In the midst of plenty, Nigerian babies seem to be battling to repossess their exclusive rights to their mother’s breast in the first 1000 days of their existence, but their efforts seem fruitless. In this report Sina Fadare x-rays the contending issues at stake.
Mrs. Ronke Ibilade hails from Igbo-ora in Oyo State, a rural community noted for high birth rate of twins. So it was not a surprise to the family when she delivered a set of triplets four years ago. Around FESTAC area of Lagos, where the woman and her husband live, mama eta-oko as she is fondly called is a household name.
Sharing her experiences on exclusive breast-feeding is like sharing tales from the moon, as she is loaded with exciting experiences that could last a lifetime. According to her, breast-feeding one’s baby is a compulsory duty, which a woman must perform. She however added that along the line, a lot of unforeseen circumstances prevailed and the reality cannot be met.
“I had a son before the arrival of the triplets, which turned everything around in the family despite the fact that we are leaving as an average family. It was practically impossible for me to go on exclusive breast feeding for them because they were voracious suckers. There was a day I nearly fainted when the two boys grappled my breast simultaneously as if their lives depended on it, by the time they were done, the only girl had nothing to suck and she would not take any other alternative.
“It was a battle in the house. We had to introduce baby nutrient food the second week of their arrival because the milk being produced from my breast was not sufficient enough to feed them. How can l rely on exclusive breast milk as was recommended by our doctor?” She queried.
Ibilade’s case is similar to that of Mrs. Kelechi Chukwuma; her children are twin and voracious breast suckers as well. Despite the fact that she had two maids employed by the husband to assist her in house core and taking care of the babies, she lamented that “they rarely spared my breasts, unless they were sleeping, which is very rare for both to do at the same time.
“When l could not cope with the babies demand in terms of breastfeeding, my husband suggested that we introduced baby food to them and that was when l had a bit of respite.”
The mother of four children said that in as much as she wanted to breastfeed the babies for at least six months, the reality on ground did not allow her, adding that the demand was just too much for her to cope with, ‘especially after l resumed for work.’
According to her, the other kids who came before them, one after the other, did not pose any pressure on her in terms of breastfeeding. ‘Even with that, I couldn’t breastfeed them exclusively because it was not realistic.’
When reminded that exclusive breastfeeding has a lot of advantages which would assist the growth of the baby, she pointed out that there is no mother who will not try to give her baby the best, particularly in terms of breastfeeding, “but in most cases, the spirit is willing, but the flesh is weak. Do you believe that there was a time the breast was dry and nothing came out of it? Will you allow the baby to be crying? Definitely, you are going to look for an alternative”
Chukwuma explained that “when the boy became naughty and was always crying especially in the night, my husband said we should give him baby food plus breast feeding. Funny enough since the day he tasted the food, he ignored the breast milk and before l knew what was happening, he never wanted to take it again. I had no choice but to cooperate with him. This eventually paid off when my maternity leave was over and l had to return to the office.”
However the experience of Mrs. Toyin Ashefon, a mother of three, was a different story entirely. As a nurse by training, she had vowed to make sure that all her children were exclusively breastfed, as babies.
According to her, her husband did not allow her to pick any job, a situation that allowed her to give the children exclusive breastfeeding at least in the first six months of their arrival.” I can tell you that this eventually paid off because up till today you can hardly see them falling sick, a situation that has been attributed to their being breastfed adequately in their first 1000 days in life.
“The good aspect of it was that the last born sucked breast till he was a year old before l weaned him. Though it was not an easy task because l rarely went anywhere and my husband made sure all our needs were provided for, today I know better and l can authoritatively tell you that exclusive breastfeeding is the best, provided a nursing mother can cope with it.” she explained.
Exclusive breast feeding has been the handout always handed over to nursing mothers during ante-natal period by medical experts. It is repeatedly echoed to them as a task that must be done and the expectant mothers in turn always looked forward to the arrival of the baby and how to put all that has been taught to practice. Unfortunately when the chips are down and reality dawns, it suddenly becomes a herculean task, all medical experts’ advice notwithstanding.
At the Innocenti Declaration in 1990, the WHO/UNICEF called for policies that would cultivate a breastfeeding culture that encourages women to breastfeed their children exclusively for the first six months and then up to 2 years and beyond. However, a recent estimate by the WHO showed that worldwide only 35% of children between birth and their fifth month are breastfed exclusively.
Based on the WHO Global data on Infant and Young Child Feeding in Nigeria, 22.3% of children were exclusively breastfed for less than 4 months, while 17.2% were exclusively breastfed for less than 6 months, in the year 2003.
Similarly, according to the Nigerian Demographic and Health Survey (NDHS), in 2008 17% of children were exclusively breastfed for less than 4 months, while 13% were exclusively breastfed for less than 6 months. The median exclusive breastfeeding period in Southwest Nigeria by months in the year 2003 was 7 months. In the year 2008, it was 6 months. Within the same period, early initiation of breastfeeding among women in the region was 12.7% in 2003, but increased to 35.5% in the year 2008. More worrisome is the fact that all these figures are far below the 90% level recommended by the WHO.
Perhaps the recommendation of the WHO/UNICEF on exclusive breastfeeding despite its huge advantages is becoming unattainable because of the travails the average Nigerian woman is passing through in raising her children.
Aside this, poor economy, cultural, political and psychological factors among others are impediments to exclusive breastfeeding in Nigeria.
The Nation’s investigation revealed that children from same parents react to different situation especially when it involves exclusive breastfeeding. However the practice of exclusive breastfeeding is still low despite the associated benefits.
Against this backdrop, The Nation sampled the opinion of about 40 mothers on how they handled the situation when reality dawned. Their responses were as exciting as their various experiences, especially the reactions of the children.
Of the 40 nursing mothers, only 10 percent confirmed that they were lucky to exclusively breastfeed their children for the six months timeline.
Perhaps the significance of the critical window of 1000 days for a child may have influenced Lagos and Enugu state governments’ newly introduced six months maternity leave for nursing mothers and three weeks paternity leave for their husbands.
Against this background, Lagos State last August set aside a week of sensitisation to mark the world breastfeeding day for nursing mothers, to intimate them on the importance of exclusive breastfeeding.
Speaking on the occasion, Dr Modele Osunkiyesi of the state’s Ministry of Health pointed out that the state’s promotion and successive exclusive breastfeeding for the first 6 months of life without any other additive requires the collective support of all, including employers of labour, fathers, mothers and family members.
In his own contribution, the campaign coordinator of the programme, Dr Olukemi Adeyoju noted that “Breast milk contains all the nutrients an infant needs in the first six months of life. Breastfeeding protects against diarrhea and common childhood illness such as pneumonia and may also have longer term health benefits for the mother and child such as reducing the risk of overweight and obesity in childhood and adolescence.”
Apparently referring to the WHO, Adeyoju explained that a child that was exclusively breastfed for the first six months life would achieve optimal growth, development and good health.
Similarly in a recent survey by the Bayelsa State government in partnership with the United Nation International Children Fund (UNICEF), only 15 per cent nursing mothers do exclusive breastfeeding.
Out of the 2,332 breastfeeding mothers sampled in the state, only 349 (15 per cent) exclusively breastfed their babies, while 1,267 (45 per cent) gave breast milk and water to their babies. The remaining gave more of other kinds of food.
Worried by the declining rate of breastfeeding among women in the state, the Chief Medical Director, Niger Delta University Teaching Hospital, Okolobiri, Prof. Onyaye Kunle-Olowu, lamented that 15 per cent of women in the state engage in the recommended standard of breastfeeding, adding that there is need for stronger advocacy for nursing mothers in their workplace, in order to promote exclusive breastfeeding.
According to him, breastfeeding helps children to survive and thrive, enables infants to withstand infections, provides critical nutrients for the early development of their brains and bodies and strengthens the bond between mothers and their babies.
“A recent Lancet study found that infants who were breastfed for at least one year went on to stay in school longer, score higher on intelligence tests and earn more as adults than those who were breastfed for only a month,” Owei said.
The commissioner said the government would continue to lead the charge by making breastfeeding a policy priority in the state’s development plans, increasing resources for programmes that support breastfeeding and working with communities and families to promote the full benefits of breastfeeding.
“Breastfed children fall sick less often, so their mothers are absent from work less often, too. These effects in turn contribute to higher productivity, ultimately benefitting businesses and larger economies,” he said.
Owei pointed out that the International Labour Organisation (ILO) has adopted three conventions to establish protective measures for pregnant women and new mothers, including the rights to continue breastfeeding. He listed the conventions as time (extended maternity leave), space (crèche at the workplace or close to it) and support (a support group at the workplace).
“Our challenge now is to make breastfeeding work in our workplaces too. Together we can help working women to breastfeed and reap the benefits for themselves, their children and for the health and wellbeing of future generations.” He said.
Why babies were shortchanged
The International Labour Organisation (ILO) convention on protective measures for pregnant women and new mothers recommend an exclusive breastfeeding for the child as a right from her mother.
Article 10 1&2 of the convention emphasised the privileges a nursing mother should enjoy in order to give exclusive breastfeeding to their children.
“A woman shall be provided with the right to one or more daily breaks or a daily reduction of hours of work to breastfeed her child.
“The period during which nursing breaks or the reduction of daily hours of work is allowed, their number, the duration of nursing breaks and the procedures for the reduction of daily hours of work shall be determined by national law and practice. These breaks or the reduction of daily hours of work shall be counted as working time and remunerated accordingly.”
However, when all the chips are down, a lot of man-made hindrances still put clogs in the wheel of mother to child exclusive breastfeeding. Speaking to The Nation why it is increasingly difficult for nursing mother to breast feed her child exclusively, a middle age woman who works as an administrative officer at the Lagos State government secretariat noted is still difficult to do exclusive breastfeeding, despite the fact that the state is operating a six-month maternity leave system.
Mama Tolu, as she is fondly called, explained that she could not cope with the demand of the little baby in the house because he always wanted a breast in his mouth anytime he is not sleeping. According to her, the situation forced her husband to start buying baby milk, a can of which the boy consumes in less than 10 days. She added quickly that ‘this does not foreclose breast feeding intermittently. That is why l told you that from my own experience, l wanted to do it but it was not successful.’
The Nation also found out that the demands of house chores, especially when couples are not buoyant enough to engage the services of house-helps also become a hindrance to nursing mothers, as they get too tired and overwhelmed to attend to the breast demands of the baby.
Mrs. Kate Aladekomo, a senior computer programmer at Alausa in Lagos confirmed to this reporter that it is easier said than done, adding that sometimes, the baby’s enemy is the father, who may not be able to withstand the long denial of access to his wife’s breasts.
“My husband so cherishes fondling my breast to the extent that it is usually a tug of war anytime l am nursing a baby. Though in a friendly manner, he would tell the baby not to suck me dry because that (my breasts) was what attracted him to me. …Strangely he could not tolerate exclusive breast feeding.” She said.
The Nation’s investigation also revealed that most of the time, career women have little time to offer their babies breast milk after the maternity leave, which is still pegged at three months in most private and public institutions. In addition, most women who go through caesarian section during delivery may experience a bit of pain in the first few days of the baby’s birth, thereby making exclusive breastfeeding a herculean task.
In addition to this, health-related crisis may also prevent the new baby from enjoying the mother’s milk. In some cases, the breast may not flow as expected and in other cases, the mother may be mistakenly bitten on the nipples, thereby making breastfeeding a painful process.
Sharing her experiences, Ms Tobi Abubakar, a single mother, said though she did not experience total biting, but constant sucking on her breasts in the first two weeks of her baby’s arrival, gave her a laceration that pained her to the marrow. “After the laceration, l could not stomach the pains that followed; l therefore had to resort to baby food for almost two weeks when l became medically okay, to contiune with breast milk.”
While a painful experience may be a determinant, Dr Vincent Ilogbo, a consultant pediatrician based in Canada argued that from experience “some breastfeeding mothers do not breastfeed because they believe it could make their breast flabby and unappealing especially to their husbands. A number of men have high preference for well-shaped breast. Hence, they discontinue breastfeeding at short intervals to discourage their husbands from looking outside.”
According to him, if such a situation arises, it is the baby that suffers the consequences, adding that the fear of the baby getting addicted to the breasts makes some mother to give breast milk sparingly.
The Nation equally learnt that cultural beliefs by some families, especially when the mother-in-law is around go a long way in discouraging the mother from exclusive breast feeding. Some mother-in-laws cannot just agree that the baby cannot be given water and in some cases, concoction that will make the baby strong. In such a case, the mother may therefore be helpless, especially if the mother in law is very domineering.
Importance of exclusive breastfeeding
According to UNICEF the importance of exclusive breastfeeding cannot be underestimated. Dr Bamidele Omotola, a nutritionist with UNICEF while speaking to The Nation noted that breastfeeding provides the best nutrition and protection from illness for the baby.
According to him, exclusive breastfeeding is fundamental in the first six months; it is easily digested and absorbed by the baby. Not that alone, it contains anti-bodies which protect the child against infection. Breast feeding also helps mother’s womb to return to normal position after birth.
Corroborating Omotola’s view, Dr Orode Doherty, a pediatrician noted that exclusive breast feeding is key and it’s essential that the kid should be fed this way.
Doherty maintained that “The first drop of breast from the mother’s breast is vital and key to the rapid growth of the baby. It is better that the baby starts the same day he is born. The first milk that comes out is very thick and contains anti-bodies that are very good for the health of the baby.”
According to her, breast milk “is like the baby’s immunisation and it sends the signal to the mother’s brain that the baby is here. It is also a time for a child and mother’s bond and the beginning of a mother’s affection to the baby. What comes out first from the mother’s breast is as much more liquid and that is what the baby needs, no water but exclusive breast feeding. The mother should empty the first before changing it. You are what you eat. The mother should be on good diet so that the milk can always flow.”
The pediatrician pointed out that mothers “have to be taught how and when to give the baby their breast. When you are about to wean, you have to look around and do soft food with ewedu, crayfish and others you find in the environment.”
Thinking along same line, Dr Titi Adesanmi consultant pediatrician and Managing Director of Life Child Centre in Lagos explained that if a child is not breast-fed adequately, he is always sick, adding that “The first 1000 days is critical to the baby to develop his brain and potentials. It is a critical window to ensure that the brain achieves optimum potentials, even from the pregnant stage. The mother needs to be adequately fed a balance diet in other to cope with the challenges of motherhood.”
Ways of encouraging exclusive breastfeeding
Since it has been established by all stakeholders that Nigerian children are being short-changed by their mothers in the first 1000 days window, then it is obvious that all hands must be on deck to correct this anomaly.
Dr Vincent Ilogbo argued that the government has a role to play on the issue by passing a favourable legislation that would give nursing mothers more time to feed their children, even at their place of work.
“Other states should borrow a leaf from Lagos and Enugu that has granted six months maternity leave for nursing mothers and three weeks paternity leave for the nursing father. The implication of this is that all things been equal, the mother will have enough time to give exclusive breastfeeding to their children for the six months that they are on leave.”
Ilogbo pointed out that crèche and nursing homes should be established in all local government all over the states, where mothers can use for their conveniences, adding that they can go there to feed their children three to four times during office hour. This will go a long way in putting their minds at rest and they will be able to give their best in whatever work they are doing. They will also not be in a hurry to sneak out of office to go home to attend to their babies.”
He said such a programme will serve dual purposes in the sense that it can be used as a research center to generate data, especially by child psychologists and pediatricians. “This type of programme is being used in Canada and it is a form of generation of employment for various professionals in the health sector.”
To Owei, government should go all out to make deliberate policies that support breastfeeding, leading to increased job satisfaction and greater loyalty to their employers. “Breastfed children fall sick less often, so their mothers are absent from work less often, too. These effects in turn contribute to higher productivity, ultimately benefitting businesses and larger economies,” he said.
He argued that it is a collective effort by all to make this dream a reality. “Our challenge now is to make breastfeeding work in our workplaces too. Together, we can help working women to breastfeed and reap the benefits for themselves, their children and for the health and wellbeing of future generations.”
Speaking in the same vein, Donald Ase a health expert in Bayelsa challenged nursing mothers to key in to the state government’s programme and give their children the best from what God has given them, adding that the children need good attention from their mothers.”
Adesanmi is of the view that since the first 1000 days is critical to the development of the baby’s brain and potentials, mothers should not only see exclusive breastfeeding as the right of the baby but a task that must be done to their babies in order to get their cooperation while growing up.
