rate in the Vietnamese project sites has risen from 19 to 63% and across the Bangladesh sites from 49 to 83% in just three years.

And the countries that have achieved the greatest progress in reducing child mortality and achieving Millennium Development Goal 4 have all recorded exclusive rates of breastfeeding well above the global average including Rwanda (85%), Cambodia (74%), Malawi (70%), Bangladesh (64%), Nepal (70%), Eritrea (52%), Ethiopia (50%), Tanzania (50%) and Madagascar (51%).

Inspired by these successes and also by what we have learned in the areas of global health that have made the greatest gains though intense, sustained and collective public and private sector action, especially AIDS, malaria and vaccines, it is time for public-private partnerships to drive innovation, progress and deliver results in breastfeeding.

Partnerships that start with the needs of mothers and work backwards.

Partnerships with the goal of identifying and then removing one by one the major barriers and costs of early and exclusive breastfeeding as experienced by mothers.

Partnerships that are best practice and lift ambitions and inspire action in the countries with very low rates of breastfeeding and high numbers of newborn deaths.

Let’s start with Nigeria.

With the second highest number of child deaths in the world – 800,000 – and one of the lowest rates of early and exclusive breastfeeding – 23% and 15% – what happens in Nigeria will not only matter for a large number of Nigerian children but will also matter for the achievement of global health goals.

With Nigeria’s sharply rising population driven by a very high fertility rate (an average of 6 children per woman), the under 5 population is forecast to grow by 10 million in the next 15 years.

What happens in Nigeria increasingly influences the world.

We have the right ingredients for a strong public-private partnership in Nigeria – a federal government committed to saving one million lives by 2015, trusted local NGO partners like the Wellbeing Foundation, support from the global health community; mobilized networks including the 2,500 strong Global Breastfeeding Initiative; and corporations like McCann Health, Philips, Medela, Ameda and Hygeia fully engaged with an appetite for innovation.

A new public-private partnership can tap into the thriving innovation community that is starting to push the envelope on new breast-feeding supportive technologies. MIT’s Media Lab recently hosted a “Make the Breast Pump NOT Suck” Hackathon which produced the Batman-inspired (yes…) Mighty Mom Utility Belt – a fashionable, discrete, hands-free wearable pump that automatically logs and analyses personal data; Helping Hands – a sturdy, easy to clean, minimal parts, hands free compression bra designed by nursing moms; and PumpIO – an open software and hardware platform to make the breast pumping experience smarter, more data-rich and less isolating.

This is the tip of the iceberg of the innovation needed in the category of “breastfeeding supportive technologies”.

Every year more than 140 million new mothers face the decision whether or not to breastfeed and this population is growing fastest in the countries with the highest child mortality. There are 8 million new mothers every year in Nigeria alone.

As more and more of these mothers will come under increasing pressure to go back to work quickly as women’s labor force participation rates rise, new mothers will need intensive support, and even incentives and rewards to continue breastfeeding. If they don’t, we can expect breast-feeding rates to continue to flatline or more likely, to fall.

But we don’t accept this scenario. We know that most new mothers want to breastfeed. It’s the external environment that needs to change to enable mothers to fulfill their aspirations.

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