Every year from August 1–7, Nigeria joins over 170 countries globally to celebrate World Breastfeeding Week. This is one of the greatest outreach vehicles for the promotion of optimal infant and young child feeding (IYCF) practices. The event, formally endorsed by the 1990 WHO Innocenti Declaration and policymakers across the globe, reaffirms commitment to breastfeeding promotion, protection, and support. The 2020 theme is “Support breastfeeding for a healthier planet.”
The Federal Ministry of Health in partnership with Alive & Thrive and other partners organised a National World Breastfeeding Week Webinar on August 3, 2020, titled “Breastfeeding and the Environment: Linkages and Opportunities in Nigeria.” The webinar highlighted the linkages between breastfeeding and the environment in Nigeria’s context and reviewed the Infant and Young Child Feeding (IYCF) policy, taking into cognizance emerging trends like the COVID-19 pandemic and climate change.
The webinar brought together policymakers, decision-makers, MDAs, influencers, thought leaders, individuals and organisations working to promote, protect and support breastfeeding in Nigeria and other climes.
Dr Chris Isokpunwu, Head of Nutrition, Federal Ministry of Health moderated the webinar with support from Dr Toyin Adewale-Gabriel, Technical Advisor, Policy and Advocacy at Alive & Thrive. Panel sessions sought to address the questions of how breastfeeding can support and promote a healthy planet, and how breastfeeding can be positioned to save our planet.
Promoting Early Initiation and Exclusive Breastfeeding
Dr Victor Ajieroh, Senior Programme Officer, Nutrition at the Bill & Melinda Gates Foundation spoke on the impact of promoting exclusive breastfeeding from the first hour of birth. He explained that the potential for breastfeeding to foster a healthier planet re-enforces the urgency for more concerted action to better protect, support, and promote breastfeeding. Government and its partners are making efforts towards improving optimal breastfeeding practices. This includes the launch of the strong brand for IYCF and the current implementation of the zero-water campaign for early initiation and exclusive breastfeeding.
The government has also revised the regulation on the marketing of breast milk substitutes by NAFDAC, institutionalized extended paid maternity leaves to six months in some states and built-in IYCF indicators into the National Health Management Information System. He explained that while many Nigerians believe in breastfeeding, and most initiate at some point, many mothers miss the full benefits when early initiation within the first hour, exclusive breastfeeding for six months, and continued breastfeeding into the second year are not practised.
Dr Beatrice Ogunba, Professor of Public Health Nutrition at Obafemi Awolowo University made the case for the environmental impact of breastfeeding. Breastfeeding leaves zero ecological footprints, it uses none of our scarce natural resources and therefore can be sustained for the health of our planet. It does not use fuel for production, for distribution or for sterilisation. For the first six months of life, a baby can be exclusively breastfed without a single drop of water.
The Impact of COVID-19 on Nutrition and Breast Milk Substitutes (BMS)
Dr Simeon Nanama, Chief of Nutrition at UNICEF spoke on the recent negative impact of COVID-19 on breast milk substitutes. Nigeria has made some progress in increasing the rate of exclusive breastfeeding, going from 17% in 2013, to 29% in 2018. This is on average, a 1% increase per year. While this is unlikely to make Nigeria meet the World Health Assembly target of 50% by 2025, still, exclusive breastfeeding seems to be one of the rare nutrition indicators on which Nigeria is making slow but steady progress.
The COVID-19 pandemic has constituted a public health emergency around the world with implications on the coverage of nutrition and health interventions. Measures put in place by governments around the world to contain the spread of COVID-19 have led to greater economic devastation and on the livelihood of people. The result is that many households, especially those with infants and young children, worry about the safety of breastfeeding their children at a time like this.
While experts are working to understand how the pandemic is changing the dynamic of nutrition behaviour in the country, producers and marketers of breast milk substitutes have seen this as an opportunity for strategic and opportunistic marketing of their products which is likely to interfere with optimal breastfeeding practices. Besides the additional financial burden placed on families, as well as its negative consequences on the development of children, breast milk substitutes such as instant formula and other milk products play a role in environmental degradation and climate change in both development and emergency contexts such as the COVID-19 pandemic.
Changing Cultural Perceptions of Breastfeeding via Social and Behavioural Change Communication
Dr Uche Ralph-Opara, Associate Director/Team Lead at Alive & Thrive spoke on Alive & Thrive’s support of Lagos, Kaduna and nine other states to scale up optimal maternal, infant and young child practices through a four-pronged approach: policy advocacy, interpersonal communication and community mobilisation, mass media, and the strategic use of data. This has been possible with support from Bill & Melinda Gates Foundation and UNICEF.
Alive & Thrive conducted a baseline survey and informative research across selected LGAs in Lagos and Kaduna States to assess the knowledge, attitudes and practices of various stakeholders about IYCF key indicators: early initiation, exclusive breastfeeding, and complementary feeding. The findings show that a significant number of mothers, family members and surprisingly some healthcare workers, noted that hot weather was a key reason why infants under the age of six months should receive water in addition to breast milk.
Following the results of findings, Alive & Thrive in collaboration with UNICEF and other government stakeholders launched the zero-water campaign to create increased awareness around exclusive breastfeeding. The zero-water campaign means no water at all for the first six months, regardless of the weather condition. Alive & Thrive has also continued to build the capacity of healthcare providers to bridge the existing gap in knowledge regarding the definition of exclusive breastfeeding.
Hajiya Yakaka Mustapha, Infant and Young Child Feeding (IYCF) Officer at Action Against Hunger explained that Action Against Hunger is working in more than five states in the area of community empowerment. In Borno state, they work in more than 41 communities. They hold quarterly meetings with Community Health Mobilizers (CHMs), community leaders, and health workers. In Borno State, they encourage early initiation of breastfeeding, and exclusive breastfeeding for up to six months.
Mass Media: A Channel to Advocate for Exclusive Breastfeeding and Better Nutrition
Dr Shittu Abdu Aguye, Deputy Project Director of the USAID Breakthrough Action Project in Nigeria spoke on the importance of media advocacy to change perceptions and breastfeeding practices. According to the 2018 Nigeria Demographic Health Survey (NDHS), 30–39% of women and men aged 18 to 49 years listen to radio, and 23- 34% watch TV at least once a week. This is a huge audience for mass media interventions, he said. Advocates for early and exclusive breastfeeding usually do not have huge budgets to promote content on mass media platforms. Most producers and presenters are not necessarily trained on health matters, so they are not well equipped with the skills to develop content that speaks to exclusive breastfeeding, early initiation of breastfeeding, and other health matters. They require a lot of support for content development and links to resources that they can use to advocate for exclusive breastfeeding and nutrition.
Organisations Must Create Breastfeeding and Maternal Friendly Workplace Policies
Alive & Thrive in collaboration with the Federal Ministry of Health and UNICEF commissioned a maternity entitlement survey across six states in the six geo-political zones. The survey found that only 9% of organisations have breastfeeding policies in place. Also, only 1.5% in the public sector and 23% of private sector organisations provided creches or lactation spaces for breastfeeding mothers to breastfeed their babies when they had to return to work.
They also found that 72% of Nigerian women surveyed were in favour of extending the maternity leave from three months to six months. Yet, only 30% were willing to take maternity leave, reasons being concerns around financial security. They were worried about returning to work, their salaries and career progression. These findings show that government at all levels must implement family friendly policies that provide all women who have just delivered with six months paid leave, or four months in the least. This has been implemented in Lagos and Kaduna States. Ekiti State gives four months maternity leave. All other states still give only three months. If we want our mothers to exclusively breastfeed Nigeria’s babies, how will they do so if they return to work after three months of delivery?
Maternity protection is an investment in maternal and child health and is key to meeting the Sustainable Development Goals (SDGs). It is time for Nigeria to become a country where both government and private sector organisations implement family friendly workplace policies.
Public Health Education important for awareness around Breast Milk Substitutes (BMS)
Mrs. Eva Edwards shared how NAFDAC is raising awareness and educating the public on Breast Milk Substitutes (BMS), especially for babies less than six months. NAFDAC is the regulatory agency designated to implement, monitor, and enforce the international code of marketing of breastmilk substitute marketing in Nigeria. Delivery on this mandate means creating a world where women are supported and allowed to freely make choices on how to feed their babies or infants without any commercial pressures from the BMS market and without direct or indirect endorsement of BMS products. NAFDAC has also embraced the zero-water campaign to encourage early initiation of breast feeding and encouraging exclusive breastfeeding with no water.
The campaign’s emphasis is on appropriate marketing and distribution not aggressive, unethical and sometimes harmful marketing. NAFDAC is responsible for monitoring and enforcing compliance with the national regulations. These revised regulations have been substantially aligned with the BMS Code, in the recent WHO, UNICEF, IBFAN (International Baby Food Action Network) 2020 code status report. NAFDAC is currently developing a national strategy for the implementation of the national regulations on marketing of breast milk substitutes. The goal is to develop a sustainable monitoring and enforcement mechanism which is critical to the effective implementation of the code and national regulations.
The 2020 National World Breastfeeding Week Webinar could not have come at a better time as the whole world grapples with the COVID-19 pandemic and its peculiar interruptions to child nutrition. The discussion around better nutrition practices must be put at the forefront of national discourse to ensure healthier babies, healthier mothers and a safer environment.
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