Breastfeeding Week: success stories, challenges and policy in Tanzania

Dar es Salaam. Tanzania is doing well in breast-feeding as some 97 per cent of mothers adhere to the practice. But only 50 per cent of these mothers properly breast-feed their children.

Low education on proper nutrition causes most mothers to introduce extra food to babies aged less than six months contrary to what nutritionists recommend.

With 42 per cent of children in Tanzania being stunted, breast-feeding is vital for child’s physical and psychological development.

Health experts suggest that mother’s milk is the best for babies, particularly in the first six months of their lives. During this period mother’s milk contains all the required nutrients and is natural and safe from environmental contamination. It also helps defend a baby against infections, prevents allergies, and protects against a number of chronic conditions.

But also, mother’s milk is easily digested and that makes a baby healthy because the body consumes all nutrients contained in the milk. Not only have that but also breast feeding helps to create and strengthen mutual relations between a mother and a child. Furthermore, a child’s IQ is also highly made from exclusive breast-feeding.

Breast-feeding also helps a mother from getting various diseases such as diabetes, breast cancer and is even used as one method to family planning.

According to the State of Breastfeeding Report of 2010 that surveyed 33 countries globally, Tanzania is among the 24 countries with the highest number of children with malnutrition, estimates being at 3 million children.

Although there is a remarkable reduction in maternal, neonatal and even children under-five mortality, there is a huge gap to be filled. Statistics shows that Tanzania is making considerable progress in the reduction of child mortality. Under-five mortality rates continue to drop from 112 deaths per 1,000 live births in 2005 to 81 in 2010. The deaths of infants under a year also decreased from 68 to 51 per 1,000 live births over the same period.

The continuing decline can be attributed to government commitment to increase use of key health interventions, such as sustained high coverage of routine under-five immunisation, Vitamin A supplementation, the use of insecticide treated bed nets and better drugs to treat malaria. Despite improvements, about 390 children under five die every day of mainly preventable and treatable conditions.

Exclusive breastfeeding and adequate complementary feeding are key interventions for improving child survival, potentially saving about 20 per cent of children under five.

Breastfeeding week

As more women engage in the practice of breastfeeding after realising its importance, there is, however, a large number of women who are still unaware, or who just ignore the practice. The World Breastfeeding Week (WBW) is, therefore, observed to sensitise communities on the importance of increasing and sustaining the protection, promotion and support of breastfeeding as the world is counting down to reach the Millennium Development Goals (MDGs).

Themed, Support Breastfeeding: it is a vital Life-Saving Goal in Tanzania, the climax was marked on August 7 in Iringa which has above 50 per cent of its children stunted. Various activities to sensitise breastfeeding and general nutrition for children were conducted. Other regions with more stunted children are Lindi, Rukwa and Dodoma.

The week was also used to promote breast feeding to both genders since there is a growing number of young girls who do not prefer to breastfeed their children and for the male partners to support their female partners to breast-feed their children exclusively in the first six months .

Testimonials from breastfeeding mothers

Among other factors why most mothers introduce extra food to their children before six months is that a mother has to go to work and so they are worried their babies would starve, while others don’t know how well to keep the mother’s milk even as they are away.

Lulu Chirande is a paediatrician but also a mother of three. She says all her three children including one who is two-months old, had never had any other milk before the age of two.

She says after understanding how important mother’s milk is for the children she learnt how to have a milk bank in her home freezer.

“So what I normally do is to pump my milk, anywhere anytime when I feel they are full, because milk has one ‘attitude’; the more you brest-feed the baby, the more it is produced.

“I have a breast pump everywhere I go, so even here at the office when I feel I am full with milk, I have some privacy and pump it out,” she says. She says since breast milk can stay up to eight hours in normal temperature, she keeps it in her office until the time she goes back home.

“In the car, I keep it on the dashboard to keep it cool.

“I have small bottles of 300 millilitres each that I keep the milk in, this is because when you warm them you cannot freeze them again, so a baby has to drink the milk till it is finished,” she adds.

Her milk bank has 15 bottles that can be used by her child for up to five days.

“That gives me the confidence that my daughter has enough food, and good enough, you are assured the househelp feeds the baby because mother’s milk can only be used by babies not like the formula milk where we have heard a lot of stories of house helps using it,” she says.

But also, Lulu says the practice saves her a lot of money that she might have been using to buy either cow or formula milk.

Another parent, Mwanaakida Adam says her seven-month old son, Accra, has an exclusive breastfeeding.

This, she says, is thanks to her husband, Adam Jabir, who encouraged her to do so from the beginning. She admits that some nurses sometimes do not give enough information about the matter.

“After I delivered at home, my elders wanted me to give water to the baby because he could be thirsty.

He used to cry a lot. I asked for the opinion of my husband. He opened up my eyes that I should breastfeed my son for the first six months without introducing anything else to him,” says Mwanaakida.

She says, there are many myths about feeding babies from the elders especially for those living up-country.

Her husband says when his wife returned to Dar es Salaam from Tanga, he made sure that she had enough time to rest and breastfeed the baby.

“And we have witnessed tremendous growth for our child. His weight gaining is good and we had never taken him to hospital,” says Adam.

The challenges of breastfeeding

A specialist in children’s health, Dr Augustine Massawe, says apart from the growing number of especially young mothers not preferring to breastfeed their babies, there are many other hindrances to breastfeeding.

He says children born of mothers living with HIV/Aids have challenges especially when the mother has mastitis, sores on nipple tissues, bleeding of the nipples and even candiasis because all these endanger a child to the virus transmitted to them, but there are a lot of mothers living with the virus who safely breastfeed their children.

He also says that there have been cases when a child refuses to breastfeed, which can be caused by sickness, poor breastfeeding techniques, overfeeding, distracting the baby while feeding and others. He says children are human beings who need a quiet and good environment to feed as any other person, and they need to eat when hungry.

He adds that another reason is that some parents use bottles to feed the babies even with the mother’s milk, some babies do not like the bottles, or being given pacifiers and the most important is introducing extra food to the baby early.

“And the secret to having more milk, is for a mother to breastfeed the child, the more you do the more milk is formed,” he adds.

Majority of mothers lack confidence in breast-feeding their children publicly, but he advises that, having an extra cloth to cover a baby and a mother during the feeding process can help in adding to the confidence.

He says although it is rare to see a child dying from hunger in Tanzania, but there are a lot of children dying from diseases related to poor nutrition.

But another challenge is when a mother has more than one child like Caroline Shedafa, who has pre-mature twins.

Caroline shares her story and the challenges she faces when breastfeeding her son and daughter.

She says that, when the two were born at the Aga Khan Hospital in Dar es Salaam, they couldn’t suck long enough, their mother’s milk directly, so she had to pump the milk and bottle-feed them.

“I had them exclusively breastfeed for three months, it was hard to get enough milk for them both. So I introduced them with formula but only once a day.

“But still I never gave them anything else apart from my milk and infant starter formula until after six months,” says Caroline.

She adds that, getting nutrition information is nowadays simple because apart from the education she was getting during the antenatal visit, she also browses on the internet and reads books.

Her eight months twins are now healthy and strong. Extra food should be given only after six months

Experts say the first 1000 days are very important for the baby; the days start to be counted from the day a pregnancy is conceived to two years.

Nutritionist Luitfrid Nnaly says after a baby had an exclusive mother’s milk for the first six months, additional food is important to support his weight.

But he warns that, a mother should start slowly, with light food such as soft porridge and make it thicker as the baby grows.

He, however, warns that as a child is given extra food, mother’s milk still has the same position -- important than any other milk.

Therefore, a parent shall consider, various issues including number of meals per day, thickness of the food, varieties, cleanliness and quantity.

“Because all these can lead a child to malnutrition even if a child was exclusively breastfed.

But also a parent should understand that excessive eating does not necessarily give normal weight gain which ranges from 500 grams to a kilo,” he says.

Government initiative

Tanzania made a strong commitment to improve maternal health and child nutrition, and reduce child deaths from preventable causes, particularly stunting – the promise that was renewed in May 2014 with the launch of the sharpened One Plan and scorecards to monitor progress.

A High Level Steering Committee for Nutrition was created within the Prime Minister’s Office to coordinate multi-sectoral interventions to reduce child malnutrition and promote optimal breastfeeding.

The joint efforts of the government and its partners, including Unicef have already produced important results in nutrition, but there is still more to be done, as the stunting (when a child is too short for their age) prevalence in the country is still high, affecting 42 per cent of children under-five.

Stunting undermines both the physical and cognitive development of children and prevents them from growing as healthy, productive adults.

Also Tanzania has adopted a bylaw that guides the supply and marketing of milk formula for infants since 1994. This was adopted in order to control the selling of optional milk in order to encourage breastfeeding.

Although working mothers in Tanzania have 84 and 100 days maternity leave, many introduce their children to additional food right after resuming working.

Statistics show that, although we have about 81 per cent of children getting exclusive breast-feeding for the first two months, number drops as the child grows, 51 per cent are exclusively breastfed on the second and third months while only 21 per cent get exclusively breastfed for the first six months.

This indicates that, early introducing extra food to a child less than six months is a serious problem in the country.

Speaking about the efforts in promoting breastfeeding habit to mothers, Tanzania Food and Drugs Authority (TFDA) spokesperson Gaudencia Simwanza says TFDA supports government efforts in making sure that milk is better than canned formula.

“We are working on the regulations that guide the kind of information to be included in the formula milk, like we prohibit the formula to have photos or any description that will tell a mother, that particular milk is better than mothers,” she says. But she highlights the challenge of influx of unregistered formula in the market.

“The thing is someone might have seen a certain formula famous in a certain country and decide to bring it here without following required regulations.

What we are saying is that, it doesn’t matter how much that milk is famous in those countries, Tanzania has its own ways of approving the products to be used by its people and people have to follow those procedures.