Dr. Anthony Nsiah-Asare interacting with a nursing mother. inset: Mothers at the child health clinic of the Ridge Regional Hospital
The howling cry of babies can be heard as the delegation from the Ghana Health Service (GHS) made its way to the child health clinic of the Ridge Regional Hospital Monday morning.
As they got closer, the voice of the midwife on duty can be heard singing ‘only breast milk, no water in the first six months’ in Twi. The mothers, clad in white print fabrics and holding their babies, responded in like manner.
As the song fades, a mother raises the hand asking, “When I am breastfeeding my newborn and I feel light in my breast does it mean the milk is finished?”
“No, although you may feel that you have emptied the breast, the breastmilk will come once the baby suckles on the breast so you do not have to see your breast full before you give it to the baby to feed,” Dr. Patrick Aboagye, Director of the Family Health Division of the Ghana Health Service (GHS), who was visiting the clinic explains.
How many months are we supposed to breastfeed new-born babies with only breast milk?” Dr. Anthony Nsiah-Asare, Director General of the GHS, also a visitor, asked.
“Six months,” another mother answered.
Exclusively breastfeeding babies for six months has been identified by the World Health Organization (WHO) as a universal solution that gives every child a fair start in life and lays the foundation for good health and survival of children and women.
Breast milk is perfectly designed for the child’s nutritional and immunological needs and the good news is that it is a natural and optimal way of feeding children, which promotes bonding between mother and child regardless of the setting.
Beyond being the cornerstone of a child’s healthy development, exclusive breastfeeding is also the foundation of a country’s development, as it acts as the great equalizer that helps break the cycle of poverty.
However, poor or sub-optimal breastfeeding practices put babies at a higher risk of compromised health malnutrition which has the potential of increasing infant illness and death.
Globally, although nutrition rates are relatively high, only 40 per cent of all babies under six months of age are exclusively breastfed and 45 per cent continue breastfeeding up to 24 months of age.
Additionally, there is a large regional and in-country variation in breastfeeding rates.
“Scaling up optimal could prevent more than 823,000 child and 20,000 maternal deaths each year,” the World Alliance for Breastfeeding Action (WABA), states in its report.
Mothers at the child health clinic of the Ridge Regional Hospital
Exclusive Breastfeeding In Ghana
- Since the country signed unto the Baby Friendly Hospital Initiative (BFHI) and began a National Breastfeeding Programme under the Ministry of Health in 1993, a lot has improved with regard to Ghana’s breastfeeding rate.
Data from the GHS shows that 634 facilities with maternity services has officially been declared baby friendly, while breastfeeding activities have been integrated into all health facilities across the country.
Nurseries in hospital where the newborns are kept from their mothers have also been abolished. Now, the mothers remain with their babies after delivery.
Again, more than half (56 per cent) of all babies born in Ghana are put to breast within the first hour of birth. This figure, according to the WHO, is slightly higher that the regional average of 50 per cent and the global average of 42 per cent.
Ghana has also enacted the Breastfeeding Promotion Regulation enacted in 2000 (LI 1667), which among others, prohibits marketing of breast milk substitutes no sale and promotion of designated products, exhibition of manufacture and expiry dates, distribution of free and low cost designated products, display of printed material or designated products in a healthcare facility, donation of equipment and material and provision of fellowship and sponsorship to health officers.
Despite this progress, inadequate information on the benefits of breastfeeding, poor support from their spouses, family members, work environment and changing demographic environment sometimes make mothers think or have the perception that breast milk may not be sufficient for their babies.
But one practice that will not just go away is giving water to babies when they are being exclusively breastfed.
Esi Amoaful
No Water!
The Family Health Division of the GHS has, therefore, decided to focus on advocating mothers to stop giving water during the commemoration of the World Breastfeeding Week.
Ms. Esi Amoaful, Director of Nutrition at the GHS, says water does not have any nutrient, but takes the place of breast milk and does not allow the baby to have the required quantity at the end of the day.
“Children grow well, survive and thrive on breast milk alone, somehow mothers are not convinced that babies do not need anything else, including water, if they are exclusively breastfed but breast milk has all the water a child needs (up to 80% of breastmilk is water),” she explains.
She opines that breast milk has over 200 known constituents as well as constituents that are not yet identified.
Ms. Amoaful says a mother’s milk is especially suited for her own baby as it changes to provide nutrition suitable for the baby’s needs.
“Colostrum and breast milk are adapted to gestational age, and mature breast milk changes from feed to feed, day to day, and month to month to meet the baby’s needs. Breast milk alone supplies all the nutrient needs of the child from birth till 6 months,” she adds.
“At the beginning of a feed, the milk that comes is mainly water and vitamins and quenches the thirst of the baby then the fat that makes baby grow and put on weight follows.”
Challenges
Ghana has made great strides in breastfeeding, particularly exclusive breastfeeding. However, major challenges remain with mounting evidence.
The last Ghana Demographic and Health Survey figures show that both exclusive breastfeeding and continued breastfeeding rates have stagnated in recent past.
The report shows that only 52 per cent of Ghanaian children are exclusively breastfed with wide disparities, an indication that close to half of all Ghanaian children are somehow deprived of this life-saving intervention.
Despite the country joining the world to celebrate the World Breastfeeding Week for many years, hospital practices are not changing as fast as recommended.
There is also the issue of policy coherence. For instance, the National Breastfeeding Policy advocates six months exclusive but only allows mothers a maternity leave of six months.
Data shows that due the incoherence in national breastfeeding policies, exclusive breastfeeding practice reduces from birth and by four to five months, the rate is only 36 per cent.
Lack of community level actions to support breastfeeding mothers, workplace baby-friendly activities lagging behind, continuous pressure on health staff by formula companies to promote BMS are but a few of the many challenges facing the full implementation of the breastfeeding policies.
Call to Action
Dr. Nsiah Asare, outlining activities by the GHS to address the shortfall in exclusive breastfeeding in the country, says the health service is embarking on a series of advocacy and orientation session with stakeholders to advocate the need to review and extend the provisions of the International Labour Organization’s (ILO) Maternity Protection Regulation which is currently 12 weeks and the need to support women at the work place.
A nationwide campaign on the benefits of breastfeeding and why water is not needed in the first six months of life will be launched to improve the quality of the practice of exclusive breastfeeding alongside engaging community groups to support women to breastfeed exclusively.
WHO Country Representative, Dr. Owen Kaluwa, says the full implementation of key policy actions in order to improve breastfeeding in the country is needed urgently.
He points out that increased funding to strengthen, promote and support breastfeeding practices, enhance quality of care in facilities in support of early initiation of breastfeeding as well as skilled breastfeeding counselling form part of the global breastfeeding framework that countries need to implement.
“Fully implement the international code of marketing of breast milk substitutes and other World Health Assembly resolutions through strong legal measures that are enforced and independently monitored by organizations free from conflict or interest,” he adds.
Ten Steps To A Successful Breastfeeding
- In 1993, Ghana signed onto the Baby Friendly Hospital Initiative (BFHI) and began a National Breastfeeding Programme under the Ministry of Health.
- The aim of the BFHI is to implement the ten steps to successful breastfeeding and to end the distribution of free and low cost supplies of breast milk substitutes to health facilities.
- Have a written breastfeeding policy that is routinely communicated to all healthcare staff.
- Train all healthcare staff in skills necessary to implement this policy.
- Inform all pregnant women about the benefits of breastfeeding.
- Help mothers initiate breastfeeding within a half-hour of birth.
“Place babies in skin-to-skin contact with their mothers immediately following birth for at least an hour and encourage mothers to recognize when their babies are ready to breastfeed, offering help if needed.”
- Show mothers how to breastfeed and how to maintain lactation, even if they should be separated from their infants.
- Give newborn infants no food or drink other than breast milk unless medically
- Practise rooming-in — allow mothers and infants to remain together — 24 hours a day.
- Encourage breastfeeding on demand.
- Give no artificial teats or pacifiers (also called dummies and soothers) to breastfeeding infants.
- Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.
By Jamila Akweley Okertchiri