When I first traveled to Tanzania as a research student two years ago, I assumed that breastfeeding was the common practice among new mothers. This was only my second trip to Africa and I didn't have to travel far to find posters promoting breastfeeding. Within the first hour of arriving in Himo I had already seen two mothers breastfeeding their newborn babies. So I was shocked to find out that less than 50% of children in Tanzania are breastfed exclusively for the first six months. Globally, the figures are worse. According to the World Health Organisation (WHO) exclusive breastfeeding rates have stagnated, with less than 40% of infants under six months of age being exclusively breastfed.
Along with having low rates for exclusive breastfeeding Tanzania has some of the highest rates of child undernutrition in the world, with 42% of children under the age of five suffering from stunted growth. I was shocked to find out of the small girls called Zai, who had brought me passion fruits every day, was seven years old. By looking at her I thought she could be no more than five. It was only later one of the neighbours told me that as an infant she suffered with frequent bouts of diarrhoea and became quite malnourished. She suspects this was because, at the time, the family did not have access to safe clean drinking water.
Breastfeeding is one key intervention, identified by the Lancet, which can help prevent children from becoming malnourished. It can help to protect children from killer diseases like pneumonia and diarrhoea, which can also exacerbate malnutrition further. New research suggest that infants who are not breastfed are 15 times more likely to die from pneumonia and 11 times more like to die of diarrhoea than those who are exclusively breastfed.
Despite it being a free and natural way to protect a newborn baby, sub-optimal breastfeeding practices are responsible for approximately 804,000 child deaths each year. This is largely due to too little attention is being paid to help mums breastfeed.
It is not simply enough to tell mothers to 'breastfeed' if we are not providing them with an enabling environment for them to do so. We need to make sure mothers, especially mother who are struggling with breastfeeding, are given adequate support, education and accessibility.
One major barrier to breastfeeding is the critical shortage of skilled health workers. WHO infant-feeding guidelines recommend that all infants should be breastfed within one hour after birth, yet only 49% of children are breastfed within the first hour in Tanzania. This is a key window of opportunity, as the mothers first milk - colostrum - is rich in protein and antibodies that provide passive immunity to babies who do not have a fully developed immune system. Babies who are breastfed within the very first hour after birth are three times more likely to survive than if they are breastfed a day after birth. Evidence suggests that mothers are twice as likely to breastfeed within the first hour after birth if a skilled health worker is present. However, the shortage of global health workers means that too many mothers are not given the support to breastfeed in the critical hour.
There is often a lack of legislation to support mothers in breastfeeding, particularly around maternity leave. In Tanzania, for example, maternity leave is only 12 weeks. A mothers choice to return to work should not affect her ability to breastfeed. Yet, more times than not, the work environments are not conducive to help mother breastfeed. If mothers do make the decision to return to work employers need to realise the importance of providing safe clean environments for mothers to breastfeed, including on-site day-care and facilities for mothers to express and store breast milk.
When mothers do return to work, where they are not able to breastfeed, many feel they have no choice but to wean their babies off from breast milk, often earlier than WHO guidelines, and introduce them to powered formula. Formula is inferior in many ways to what mothers can provide freely and naturally. It does not contain antibodies found in breast milk and the proteins found in formula are often difficult to digest. When infant formula is not properly prepared, there are risks arising from the use of unsafe water and unsterilised equipment or the potential presence of bacteria in powdered formula. Formula is not free, unlike breast milk, and when resources are low some families may resort to over-diluting formula to "stretch" supplies, which can lead to further malnutrition. Returning to breastfeeding is not always possible, as infrequent and irregular breastfeeding can diminish breast milk production.
Breastfeeding is the most natural way to improve child nutrition. More needs to be done to get nutrition and breastfeeding onto the political landscape. We also need to identify barriers to breastfeeding to ensure that both mothers and babies are given the best start to life.