| Community Nutrition Action for Child Survival |
|Part I - Community nutrition problems and interventions|
|Unit 3: PROMOTING BREASTFEEDING|
In this session, trainees discuss the experience of a unique Kenyan organization, Breastfeeding Information Group (BIG), started in 1978 by Breastfeeding mothers to promote Breastfeeding in their country. Educational materials produced by BIG for use with health workers, mothers and fathers are provided for review and comment.
Time: 1 hour
- One copy of the case study "Breastfeeding Information for Kenyans" for each trainee
- Multiple copies of educational materials developed by BIG and other organizations to promote successful Breastfeeding
- Flipchart and marking pens
1. Distribute the case study "Breastfeeding
Information for Kenyans" to each trainee. Ask them to read the case study individually.
2. Divide trainees into small work groups of 5-7 persons each. (It is best to form homogeneous groups of people from, the same regions, organizations, countries, etc. Groups will be discussing whether a project like the one in the case study could be organized in their own areas.) Ask each work group to discuss and answer the questions at the end of the case study.
3. Conduct a discussion based on the groups' answers to the case study questions.
4. Display or distribute copies of educational materials developed by the Kenyan Breastfeeding Information Group and other organizations. Encourage trainees to examine and/or copy materials that could be adapted for use in their areas.
5. Summary: Ask trainees to summarize the most important information presented in this session and/or unit. (You may also want them to state their impressions of the content and the methodologies used.)
MOTHERS AND CHILDREN
Volume 3, Number I
ISSN 0272-69 17
Breastfeeding Information for Kenyans by the Breastfeeding Information Group, Nairobi.
A widely circulated myth in Kenya holds that ''African women all breastfeed." While it is true that almost all Kenyan mothers start breastfeeding (97% in 1977) old traditions of exclusive breastfeeding for the first months give way to social pressures and the ready availability of commercial products, Early supplementation has become the custom among many families.
A mother attending a clinic with her three-month old may say, ' Oh, yes, I am breastfeeding," while a bottle of formula mixed hours before peeps from her basket. There is no intention to deceive. only the fact that for many mothers today, "breastfeeding" automatically is taken to mean breast-plus-bottle. The bottle may be filled with water a fruit-flavored drink or vitamin preparation, a glucose drink, or some kind of milk feed.
Few parents understand how this recent custom interferes with lactation. Often the health workers themselves do not realize this. In many cases the top-up bottle of glucose water for formula is started soon after delivery. In a nationwide study, researchers from the Breastfeeding Information Group and Ministry of Health found that 97% of the maternity unit nurses and midwives surveyed felt that babies should have pre-lacteal supplements of glucose water or formula, and 95% actually give them. (Veldhuis, Nyamwaya, et al, 1982). This routine once established is continued at home.
"Unfortunately I was never advised about breastfeeding before my baby was born. However, after I hod the baby these was advice from of sides to breastfeed. I hove tried my best in this effort but the baby is not satisfied. She is 15 days old and keeps crying when she is hungry until I feed her the formula milk. Please advise. "Mrs. P.K. (Kisumu)
With this pattern widespread, it is not surprising that mothers who are sincerely trying to do their best for their babies experience two very common problems: "I don't have enough milk to satisfy my baby," and "the baby refuses my breast and prefers bottles.''
The Breastfeeding Information Group (BIG) was started quite informally by a group of seven women to provide help with these kinds of breastfeeding problems. At first we discussed what we knew about breastfeeding. problems we had observed end experienced, and what activities might be useful in Kenya. By late 1978, we had decided to register officially as a voluntary society with a constitution and officers, and to offer advice directly to mothers and also through posters and leaflets on breastfeeding topics.
Parents have responded enthusiastically to talks we have given at clinics, meetings of women's troupe, and also to our printed materials. Our attempts to hold special breastfeeding mothers discussion meetings outside the clink atmosphere have not, on the other hand, drawn more than a handful of participants. In Kenya, breastfeeding help on a mother-to-mother basis seems best given through existing social communities.
We use every medium we can to reach people. The letters quoted in this article were selected from 42 responses to a 'Letter to the editor' which appeared in the Kenya Daily Notion in September 1982. Such publicity reaches a far wide; pubic than the clinics do and draws a varied response.
We answer all inquiries individually. We have responded to frequent questions by developing leaflets. For example, Kenyan men have frequently asked what they can do so we wrote a leaflet called, "Please help your wife to breastfeed." This leaflet is now being translated into Swahili. It joins a number of other leaflets for parents, and a booklet for health worker. Funds for publishing and for the free distribution of our materials were provided by UNICEF and OXFAM.
Answering letters, working on publications and giving talks are frequently done by volunteer temporarily resident in Kenya who can donate substantial time to the breastfeeding Information Group. Increasingly, Kenyans are taking active roles, even though most of them have full time jobs and families to look after. Among our approximately 40 active members in Nairobi, many donate between five and fifteen hours per week to our work. Although we always use breastfeeding mothers to work directly with other mothers, we also value active members who are men, single women, and mothers who could not breastfeed due to lack of information. Throughout the country. we have between 200-250 paying members, including many health workers and teachers. For their yearly membership fee, (about U.S. $1.50) they receive our bi-monthly newsletter. The majority of our officers and members are Africans, but Kenya's Asians and whites also participate.
Through reading and discussion classes, we provide training to our volunteers, end we also maintain a library they can use. Thanks to a grant from OXFAM we can now pay two Kenyan counselor to work with Swahili-speaking mother. Our policy has always been to give help where we are asked, and this means that we work with every sector of Kenyan society from the busy attorney in her Peugeot, to the illiterate mother struggling to support her children alone; from the well-to-do homes of business people to the disadvantaged urban squatters. In the next few years, we expect to strengthen and expand our outreach into the rural areas through existing women's groups, and the rural health service networks.
On a typical day, one of our members might give a talk to patients waiting for treatment at the Mathare Valley Baptist Clinic, in one of Nairobi's poorest areas, and then go on to nearby Pumwani Maternity Hospital where about 100 women crowd the antenatal clinic. In this city-run hospital, the management of breastfeeding is good, but nurses are usually too rushed to discuss mother' questions in detail. So the counselor explains the superiority of breastfeeding, how to have plenty of milk, when to add other foods, and the like. She hands out simple leaflets in Swahili for women whose reading skills may be newly acquired.
Today at the Kawangware-Kabiro Clinic, there is a weaning food demonstration using common local foods to make a nutritious low cost porridge. The clinic is located in a peri-urban, low-income area and is headed by one of our members. The mothers at the clinic have been actively discouraged from the use of supplementary bottles. If a mother comes to the clinic with a feeding bottle, she usually agrees with the nursing sister to exchange it for a cup, and instructions on how to feed with cup and spoon.
In another part of the city, in a private hospital with poor breastfeeding practices (timetable feeds, no rooming in, top-up bottles, and a formula gift pack for every new mother), an expatriate counselor sits with a group of 15 to 20 mothers who have recently delivered. She emphasizes how the home pattern of breastfeeding should differ from the hospital routine. Developing a good milk supply, promoting the let-down reflex, and preventing breast refusal dominate the discussion, and the points made are reinforced with this very literate group by a set of homemade teaching posters. In this hospital, with its well-educated private patients, most will be returning to jobs soon.
"I am expecting my first baby this year and I am a working mother. I will be allowed two months maternity leave. What advice would you give to a working mother who would love to breastfeed but is unable to do so since she is away most of the day?" Mrs. A.D. (Nakuru)
"I am a young mother of one child aged four months. I really find it difficult to cope up with breastfeeding since I work in an office far away from home. I would be very grateful if you could send me your leaflets on increasing one's breast milk, and managing a job and breastfeeding." Mrs. G.I. (Nairobi)
For most urban women in Kenya, workplace child care is not available and returning home during the workday to breastfeed is not possible. We encourage working women to continue breastfeeding at whatever level they can manage, leaving some suitable alternative feed to be given by teaspoon or cup. We also stress the value of extra breastfeeding over weekends and holidays, and the importance of close contact and demand feeds during evenings and nights.
In addition to advising mothers, we also distribute materials throughout the country. Our literature reaches a much wider audience, and we consider it essential to our efforts. Our literature reaches all sorts of people - nurses and mothers of course, but also school girls, church groups - anyone who asks may have it. In the future we plan to do more training of health workers. Our study with the Ministry of Health indicated many areas where nurses do not know enough about breastfeeding management. For example, if a one or two months old child shows insufficient weight gain, more than 3/4 of our wealth workers would at present recommend use of formula, rather than first trying to increase the child's intake of breast milk. In cooperation with the Ministry of Health, we are starting to provide speakers for in-service training workshops, and occasionally organizing our own.
Of course public policies also affect breastfeeding. We are working with health professional organizations and women's organizations to try to establish in Kenya a national Code of Marketing based upon the WHO/UNICEF international model. This effort takes a tremendous commitment of time, but in the long run will be a powerful protection for ** mothers, and babies. Our International Cooperation Committee is coordinating similar breastfeeding support efforts in other African countries, through the IBFAN (International Baby Food Action Network) - Africa Network.
How do we get it all done? We often wonder. We have been fortunate in having many excellent officers, elected annually. Several are nurses, midwives, doctors and nutritionists. We take care to avoid a situation where the Breastfeeding Information Group might come to be seen as a personal power base for individuals, and we emphasize cooperative effort. Through our numerous committees (including publications, counseling, research, newsletter, fund raising) we give a responsible job to any member who wishes one. Each of us get a great deal out of working together, on this matter so close to our hearts which also builds the nation. Throughout all our work runs a common aim: to give parents the information and encouragement they so urgently ask for.
For copies of Breastfeeding Information Group (B.I.G.) publications including an article on starting a group, write the Clearing house on Infant Feeding and Maternal Nutrition, 1015 15th Street N.W., Washington, D.C. 20005, U.S.A. The Clearinghouse would also be interested in information about other groups involved in similar kinds of breastfeeding support activities.
The Breastfeeding Information Group cannot engage in extensive overseas correspondence, but welcomes letters from people in Africa who would like to be on the IBFAN - Africa mailing list. Breastfeeding Information Group materials are not copyrighted and may be reprinted or adapted to conditions elsewhere. If the text is modifies however, please contact the Breastfeeding Information Group , P.O. Box 59436, Nairobi, Kenya.
Note to readers:
In November 1982, an international meeting of community-based breastfeeding support groups was held in Jamaica. Representatives from organizations in more than 20 countries attended (including the Breastfeeding Information Group ). For more information about the conference recommendations, write: Ron Israel, INCS, Education Development Center, 55 Chapel Street, Newton, Massachusetts 02160, U.S.A.
Case Study-: Breastfeeding Information For Kenyans
1. What is the goal of the Breastfeeding Information Group?
2. What activities does the group carry out to reach that goal?
3. Who started the Breastfeeding Information Group? Who carries out the work of the group now?
4. How does the group raise funds for its activities?
5. What aspects of the Breastfeeding Information Groups' program would be beneficial and feasible in your area?
How to have plenty of milk
- Start breastfeeding as soon as possible after birth. Most babies can suck well right after being born. The baby needs your colostrum in order to be healthy.
- Breastfeed the baby whenever he is hungry. This may be ten or more times each day. The more the baby sucks, the more milk supply you will produce,
- Night feedings help to develop a good milk supply. Keep the baby close to you at night.
- Give both breasts at each feeding. Let the baby suck as long as he wants.
- Do not give glucose water or other milk from a bottle between breast feeds. 11 you think that you do not have enough milk. give extra breast feeds to increase your milk production. Do not give other foods instead of the breast.
- Do not stop breastfeeding. Breastfeeding is still good even when your child is two years old, or older. Most babies will give up breastfeeding (wean) slowly, some time between the ages of one and three years. This is natural weaning. You do not need to hurry it.
- When the child is four to six months old, breast milk alone is no longer enough. Start giving other foods in addition to (not instead of) breast milk.
Take care of yourself
- Be sure you drink plenty of liquids every day.
- Eat energy, protective, and body-building (protein) foods. All help you make milk.
energy foods: porridge, ugali, sweet potatoes, arrowroot, bread, rice
protein foods: beans, peas, cow or goal milk, eggs, meal, fish
protective foods: fruits and vegetables such as papaya, mango, carrots, spinach
- Rest whenever you can. Sometimes breastfeed lying down.
- Use family planning to space your children. If possible, use any method except pills. The pills can reduce your milk supply.
Do not worry
- Do not worry about days when the baby cries more than usual. Comfort him by letting him suck.
- Do not worry about small or soft breast,. After the first days or weeks. your breasts will probably not leak milk. They may not be hard or large. But you still have plenty of milk. It does not simply go away. It will flow when your baby sucks.
If you have any more questions about breastfeeding, please write to:
Breast feeding Information Group PO BOX 59436, NAIROBI
WHY BREASTFEED ?
BECAUSE BREASTMILK IS BETTER THAN ANY OTHER MILK FOR YOUR BABY
- Breast milk Is the best food for your baby. He does not need any other food for the first four months of his life.
- Breast milk is always clean, always ready, and always warm enough. Night feedings are easy.
- A baby digests breast milk easily. This means he has fewer stomach problems.
- Babies who get only breast milk do not get constipation.
- Breastfed babies get more protection against diarrhoea, colds, flu and skin problems. For two to three days after you give birth, a special milk (colostrum) comes from your breasts. This colostrum gives your baby special protection.
- Sucking at the breast helps your baby's tooth and jaw development
- Breastfeeding saves you money because you do not need to buy costly artificial milk foods.
- Breastfeeding develops close and loving feelings between baby and mother.
Breast feeding Information Group PO Box 59436, NAIROBI
Please help your wife to breastfeed
DO YOU KNOW THAT YOUR WIFE NEEDS MORE TO EAT during pregnancy and during breastfeeding (for at least two years)?
- Be sure you bring home protein foods e.g. beans, ndengu, groundnuts, meat, fish, eggs, milk. Be sure your wife eats plenty of these.
- Also she needs some extra protective foods (fresh fruits and vegetables) and energy foods. Encourage her to have bread. bananas. cassava. potatoes or groundnuts with her morning tea.
DO YOU KNOW SHE ALSO MUST HAVE PLENTY TO DRINK?
- Make sure she has something to drink each time the baby suckles: tea, uji, water, squash, or any other drink.
Enough food for the mother means enough breast milk for the baby. And buying some extra food for the mother is cheaper than buying tinned milk for baby!
Do YOU KNOW THAT YOUR WIFE NEEDS YOUR APPROVAL FOR BREASTFEEDING? If she thinks that you don't care, she may give up.
Tell her, and tell your relatives and friends, that you are proud your baby is being breast fed. Remind them why breast milk is the best baby milk:
- It is free from germs and it protects baby against illnesses. Baby will be healthiest on breast milk. (Not so much diarrhoea or colds).
- It has the comet temperature and is always ready.
- It is easily digested by the baby. (Not so many stomach problems and allergies)
- It is inexpensive. ( No extra expenses for bottles, tinned milk, fuel, etc.)
- Baby is happier close to mother, nights are quieter, and parents sleep better
DO YOU KNOW THAT YOUR WIFE NEEDS REST? An exhausted woman has trouble producing enough milk.
- See what you can do to lessen your wife's burdens so that she may sometimes rest.
DO YOU KNOW THAT GOOD ADVICE CAN SOLVE BREASTFEEDING PROBLEMS? For. example. the milk supply can be increased at any time if you only know what to do. If your wife's milk 'is "going away," encourage her to put the baby to the breast as often as the baby demands. More sucking makes more milk. For the safety of your baby, don't allow the use of feeding bottles unless the clinic or doctor has prescribed them for a special reason.
DO YOU KNOW THAT WHEN YOUR WIFE IS RELAXED AND HAPPY, MILK FLOWS WELL?
- Keep your wife as happy as you can. Avoid quarrels.
- Listen it she talks about her worries and try to help her solve any problems.
- Be sure you are at home enough to give her real help with the other children.
DO YOU KNOW THAT GRADUAL WEANING IS IMPORTANT TO YOUR CHILD’S HEALTH?
- Encourage your wife to continue breastfeeding until the baby is two years old. (It she goes out to a job, she can still breastfeed when she is at home.)
- Other foods should be added to the baby's diet starting when he is about four months old.
- Agree with your wife on a family planning method so that another pregnancy will not come sooner than you want Baby should be eating many other foods and drinking from a cup before the next pregnancy is begun
With your help and encouragement your wife can breastfeed happily.
For more information or advice, please write to us. Breastfeeding Information Group, P. O. Box 59436. Nairobi
"Breastfeeding Information for Kenyans." Mothers and Children, Vol. 3, No. 1, January 1983.
Cameron M. and Hofvander, Y. Manual on Feeding Infants and Young Children. Oxford University Press, 1983.
Ebrahim, G.J. Breastfeeding the Biological Option. MacMillan Press Ltd., Hong Kong, 1978.
Helsing, E. and Savage King F. Breast-feeding in Practice - A Manual for Health Workers. Oxford University Press, New York, 1982.
World Health Organization. Women and Breastfeeding 1982.
World Health Organization. Report of a Joint WHO/UNICEF Consultation Concerning "Infants WHO Have to be Fed on Breast-milk Substitutes." 1986.
World Health Organization. Factors Influencing Breastfeeding in Relation to Infant and Maternal Health. 1986.