WHO recommends that nursing mothers exclusively breastfeed their newborn for the first six months of life to protect them against child-killer diseases like diarrhea and pneumonia and at the same time achieve their optimal growth and mental development .
Although, in Nigeria due to cultural orientations that date back to days of yore, there is a very strong culture of breastfeeding with about 97 % of nursing mothers breastfeeding , only 13% of them practise exclusive breastfeeding. Their reasons fall into any of these 7 factors listed below:
- Myth that one must drink water after food
Position 1: The convention is that food and water go pari-passu . Old wives tales from mothers and mothers-in-law have stretched this age-long perception to breastfeeding. They advise young mothers to give their infants water after breastfeeding, a position that contravenes WHO’s recommendation that babies should be given breast milk without addition of any other food or water for the first six months of life.
Fact: Dr Bart Brai, a nutritionist and research fellow at the Nigeria Institute of Medical Research (NIMR) explained that milk is a complete with all the nutrients a baby needs including water.
“ There is enough water in the breast milk (breast contains about 80% of water), the baby does not need additional water,” Brai said.
- Fear of loss of sex appeal /sagged breasts
Position 2: “Some women believe breastfeeding sags their breasts. Some worry that when they are breastfeed, their husbands cannot ‘play’ with their breasts,” disclosed a nursing mother, Nonye Ekwomadu. “You know, once a woman(who is breastfeeding) gets sexually excited, breast milk starts to drop and some men don’t like it,” she continued.
Fact: However, a gynaecologist, Dr. Joseph Akinde said, “Whether they breastfeed or not, the breasts will still sag. Sagging is a function of aging.”
- If they had Caesarean Section
Position 3: Caesarean sections (CS) like every other major surgery come with a lot of pains. Many nursing mothers are weak and in so much pain after undergoing a caesarean section that the last thing on their mind is to breastfeed their newborn.
“I gave birth through CS and could not get by, by the first two days. When the baby started crying, the nurses advised my mum to give her glucose water till when I could breastfeed,” revealed Oge Okafor, a nursing mother. Even after regaining strength, Okafor found that she was not lactating well to assuage her baby’s hunger and had to complement breastfeeding with baby formula.
Fact: A Consultant nutritionist, Dr Chika Ndiokwelu, said that not putting a newborn to breast immediately after delivery affects lactation. “Breastfeeding obeys the law of demand and supply. The more a baby suckles the breast, the more the breast milk flows. It(breastfeeding stimulates the breast to produce more milk.”
- Fear of Infecting their new-born Child with HIV
Position 4: HIV-positive mothers are reluctant to breastfeed their babies for fear of vertical transmission of the virus to their babies.
Fact: Their fears are well-founded as experts say, breast milk contains HIV which could be passed to a baby born by an HIV-positive mother. WHO and medics advise HIV-infected mothers not to breast feed where baby formula and clean, boiled water are always available or to practise exclusive breastfeeding when mother and child are on ant-retroviral drug (ARV.)
Nigeria accounts for 21 percent of global new HIV infections in children. According to 2013 Progress Report on Global Plan released by United Nation, about 60,000 Nigerian children were infected in 2012 out of 210,000 from 21 countries reviewed in the report.
A large percentage of the HIV population in Nigeria are women in the reproductive age of 15-49 and 90 percent of HIV in children are transmitted through mother-to-child transmission (MTCT).
HIV activists and doctors blame the high burden of mother –to-child transmission on low awareness of HIV status especially by women who do not go for antenatal or those who access maternal care from traditional birth attendants and so are unable to comply with WHO-recommendations for prevent HIV transmission to their babies.
Chris O Agboghoroma et al, in the report , “Nigerian Prevention of Mother to Child Transmission of Human Immunodeficiency Virus Program: The Journey so Far” published in the Journal of HIV and Human Reproduction , identified poor buy-in by state and local governments, high fertility rate and high breastfeeding culture and low exclusive breastfeeding among responsible factors. More importantly, not all HIV pregnant women have access to anti-retroviral drugs which will help halt the multiplication of their viral load. According to the Federal Ministry of Health , only about 15% of pregnant HIV mothers have access to ARV.
Position 5 : It is not only HIV that deters Nigerian mothers from wanting to breastfeed. Sicknesses ranging from simple ones like malaria to complex ones like tuberculosis(TB) and cancers may prevent a woman from breastfeeding her baby exclusively.
Fact: According to WHO, Nigeria ranks 5th among the 22 high TB burden countries of the world
Second highest TB burden in Africa according to 2007 estimated annual incidence of 311/100,000. Also medications, especially prescription drugs such as cancer treatment drugs, could get into breast milk and so deter Nigerian mothers from breastfeeding.
- Inadequate lactation
Position 6 : “I delivered in the morning through CS and breastfed him for the first time in the evening,” revealed Stella Esharive, a nursing mother of a 5-month old. Esharive soon found out that her breast milk was not enough to sustain her son who she noted ‘eats too much.’ “They( doctor) said we should give formula because the baby was hungry ,” she added.
Many Nigerian women have had to resort to drinking pap and palm wine among other recommendations by grand mothers in a bid to enhance breast milk production. However, experts advised against the practice of drinking palm wine in the bid to enhance breast milk production.
Fact: Dr Ndiokwelu, said that,” It is not the amount of fluid a mother takes that determines the amount of breast milk she produces. It is the intensity of the suckling and the length of time the baby suckles.”
She advised that infants must be put on the breast immediately after delivery, breastfeed on demand` and make their babies suckle each of the two breasts long enough for the baby to get the hind milk which she said contains enough energy and prolactin (milk producing-hormone) that will sustain the baby and the same time stimulate more production of breast milk.
Dr Ndiokwelu described drinking palm wine as counterproductive saying: “Palm wine does not make the breast flow. It contains alcohol and alcohol is a mild sedative. When a nursing mother takes it, it gets into the breast milk and the baby sleeps and nobody is suckling anything. Soon, the mother starts complaining that she is not lactating enough.”
- Demands of work outside the home
A working mother, Vera Olubi, did not lactate for the first two days after delivery. When she did, the knowledge that she would soon resume after two months dampened her enthusiasm towards exclusive breastfeeding.
“My breast did not lactate for the two days. They (doctors) advised me to use baby formula. I also didn’t want her to get used to breast milk because I had just two months before I resumed work. If I should start work, it wouldn’t have been easy for her to cope,” revealed the mother of a now 8-month old baby.
Many working mothers like Olubi can barely breastfeed exclusively beyond the first three months that they are allowed maternity leave. Some of them resort to expressing and refrigerating breast milk for their babies. But some babies would rather go hungry and angry than be fed with expressed milk even as some mothers worry that expressed milk might get contaminated.
Fact: Experts advocate the introduction of crèches by businesses to enable working mothers stay close to their babies and breastfeed their infants on demand. According to Dr Ndiokwelu, “it will enhance productivity because the heart of these mothers will be settled at work and they are likely to perform better.”