This
monthly summary is a publication of Prime Lactation Center
Ngala
Elvis Mbiydzenyuy MAPS
MILCA
Lactation
Management Specialist
Director
Prime Lactation Center Cameroon
Twitter:
www.twitter.com/primelactation
Tel: (237) 33 11 45 78 or 51 03 02 65
The benefits of breastfeeding to the newborn are not a
strange patterned occasional recitation at antenatal care in most clinics in
the North West Region of Cameroon. Little is often mentioned of the benefits to
the mother and distinction is seldom made between the benefits of breastfeeding
and the breast milk. The traditional ANC approach hinging on frequency and not
quality of visits gave room for a series of contacts though never effective as
1 in 40 health care workers are trained in breastfeeding counseling or lactation
management and support. The one-on-one approach of goal targeted ANC (which admonishes
at least 4 to 5 ANC focused visits) leaves us with the questions as to the
effectiveness of prenatal breastfeeding education where health care providers
are not trained in breastfeeding counseling and management.
Breastfeeding in Cameroon is normative but exclusive
breastfeeding is not customary. National statistics from WBTi Cameroon shows
that 45% of newborns initiate breastfeeding within 30 minutes to one hour as
stipulated in the 10 steps to successful breastfeeding, but only 21% breastfeed
till the sixth month without giving water, other fluids and food. From a rural
point of view, the unasked question could be answered, as most births occur out
of health facilities. In addition cultural taboos surround birth and first feed
for infants. What could be the crack in the urban healthcare system to account
for such low statistics?
Many problems contribute to the erosion of breastfeeding
practices: misinformation, traditional practices, misconception and the
unavoidable demerits of changing times. One of them is the detrimental fragmentation of our traditional family support
system especially in urban areas. Instead of “families with traditional systems
in a modern society” we have an improper-sized society in traditional homes.
Modernization has changed our family structures, norms, values and attitudes
tending families to rely on other institutions and frameworks for social
learning. Breastfeeding has lost its place in the ongoing socio-cultural
evolutions. Our families have been torn between the gaggling fangs of formula
manufacturers and evangelists of modern family structures and norms (themselves
being products of a continental exodus).
Prime Lactation Center has observed a trend of causal
factors contributing to these low statistics. The educated mothers invariably
tend to discontinue breastfeeding earlier than their illiterate counterparts.
This in part can be due to their work schedules, perceived social status and
undue fear to have breasts fallen much earlier in their prime. They find it
difficult to breastfeed their infants and wean them early. Some have resorted to what is called the
“breastfeeding style”, women tending to maintain specific pattern of the number
and duration of feeds per day. In simple, breastfeeding their babies on
schedule often less frequent as advisable.
On the other hand breastfeeding has received a poverty image
and economically-deprived mothers tend to breastfeed their babies for a longer
period. However very few of them practice exclusive breastfeeding, many adhere
to predominant feeding, giving their infants water, herbal teas and local feed
within weeks or few months after delivery. The guarantee of proper feed
preparation is questionable as source of water and kitchen environment are
never safe. We will imagine something much dangerous to those who laden their
ego with formula for their infants.
In our community breastfeeding outreach, we observed that
breastfeeding in the first few days with colostrums is often not initiated or
practiced as most births are out of birthing centers and health facilities. The
untrained birth attendants, mostly elderly women admonish that the “dirty
fluid” as is called be thrown away. To them it is the accumulated waste of
several months in the mother’s breast. Breastfeeding initiation is thus often
delayed. You may want to imagine the consequence this might have on the health
of the infant as the babies are seldom guarded against the non-sterile
environment by the active actions of the passive immunity conferred on by
colostral antibodies together with the numerous anti-infective proteins
therein. Could anything more than this account for the high incident rate of
neonatal and infant diarrhea in rural communities in Cameroon? We believe this
attitude could be largely a result of the unawareness of the benefits of
colostrums. This poverty of knowledge does not leave urbanites out as urban
women and to an extend health care workers know they should give colostrums to
their babies but the reason and its importance is not known. The cultural
environment and practices are also strongholds in this knowledge battle. Widowhood
and the birth of a disabled are huge occurrences that deprive newborns of breastfeeding. In widowhood, the mother is often
separated from the newborn for certain traditional practices. In the event of
these, the newborn is not breastfeed and is given local teas and food. On the
other hand if the newborn is a disable, the quick and snappy conclusion is that
the child is a witch or wizard. Often the child is starved to death or left to
natural forces. A woman came to our center and recounted a similar event that
she was advised by her mother-in-law to starve her first child to death when he
was born with a cleft palate. That in a way was a push for her to quickly get pregnant
with the second child. We are yet to see a condition so misconstrued as
epilepsy and breastfeeding. In no way has breastfeeding been discouraged as in
mothers with epilepsy.
The reasons for low exclusive breastfeeding statistics does
not leave health professionals out of the success equation. Trainings in
lactation management and support have barely been organized in years. Most of
the messages given by health professionals to breastfeeding mothers are often
late, incomplete or contradictory. We have listened to women at the center
mention haven being advised to drink alcohol (‘palm wine’) to increase milk
flow; breastfeeding in the side-lying position will cause deafness to the
child; when nipples are sore, do not breastfeed instead stop until it gets
healed; breastfeeding a baby past the age of 2 makes the child dull and
sluggish; when your baby has hiccup you can give him water irrespective of the
age etc.
We have also noticed that most of the breastfeeding
challenges are a spill-over effect of the labor and delivery room practices.
These include the indiscriminate use of epidural analgesics and infusions. The
latter often increase tissue fluids formation and possible retention, a risk
factor for breast engorgement. If this situation meets poor latching and
positioning, sore and/or cracked nipples might develop a potent portal for
microorganisms, a likely genesis for mastitis. Forcep and/or traumatic
delivery, indiscriminate handling of the newborn after delivery for routine
medical procedures could also lead to “baby shutdown” thereby slowing
breastfeeding initiation. This terrifies anxious first time mothers who resort
to alternative feeding most often formula. Cesarean section often has led to
separation of mother and child and the introduction of fluids to the baby. Our
observations are that it is not the cesarean section that causes the
lactational failure but most often the practices and behavior after the
operation that adds or aggravates the situation.
It is important to note that Cameroon is a signatory to
several international injunctions related to infant nutrition. These include
the Innocenti Declaration on the Protection, Promotion and Support of
Breastfeeding, Global Strategy for Infant Young Child and Feeding and the
International Code of Marketing Breast Milk Substitutes. National adherence and enforcement are hugely
lacking. This together with breastfeeding being branded with a poverty image
has given formula companies the opening to use even health care workers to
market their products at the slightest mention of low milk supply, engorgement,
work or illness. An infant formula promoter (some of them nurses –milk nurses) markets
a product saying “this drug stimulates appetite and control fever, vomiting and
diarrhea”. He goes further to say “they were designed for infants from one
month old”. With sales commission he gave samples and recommended that they be
prescribed. A health worker mentions
“even if we stress breastfeeding, it is impossible to do without canned milk
because some mothers have difficulty breastfeeding and others don’t have enough
milk, some can afford canned milk, the process of expressing is unpleasant,
there are no pumps in hospitals, and furthermore, this milk in my hand contains
essential amino acids that strengthen the baby’s immune system; it is very
similar to mother’s milk”. A lady went
to a health facility and mentioned “I will be going back to work so I want to
give my child canned milk”, the professional did not talk to her about the
option of expressing and preserving her milk, but prescribed the baby a breast
milk substitute showing the mother that sticker and saying “this is good milk,
you see the beautiful baby”. Sometimes you don’t tend to blame these workers,
they are under-motivated, and the organizations admonishing health systems to
ward-off formula companies are never also willing to support breastfeeding
advocacy programs leaving these companies their financial prowess and gumption
to ride their marketing interest through. Billboards littered around the cities
show formula with bold captions and pictures giving the impression that formula
are acceptable alternatives to breastfeeding.
No counseling and breastfeeding support is ever given to
women who seek the uninformed way out. Informational and educational materials
promoting breastfeeding are few and the available ones are often in the hands
of health care professionals often in technical language. It is on these bases
that Prime Lactation Center, a not-for profit clinical, advocacy educational
and research center with a mission to protect, promote and support
breastfeeding while helping parents and babies to breastfeed effectively seeks
collaborators and support to improve breastfeeding outcomes using varied tools.
The traditional community and extended family network of support and
information related to breastfeeding is lost at the individual level. Thus to
initiate and continue successful breastfeeding the health care system needs new
models and approach while providing the mothers information (in local
language), motivation, encouragement and confidence in their own ability. We
believe the key to best breastfeeding practice is continued day-to-day support
for the breastfeeding mother within her home and community. This ties strongly
and timely with this year’s World Breastfeeding Week theme, Breastfeeding
Support: Close to mothers. Striving to create mother-to-mother support groups
in the region and hopefully the nation at large is the prime focus of this
center together with developing advocacy strategies and tools (short
documentaries, videos, radio call-in programs, bill board adverts, and relevant
literature for pregnant and nursing mothers). Incorporating men in what we call
“Real Men Support Breastfeeding” team is a foreseeable goal. Most doors we have
knocked for support in the nation are more focused on HIV and AIDS
Following a public survey we conducted in Bamenda the
capital of the North West region on “public perception on breastfeeding in
public” has illuminated and broadened our scope on the evolution of the
breastfeeding practices in our contemporary cultural, social and religious
settings. A majority of nursing mothers beckon the creation of hygienic, clean
water available walk-in breastfeeding spots in the city. This is a view we hope
to achieve with support from stakeholders.
Situational analysis and statistics that
might startle you about breastfeeding in Cameroon:
- 40% breastfeeding initiation rate within ½ - 1 hour after delivery
- 21% exclusive breastfeeding rates (MICS, 2006)
- 1 in 40 health care professionals have received lactation management and support training
- 75% bottle feeding rates with artificial milk (Ministry of Public Health)
- No hospital in Cameroon is baby friendly (WBTi Cameroon, 2009)
- Under five mortality rate in Cameroon is 126 deaths per 100 live births (IGME 2011)
The Center in the months ahead with the availability of
funds the seminar hopes to bring together experts to address the impact of
labor and delivery room practices and procedures on breastfeeding initiation
and duration. Key issues to address will include: review of current maternity services breastfeeding policies; update knowledge and build health care
professional capacity on: Labor
and delivery room protocols: reviews and recommendations; Cesarean section:
skin-to-skin care, Infant separation and breastfeeding initiation
Our
desire is to have Cameroon's breastfeeding statistics changed with mothers
having the full support.
We solicit organizations that we can work with to establish these mother-to-mother support groups across the nation.
We solicit organizations that we can work with to establish these mother-to-mother support groups across the nation.
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