By Kemo Cham
Kadija Marrah is in the eight month of pregnancy with her third child. But like the ones before, she has no plans to breastfeed the unborn baby. Kadija said she has bad breast. Her babies get sick when they breastfeed, she explained.
Many babies in Sierra Leone are missing out on what nutritionists say is the best start in life – breastmilk - due to misconceptions like this.
But persistent advocacy appears to be paying off, thanks to an innovative community engagement approach.
Breast milk is said to contain all the necessary nutrients a baby needs to grow. The World Health Organisation (WHO) recommends exclusive breastfeeding up to six months; from within the first hour of birth, the baby is introduced to breastmilk and no other form of food is given to it until six months. Thereafter, they should receive complementary foods with continued breastfeeding for at least two years.
Particular emphasis is on colostrum, which is the first milk that comes out of the mother’s breast. It’s so rich in antibodies, which protect against infections, that it’s considered the baby's first immunization.
But like Kadija, many women deny their babies this important experience due to fallacies that border on sex life, eating habits and longstanding traditional practices.
These are some of the issues that feature in discussions during community outreach by members of the Kombra Network, a consortium of grassroots organizations working to promote maternal and child healthcare in the country. Its members comprise religious figures, market women, traditional healers, civil society, and the media. This Network is the brainchild of the health NGO Focus 1000.
Malnutrition, one of Focus 1000’s intervention areas, is considered one of the fueling factors of child mortality in Sierra Leone. And breastfeeding is said to be one of the best ways to address it.
Data from the Ministry of Health and Sanitation (MoHS) show that 31.1% of under-five children are stunted in Sierra Leone which is also ranked among the top five countries globally with the highest rates of Infant Mortality (114 deaths per every 1000 live birth).
Global efforts to promote breastfeeding have been on since the 1991 Innocenti Declaration, which designated August 1-7 as World Breastfeeding Week, when advocacy in promoting breastfeeding is intensified.
The theme for this year’s commemoration was: ‘Breastfeeding: the foundation of life.’
At the Macauley Street Government Hospital in central Freetown, over 40 suckling mothers and pregnant women gathered to hear presentations from Kombra Network partners. The women later took turns to narrate their experiences and perceptions about breastfeeding.
Theresa Conteh recalled dealing with a “strange” illness when her mother-in-law advised her to give water to her three months old baby. The child experienced frequent stooling, prompting her to seek medical attention.
“With the knowledge I have gained from this meeting, I will not give water to my baby anymore,’ she assured.
Collaboration with government
Focus 1000 works in close collaboration with the government through the MoHS which says latest figures from its periodic National Nutrition Survey suggest major gains in behavioral change towards breastfeeding. Data from the study conducted last year reveals that 61.6% of babies were exclusively breastfed, compared to 32 percent previously.
Aminata Shamit Koroma, Director of Food and Nutrition Services, credited this to the increase in advocacy, warning however that much more needed to be done to build on the achievement. The emphasis, she said, must be on exclusive breastfeeding.
Besides the protection it provides, experts say breastmilk has huge positive impact on cognitive development. It also contributes to the health and well-being of mothers through spacing of children, reduction of the risk of ovarian and breast cancers.
Dr Hamid Ibrahim, UNICEF’s Country representative, sums it up as a win-win situation. He noted besides promoting a bond between mother and child, which allows the latter to grow healthily, breastfeeding lowers the risk of mothers contracting illnesses like hypertension. Ibrahim added that this means less economic burden on the government.
“So it’s a win-win situation for the baby and the mother, as well as the nation,” he said.
A joint UNICEF/WHO report on the eve of the World Breastfeeding Week reiterated the importance of breastfeeding and timeliness in introducing babies to breastmilk.
Newborns who breastfeed in the first hour of life are significantly more likely to survive, it says, stressing that even a few hours delay after birth could pose life-threatening consequences.
That report, dubbed Capture the Moment, found that an estimated 78 million babies worldwide – three in five – are not breastfed within the first hour of life, putting them at higher risk of death and disease. Most of these babies are born in low- and middle-income countries.
Globally, early initiation rate of breastfeeding are highest in Eastern and Southern Africa, at 65%, and lowest in East Asia and the Pacific at 32%, according to the report. In West and Central Africa, the rate is 40%.
The global average of early initiation rate is 42 percent.
Sierra Leone is ranked 36th with a rate of 53.8%.
Koroma said these figures show that at individual country performance level, Sierra Leone is doing quite well both in terms of early initiation rate and exclusive breastfeeding.
Sierra Leone did quite better than its neighbor Guinea which ranks 64, with a rate 33.9%. The two countries trail far behind their tiny neighbor, Liberia, which is impressively ranked 29 with a rate of 61.2%.
“We want to improve on this and that is why everybody needs to be on board,” Koroma said at one of several radio interviews conducted as part of the weekly community engagement.
The Kombra mantra
The global nutrition target for exclusive breastfeeding is at least 50% by 2025. But Sierra Leone’s target is 80%.
And for this to be realized, the role of groups like the Kombra Network is crucial, as is continued introduction of policies and review of existing ones by government.
Through its advocacy, the Kombra Network promotes the idea that suckling is an issue for both men and women.
‘Kombra’ is the Krio word for a suckling mother. For the network, both the wife and husband are ‘Kombra’, hence the advocacy to get husbands support their women not just during breastfeeding but all throughout the pregnancy period. This is in line with the goal of WHO, which is to scale up support to mothers - from family members, health care workers, employers and governments – to breastfeed their babies.
There is a mantra in the campaign that goes: ‘Me na Kombra! We all na Kombra.’ It translates: I am a Kombra. We are all Kombra.
The Kombra Network comprise religious leaders from both the Christian Action Group and the Islamic Action Group, who use their pulpits to justify the practice of breastfeeding using the scriptures. Members of the influential Market Women Association of Sierra Leone help in mobilizing fellow women through constant sensitization in their plaes of business. Traditional healers, who in the past were seen as obstacle to the acceptance of conventional medicine, have become instrumental in this effort of changing behavior under the Kombra Network.
The Kombra Media Network (KMN) serves as the conduit for information dissemination for the network.
The efforts of the Kombra Network are complemented by the Ministry of Health in various ways. For example, the community engagement sessions incorporate community health workers who provide expert views on emerging technical issues.
The Network also works with established community structures, like the ‘mother-to-mother support group, created by the MoHS, which bring together pregnant women and suckling mothers to share experiences in their communities. Over 14, 300 such groups have been established throughout the country.
Koroma said these mother-to-mother support groups are important because they involve elderly women who are blamed for advising young mothers to engage in practices that go against conventional practices, like to give babies water, honey, and other traditional medicinal substances.
Besides this community advocacy, the government and partners have also been working to put policies in place to address other factors that militate against breastfeeding. An example is the domineering effect of breastmilk substitute. These baby formulas come in handy for particularly working mothers, but also those who are driven by misconceptions, like Kadija.
Efforts are underway to introduce a code of marketing of breastmilk substitutes. The idea, being championed by the Scaling Up Nutrition and Immunization Movement, of which Focus 1000 is a leading member, is to prevent the spread of misleading information in advertisements.
Mohamed Bailor Jalloh, CEO of Focus 1000, stressed the role of the media in this crucial aspect of the advocacy. He said journalists should follow their conscience rather than the money that justifies the dissemination of messages that only confuses the public.
“When these companies come to you to advertise baby formula, they tell you it’s the best, better than breast milk. Say no,” Jalloh said at an engagement with KMN members.
In 2017, the MoHS commenced implementing the Baby-Friendly Hospital Initiative. This UN initiative, launched since 1991, requires member countries to provide mothers with practical support to enable them initiate and establish breastfeeding and manage common breastfeeding difficulties.
The program is currently available only at regional hospitals, with plans to scale it up over the next coming years.
Like many other areas in the world, full time engagement as a working mother prevents many babies from getting breastfed in Sierra Leone, where maternity leave is 12 weeks. Campaigners say this discourages exclusive breastfeeding, and there are moves to get the period extended.
There have also been some advocacies around this with the goal of having employers provide baby-friendly environment for working mothers. The idea is to have offices fitted with specially dedicated areas for breastfeeding.
Proponents of this say it will allow the mothers to work while fulfilling their motherly role.
The author is the National Coordinator of the Kombra Media Network.
© 2018 Politico Online
