Breastfeeding gives children the best start in life: key for sustainable development

Giving children the best start in life begins with breastfeeding.  Breastmilk is the natural first food for newborns. It provides children with necessary nutrients for their growth and development and protects them from deadly diseases such as pneumonia and diarrhoea.

There is no better substitute food for a breastmilk. A breastfed child is 14 times less likely to die in the first six months than a non-breastfed child, and breastfeeding drastically reduces deaths from acute respiratory infection and diarrhoea, two major child killers. The longer breastfeeding is delayed, the higher the risk of death for children in their first month of life.

This year when the world celebrates breastfeeding week (1-7 August) emphasis has been made on breastfeeding and its importance to achieve Sustainable Development Goals (SGDs).

Here in Ethiopia, when the event was celebrated at the Ministry of Health the State Minister of Health, Dr Kebede Worku, said that breastfeeding has an ‘all rounded’ benefit that keeps children healthy, happy and more productive at later age. He also stressed that mothers need to be supported to breastfeed their children both at home and in the workplace.

World Breastfeeding Week 2016
UNICEF deputy representative to Ethiopia, Shalini Bahuguna, speaking at the World Breastfeeding Week ©UNICEF Ethiopia/2016/Bizuwerk

UNICEF Deputy Country Representative to Ethiopia, Shalini Bahuguna, on her part said “optimum breastfeeding to children under six months is an effective resilience measure.”  She also underscored UNICEF’s commitment to promote early and exclusive breastfeeding by engaging fathers, religious leaders as well as members of the community.

According to UNICEF, early breastfeeding rates in sub-Saharan Africa have increased by 19 per cent from 1995 to 2011. This is the highest rate when compared to other regions.  It is estimated that 41 per cent of children in sub-Sharan Africa are exclusively breastfed. When it comes to Ethiopia, the numbers are encouraging. Ethiopia is one of the leading countries with 52 per cent of children exclusively breastfed within the first six month. But still there is a long way to go as the country has high stunting rate.

Breastfeeding and sustainable development

Early and exclusive breastfeeding helps children to survive. That is a fact. Yet, breastfeeding is also linked with national development. Evidence shows that the benefits of breastfeeding extend into adulthood.  A well breastfed child has good sensory and cognitive development which is associated with better educational achievement. Healthy and better educated children will be more productive and positively impact socio-economic development.

Breastfeeding also contributes to poverty reduction. It is a natural and cost effective way of feeding which do not burden household budget as compared with formula feeding. Thus, supporting breastfeeding is the smartest investment nations can make to ensure the wellbeing of their citizens.

It is, therefore, critical to promote optimal breastfeeding and provide support to mothers who have social and commercial pressures that compromises their decision to breastfeed.

 

World Breastfeeding Week 2016

Laws to protect breastfeeding inadequate in most countries

HALABA WOREDA, SNNPR – 24 JANUARY 2016
Mundene, 21, breastfeeds her two-month-old baby Melesech at the Gedebe Health Post in Halaba Special Woreda (district) in SNNP Region. ©UNICEF Ethiopia/2016/Ayene

GENEVA/NEW YORK/ADDIS ABABA, 9 May 2016 – A new report by the World Health Organization (WHO), UNICEF, and the International Baby Food Action Network (IBFAN) reveals the status of national laws to protect and promote breastfeeding.

Of the 194 countries analysed in the report, 135 have in place some form of legal measure related to the International Code of Marketing of Breast-Milk Substitutes and subsequent, relevant resolutions adopted by the World Health Assembly (the Code). This is up from 103 in 2011, when the last WHO analysis was done. However, only 39 countries have laws that enact all provisions of the Code—a slight increase from 37 in 2011. 

WHO and UNICEF recommend that babies are fed nothing but breast milk for their first 6 months, after which they should continue breastfeeding—as well as eating other safe and nutritionally adequate foods—until 2 years of age or beyond. In that context, WHO Member States have committed to increase the rate of exclusive breastfeeding in the first 6 months of life to at least 50 per cent by 2025 as one of a set of global nutrition targets.

The Code calls on countries to protect breastfeeding by stopping the inappropriate marketing of breast-milk substitutes (including infant formula), feeding bottles and teats. It also aims to and ensure breast-milk substitutes are used safely when they are necessary. It bans all forms of promotion of substitutes—including advertising, gifts to health workers and distribution of free samples. In addition, labels cannot make nutritional and health claims or include images that idealize infant formula. They must include clear instructions on how to use the product and carry messages about the superiority of breastfeeding over formula and the risks of not breastfeeding. 

“It is encouraging to see more countries pass laws to protect and promote breastfeeding, but there are still far too many places where mothers are inundated with incorrect and biased information through advertising and unsubstantiated health claims.

This can distort parents’ perceptions and undermine their confidence in breastfeeding, with the result that far too many children miss out on its many benefits,” says Dr Francesco Branca, Director of WHO’s Department of Nutrition for Health and Development. The breast-milk substitute business is a big one, with annual sales amounting to almost US$45 billion worldwide. This is projected to rise by over 55 per cent to US$70 billion by 2019. 

“The breast-milk substitutes industry is strong and growing, and so the battle to increase the rate of exclusive breastfeeding around the world is an uphill one—but it is one that is worth the effort,” says UNICEF Chief of Nutrition Werner Schultink. “Mothers deserve a chance to get the correct information: that they have readily available the means to protect the health and wellbeing their children. Clever marketing should not be allowed to fudge the truth that there is no equal substitute for a mother’s own milk.” 

Topic: Breast Feeding
Click to see breastfeeding photos

Overall, richer countries lag behind poorer ones. The proportion of countries with comprehensive legislation in line with the Code is highest in the WHO South-East Asia Region (36 per cent – 4 out of 11 countries), followed by the WHO African Region (30% – 14 out of 47 countries) and the WHO Eastern Mediterranean Region (29 per cent – 6 out of 21 countries). The WHO Region of the Americas (23 per cent – 8 out of 35 countries); Western Pacific Region (15 per cent – 4 out of 27 countries); and European Region (6 per cent – 3 out of 53 countries) have lower proportions of countries with comprehensive legislation.

  •  Among the countries that have any laws on marketing of breast-milk substitutes, globally:
  • Just over half sufficiently prohibit advertising and promotion.
  • Fewer than half prohibit the provision to health facilities of free or low-cost supplies of breast-milk substitutes.
  • Just over half prohibit gifts to health workers or members of their families.
  • The scope of products to which legislation applies remains limited. Many countries’ laws cover infant formula and ‘follow-up formula’, but only one third explicitly cover products intended for children aged 1 year and up.
  • Fewer than half of countries ban nutrition and health claims on designated products.

 IBFAN, with its International Code Documentation Centre (ICDC) taking the lead, has closely cooperated with WHO and UNICEF to prepare this report. The results are in line with the findings reported in ICDC’s own State of the Code 2016.

“IBFAN hopes that the report will lead more countries to improve and enforce existing legislation so that breastfeeding will have a better chance and save more lives,” says Annelies Allain, Director of IBFAN’s ICDC. “Legislation needs to keep pace with new marketing strategies and this report will help policy makers to do so.”

The report, Marketing of breast-milk substitutes: International implementation of the International Code – Status report 2016, includes tables showing, country by country, which Code measures have and have not been enacted into law. It also includes case studies on countries that have strengthened their laws or monitoring systems for the Code in recent years. These include Armenia, Botswana, India and Viet Nam.

 Monitoring is essential to enforcement

Monitoring is essential to detect violations and report them to the appropriate authorities so they can intervene and stop such activities. Yet, only 32 countries report having a monitoring mechanism in place, and of those, few are fully functional. Among the countries with a formal monitoring mechanism, fewer than half publish the results, and just six countries have dedicated budgets or funding for monitoring and enforcement.

WHO and UNICEF have recently established a Global Network for Monitoring and Support for Implementation of the Code (NetCode) to help strengthen countries’ and civil society capacity to monitor and effectively enforce Code laws. Key NGOs, including IBFAN, Helen Keller International and Save the Children, academic centres and selected countries have joined this network. 

Why breastfeed?

Globally, nearly two out of three infants are not exclusively breastfed for the recommended 6 months—a rate that has not improved in two decades. Breast milk is the ideal food for infants. It is safe, clean and contains antibodies which help protect against many common childhood illnesses. Breastfed children perform better on intelligence tests, are less likely to be overweight or obese and less prone to diabetes later in life. Women who breastfeed also have a reduced risk of breast and ovarian cancers. Inappropriate marketing of breast-milk substitutes continues to undermine efforts to improve breastfeeding rates and duration worldwide.

New analyses have revealed that increasing breastfeeding to near-universal levels could save the lives of more than 820 000 children under the age of five and 20 000 women each year. It could also add an estimated US$300 billion into the global economy annually, based on improvements in cognitive ability if every infant was breastfed until at least 6 months of age and their expected increased earnings later in life. Boosting breastfeeding rates would significantly reduce costs to families and governments for treatment of childhood illnesses such as pneumonia, diarrhoea and asthma.

In Ethiopia

Tena Esubalew Health Extension Worker comes to Etenesh Belay's house for counselling on breast feeding practices
Tena Esubalew Health Extension Worker comes to Etenesh Belay’s house for counselling on breast feeding practices Amhara region of Ethiopia. ©UNICEF Ethiopia/2014/Tsegaye

Food, Medicine and Healthcare Administration and Control Authority (FMHACA) is mandated by the proclamation of 661/2009 for the regulation of food safety and quality in the country. The authority has thereby issued a directive for the control of the promotion of infant, follow up formula and complementary foods by making sure of the safety, quality, nutritional value and promotion of the products. The registration of infant and follow up formula is one of the major requirements before getting its market authorization which helps for close control and monitoring of the products. The authority has already started the enforcement and monitoring of implementation of these activities.

 Although most women in Ethiopia breastfeed (96 per cent) their children up to the age of one year, only 52 per cent of children under 6 months are exclusively breastfed.[1] The promotion of breast-milk substitutes with increasing urbanization and changes in societal norms, creates a threat to breastfeeding by confusing mothers and families about the best possible feeding choices for their infants and young children.[2]  Poor breastfeeding practices can contribute to failure to grow and to thrive in children, a wide-spread problem in Ethiopia, affecting 40 per cent of children who are stunted[1]. 

[1]Ethiopian Demographic and Health Survey (EDHS) 2011

[2] Howard C., Howard F., Lawrence R., Andresen E., DeBlieck E. & Weitzman M. (2000) Office prenatal formula advertising and its effect on breast-feeding patterns. Obstetrics & Gynecology 95, 296–303.

UNICEF Ethiopia inaugurates its breastfeeding room at the new office facility

By Wossen Mulatu

Inauguration of UNICEF Ethiopia’s breastfeeding room at its new office facility.
Staff children inaugurate UNICEF Ethiopia’s breastfeeding room ©UNICEF Ethiopia/2015/Sewunet

7 August 2015:- Globally, World Breastfeeding Week is celebrated from 1-7 August. This year, World Breastfeeding Week focuses on working mothers with the theme, “Breastfeeding and work- let’s make it work! The aim is to empower and support all working women to breastfeed, whether in the formal or informal sector so they can combine work with child-rearing, particularly breastfeeding.

“Giving children the best start in life begins with breastfeeding”, said Gillian Mellsop, UNICEF Representative to Ethiopia during the inauguration of UNICEF Ethiopia’s breastfeeding room at its new office facility. The aim is to allow breastfeeding mothers in the office to continue breastfeeding their new-borns after returning to work. “By allowing our female colleagues the time, space and the necessary support to breastfeed in the working environment, children will receive the best food, care and protection possible. It also reduces absenteeism and increase productivity. We want the same for all Ethiopian babies and young children”

Exclusive breastfeeding for the first six months of life yields tremendous health benefits including; providing critical nutrients, protection from deadly diseases such as pneumonia and fostering growth and development. Continued breastfeeding after six months, for up to two years of age or beyond, combined with safe and appropriate complementary feeding, is the optimal approach to child feeding.

Inauguration of UNICEF Ethiopia’s breastfeeding room at its new office facility.“Having a breastfeeding room in UNICEF is wonderful because it allows me to spend quality time with my baby without having to leave the office”, says Lina Jalouqa, Donor Relations Specialist in UNICEF Ethiopia. ”Besides, breastfeeding is one of my favourite things about being a mother since I can spend my special time with my little one. In addition to its incredible health benefits, breastfeeding gives me and my baby a chance to connect and share love and trust,” she added.

“I am honestly thrilled that I can be able to nurse my nine months old baby at work,” says Sarah Sahlu, who works in Nutrition section at UNICEF. “Since I live far from work, the drive back and forth takes longer time and that decreases the volume of milk that is produced for my baby.”

For working mothers, a baby’s right to breastfeed can be interrupted or hindered by a nursing mother’s limited chance to combine breastfeeding with work due to lack of adequate support. For example, nursing mothers often do not have the necessary maternity leave or do not have access to the time, space and support that would allow them to breastfeed or express (pump) milk once they have resumed work.

Working women in the formal and informal sectors around the world face challenges combining work with breastfeeding. Women with full- or part-time work, those that are self-employed or have only seasonal or contract work, even those with unpaid home and care work, all require an enabling environment in order to succeed.

Worldwide, only 38 per cent of children under six months are exclusively breastfed.[1] Babies who are not breastfed have a higher risk of illnesses and death than those that are. They also face long-term physical, educational and economic setbacks. 

In Ethiopia, while 99 per cent of children are breastfed, only 52 per cent of children are exclusively breastfed within the first six months (EDHS, 2011). Additionally, among children 6-23 months, only 5 per cent received four or more food groups, and 49 per cent were fed at least three times per day (EDHS,2011).

With increasing urbanization and industrialization, more women will participate in formal labour forces and hence need to ensure their right to breastfeed in their workplace.

 

[1] UNICEF global databases, 2015, based on MICS, DHS and other nationally representative surveys

A Day in the Life of a Well-fed Child: Ethiopia

By Frehiwot Yilma

AMHARA REGION, 05 June 2014 – Kossoye Ambaras is a small lush green village within Wogrea woreda in northern Gondar where it is relatively cold. Amarech Ashager, a 28 years old mother of two, is used to the weather as she lived her whole life here. At the top of her daily agenda is making sure that her family, especially her youngest son, Metages Birhanu of 9 months, is well fed.

Like many of the residents, Amerech does not rise out of bed before 7 a.m., as it is too cold to leave the house. She begins her day by breastfeeding Metages and cooking breakfast for the rest of the household. Her husband, Birhanu Tagel, is a businessman and her eldest son, Muluken, 10, is a third grader. After saying ‘good day’ to Birihanu and Muluken, Amarech will cook breakfast for Metages. Since he was introduced to solid food only three months ago, Metages eats exclusively porridge. Preparing highly nutritious porridge for a child is a technique that Amarech has recently learnt. The base of the porridge, the flour, contains various grains and legumes. For breakfast the added ingredient besides the flour is an egg and minced cabbage. As well as cooking the food, feeding the child to achieve best results is also a discipline. Amarech has learnt to feed her child while also playing and talking to him to keep him engaged.

It takes a village to raise a child

Health Extension workers in Amhara region provide preventive and curative health service to the community
Health Extension workers in Amhara region provide preventive and curative health service to the community ©UNICEF Ethiopia/2014

Amarech and other mothers in the village get support from Health Extension Workers (HEWs) on how to properly raise their children. Today, HEWs Habtam Dese and Yeshiwork Tesfahun are weighing the children in the village to monitor their health and development. They too receive assistance from Gebeyaw Alamerew, the woreda Nutrition and Child Health Officer. In a typical session with a HEW, a six-month-old child will receive a vitamin A supplement, while those aged above one year will additionally receive deworming tablets. With the support of UNICEF, this has become a routine service in the woreda.

Out of 18 children weighed by the HEWs , 16 are in the average weight range. Amarech is one of the happy mothers to learn that her son, Metages, weighs 8.6 kilograms, well in the range of a healthy baby’s weight. “I am so happy that he has gained a few more grams since last time,” she says, smiling. After weighing babies in the community, Habtam and Yeshiwork demonstrate how to make a child’s diet balanced and about the importance of using iodised salt. As the child-friendly food preparation simmers over a fire, the two mothers, whose children’s weight was under the average limit, get counselling on how to improve their baby’s weight. Gebeyaw believes the woreda has come a long way. “In previous years, there were up to eight children per month in Kossoye suffering from Severe Acute Malnutrition (SAM), but this year there have been no cases,” he says. “This is because we monitor the children’s growth and give counselling and other packages of support to the mothers at the earliest stage possible, as we did with the two mothers today.” When the food has finished cooking, Habtam and Yeshiwork let the mothers feed the warm nutritious preparation to their children.

Bridging the nutrition gap before sunset

Amarech Ashager breast feeds Metages Birhanu, 9 months old
Amarech Ashager breast feeds Metages Birhanu, 9 months old © UNICEF Ethiopia/2014

The afternoons in Kossye Ambaras are usually foggy this time of the season. Amarech has subsequently decided to do her laundry the following day and so turns to preparing dinner as well as other domestic chores. For Metages, she has a new menu in mind: adding mashed potatoes and carrots to the porridge. She says she will also never forget adding iodised salt to the food. “Habtam has told us that iodised salt is key to a child’s mental growth. She also told us that we have to put in the salt after the food is cooked and out of the oven so that the iodine does not evaporate with the heat,” she says.

Habtam is one of 38,000 government salaried HEWs currently providing nutritional and other support to mothers and children across all regions of Ethiopia. Development partners such as UNICEF are committed to support this initiative. “Nations will face critical bottlenecks to economic growth if a large proportion of their working-age people’s IQ and productivity are limited by under-nutrition,” says Dr Peter Salama, UNICEF representative in Ethiopia.

As the day draws to an end, Amarech’s house becomes lively as the family come together and discuss their experiences. While breastfeeding Metages, Amarech tells her husband about the importance of investing in their children’s diet to ensure their healthy future. “I will feed my children a variety of foods so that they will have a bright mind,” she says with confidence. “And I will be happy if Metages becomes a doctor.”

On the recent Micronutrient Global Conference (June 2-6, 2014), researchers, policy-makers, program implementers, and the private sector has been discussing ways of overcoming micronutrient malnutrition. The forum has been held under the theme of “Building Bridges”, thus emphasising scientific advances and multi-sectoral programming on adequate micronutrient intake. Read more

No mother should die while giving life

By Demissew Bizuwerk

Tena Esubalew Health Extension Worker comes to  Etenesh Belay's house for counselling on breast feeding practices
Tena Esubalew Health Extension Worker comes to Etenesh Belay’s house for counselling on breast feeding practices Amhara region of Ethiopia. ©UNICEF Ethiopia/2014/Tsegaye

ADDIS ABABA, 17 April 2014 close to 2 million mothers and new-borns in Ethiopia are to benefit from improved maternal health and new-born care services.  Enhancing Skilled Delivery in Ethiopia (ESDE), a joint initiative between the European Union, Federal Ministry of Health and UNICEF, aims to increase access to and utilisation of quality maternal and new-born health services. ESDE is a 1.1 billion birr (€40 million) project financed by the European Union for a three-year period, from 2014 to 2016. Of this grant, €20 million is allocated to the Millennium Development Goal (MDG) pool fund of the Federal Ministry of Health (FMoH) and the remaining half to UNICEF.

This maternal health initiative represents one of the largest grants to maternal health ever provided to Ethiopia. ESDE will be implemented jointly by the Federal Ministry of Health and UNICEF, with the support of other development partners and health professional societies working in the area of maternal and new-born health.

Left to right: Dr. Peter Salama, Dr. Kesetebirhan Admasu and Ambassador Chantal Hebberecht officially launches ESDE Project.
Launch of Enhancing Skilled Delivery in Ethiopia (ESDE) Project. 16 April 2014 Radisson Blu Hotel- Addis Ababa, Ethiopia ©UNICEF Ethiopia/2014/Ayene

ESDE comes at a time when Ethiopia is working hard to achieve the MDG target 5 of reducing maternal mortality, which is not yet on track. Currently, Maternal Mortality Ration (MMR) stands at 676 per 100,000 live births while Ethiopia hopes to bring down the level to 267 per 100,000 live births before the MDG deadline. ESDE project is expected to benefit 625,000 mothers and new-borns annually from improved access to maternal and new-born health services – a quarter of annual national deliveries.

Why maternal health matters in Ethiopia?

  • Only 29.5 per cent women delivered in Health Facilities[1].
  • MMR is 676 per 100,000 live births[2], while the expected MDG 5 target is to bring the level below 267 per 100,000 live births by 2015.
  • In Ethiopia, up to 15 per cent of mothers and new-borns suffer serious complications that warrant referral to facilities providing Comprehensive Emergency Obstetric and Neonatal Care (CEmONC) services including caesarean sections, blood transfusions and emergency laparotomy. However, the availability of CEmONC has been limited to only over a hundred hospitals having the capacity to provide the service in the country[3].
Dr. Kesetebirhan Admasu, Excellency Federal Minister of Health
Dr. Kesetebirhan Admasu, Excellency Federal Minister of Health, makes a welcome remarks at the launch of Enhancing Skilled Delivery in Ethiopia (ESDE) Project. 16 April 2014 Radisson Blu Hotel- Addis Ababa, Ethiopia ©UNICEF Ethiopia/2014/Ayene

What are the Government plans?

  • The government sets ambitious targets for 2015 MDG deadline including availability of Basic and Comprehensive Emergency Obstetric and Neonatal Care (BEmONC and CEmONC) at 100 per cent of hospitals and health centres in the country.
  • Increase skilled birth attendance rate to 62 per cent of total deliveries and universal access of mothers and neonates for antenatal and postnatal care[4].
  • The construction of over 800 new primary hospitals [one primary hospital per woreda (district)]. The construction of over 200 hospitals has already been initiated in the various regional states and is expected to be completed soon.
  • The hospitals need to be equipped with basic supplies and equipment to provide maternal and neonatal care including equipment for basic operation facilities and essential neonatal care equipment.

ESDE project will provide:

  • Obstetric and new-born care supplies and equipment for 500 health centres and 50 hospitals.
  • Operation theatre equipment for 30 primary hospitals.
  • Training for 5000 health extension workers in community based new-born sepsis management.
  • Obstetric and new-born care training for 250 doctors and health officers from 100 hospitals.
  • Emergency obstetric and new-born care training and supportive supervision for 1000 midwives and nurses.

 

[1] EFY2006 report of the Federal Ministry of Health

[2] Ethiopia DHS 2011

[3]National EmONC Assessment Report, FEDERAL MINISTRY OF HEALTH, 2008

[4]Health Sector Development Program IV, FEDERAL MINISTRY OF HEALTH (HSDP IV), 2010