By Chioma Obinna
Sub-Saharan Africa is obviously undergoing social, economic and demographic changes. But that is not the news. The news is how these changes affect nursing mothers who combine economic and childcare roles, including consequences for family health and well-being. Mothers occupy a social position in society based on the relationship between them and their children. The relationship also involves childbearing and child-rearing. Meanwhile, investigation by Sunday Vanguard revealed that these challenges have serious implications for children as the harsh economic situation has forced many mothers to take up employment and thus replaced breastfeeding, a major source of nutrients for babies, with bottle-feeding (infant formula). Inadequate nutrition, according to experts, begins with poor universal breastfeeding practices.
A Global Baby Friendly report stressed this vividly when it showed that poor breastfeeding practices not only constitutes a drawback to the child, the mother, the family and the nation at large, it also contributes globally to 823,000 deaths, loss of $300 billion annually, and 20,000 breast cancer deaths annually. However, experts in breastfeeding and childcare say improving breastfeeding can help Nigeria reach its full human and economic potentials by preventing 10 million cases of childhood diarrhoea and pneumonia. Sunday Vanguard reports that with the poor breastfeeding rate of 17 per cent, investing in policies and programmes that support mothers to breastfeed saves lives and provides a high return on investment while continue failure of mothers to practice universal breastfeeding cost the Nigerian children their lives and cognitive as well as increased cancer deaths in women and loss of income on formula.
Many years ago, Nigerian women took pride in breastfeeding their children for as long as necessary. At that time, the nation’s Exclusive Breastfeeding Rates, EBF, were among the highest in the world. But this is no longer the practice. Today, with the breastfeeding rate of 17 per cent, the country ranks amongst the lowest in the world and a report of the United Nations Children’s Fund (UNICEF) showed that Nigeria is making slow progress in exclusive breastfeeding.
Nigerian nursing mothers no longer see breastfeeding as part of child rearing that would boost the growth of babies but as a matter of choice. The action has put more than five million newborns at risk of killer diseases which, according to the UNICEF report, deprive babies’ essential nutrients and antibodies that protect them from diseases and death. The case of Juliet Ezigbo vividly describes the current situation in Nigeria.
Dressed in a skimpy gown two days after she gave birth to her first child in a private hospital in Lagos, a first-time visitor to the hospital will never know she was a nursing mother.
“Ooooh”, she said, frowning at the baby after she was told that the child needed her attention. “Are you crying again?” Juliet shouted at the infant. Then she began to prepare formula (artificial feed) for the two-day-old baby.
Many people in the room were surprised at her action. Nevertheless, Juliet fed the baby with the artificial formula right in the presence of the staff of the hospital.
According to Juliet, there was no point delaying the introduction of artificial formula to the child as her work would not allow her to breastfeed the child subsequently.
The new mother believed that the nature of her work environment carried too many risks for her baby and the long working hours and lack of a crèche did not make things easy either.
“As I had to resume work I had to introduce food in preparation so he would get used to it”, she added.
Such a scenario is commonplace in Nigeria today and has continued to sabotage proper growth and development of infants.
Some Nigerian women also see breastfeeding as a burden while some consider it as old fashioned and some hide under the wrong notion that their breasts will sag. Mrs Mercy Adebayo, a mother of three, shares her experience with Sunday Vanguard.
“Out of ignorance, I assumed breastfeeding contributes to stress. I almost left my marriage because of my husband’s inability to provide money for formula every week”, she said
“My friends at that time were buying one of the most popular infant formulas (name withheld) and I wanted to belong despite the fact that my husband was no match financially with their husbands. But today I am well informed about well-breastfed children.”
Mercy told Sunday Vanguard that to feed their first child in one month, she and her husband were spending about N20, 000 on the formula.
“That almost dug holes in our pockets until our second child came and nurses at the General Hospital Isolo told us about the benefits of exclusive breastfeeding which I applied.
“Today, I can tell you that exclusive breastfeeding is not easy for career mothers but the benefits outweigh the troubles. Among my children, the one who had exclusive breastfeeding is different. He does not fall ill easily, he is stronger and more intelligent”.
The mother expressed guilt of having to overburden the family income and deprived her first child of the nutrients derived from breastfeeding.
The actions of Juliet, Mercy and many others confirmed the report of the United Nations Children’s Fund, UNICEF, in collaboration with Alive and Thrive on “The Economic Cost of Not Breastfeeding on Human Capital Development and Health Systems in Nigeria..”
According to the study, poor breastfeeding practice among Nigerian women is costing cognitive losses for children not breastfed up to six months, fuels mortality from diarrhoea and pneumonia, and death of mothers due to breast cancer since breastfeeding serves as protective measures for mothers.
Other costs on human and nation’s development include indirect cost on travel, caregivers’ time, uninsured health care cost borne by households for diarrhoea and pneumonia.
The report, which also noted that breastfeeding is one of the best buys in global health to save lives, improve the health and development of individuals, as well as promote economic development, revealed that for every $1 (¦ 315.25) invested in breastfeeding in low- and middle-income countries, it can generate as much as $35 (¦ 11,033.75) in economic returns.
The optimal breastfeeding practices, according to the report, will prevent 103,742 deaths of Nigerian children, prevent 10 million cases of childhood diarrhoea and pneumonia, and reduce the cost of to the health care system by $22 million (N6.93 billion) a year.
The UNICEF/Alive and Thrive report explained that investment in the health and wealth of Nigeria would save families US$38 million (N11 billion) in formula costs, prevent the loss of more than US$9 billion a year due to future cognitive losses and generate an additional US$21 billion for the economy by increasing cognitive capacity and preventing premature mortality in early years.
The UN report also found that optimal breastfeeding practices in Nigeria would guarantee additional income of N6.6 trillion for the economy and 4.1 per cent of Gross National Income over children productive years.
Since optimal breastfeeding improves human capital development and reduces families’ out-of-pocket expenditures to treat diarrhoea and pneumonia, the report called for investment in policies and programmes that support mothers to breastfeed to save lives and provide high return on investment.
It stressed the need to update and strengthen the International Code of Breast-milk Substitutes to bring regulations on the marketing of breast milk substitutes in line with global recommendations, including effective enforcement and monitoring mechanisms.
The organisations, in the report, recommended the need to allocate adequate funds for the effective implementation of the National Strategic Plan of Action on Nutrition at the national and state levels. They also recommended strengthening the capacity of health systems to provide support and counselling on infant and young child feeding practices, including the expansion of the Baby-Friendly Hospital Initiative.
In her presentation entitled, The Overview of the Nigerian Regulations on the Bms Code and Its Provisions, during a Sensitization Workshop on the International Code of Marketing of Breast-milk Substitutes/National Regulations organised by the National Agency for Food and Drug Administration and Control, NAFDAC, Mrs Ummulkhairi A. Bobboi, who stated that it took Nigeria five years from 1981, after the adoption of the International Code of Marketing of Breast milk Substitutes, to come up with her National Code in 1986, said company promotion reduces breastfeeding and increases the use of breast milk substitutes.
According to Bobboi, implementation of the International Code of Marketing of Breast milk Substitutes and National Regulations prohibits the unethical marketing practices that undermine breastfeeding.
She said without adequate Code implementation and enforcement, breastfeeding rates will remain low in the country, leaving infants and young children at risk of morbidity and mortality.