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TRANSCRIPT
Addressing Challenges to Immediate and Exclusive Breastfeeding
in the First Months of Life- Findings From Egypt
Presenter: Justine A. Kavle, PhD, MPH
Sohair Mehanna, Gulsen Saleh, Mervat A. Fouad, Magda Ramzy, Doaa Hamed, Mohamed Hassan, Ghada Khan, Rae Galloway
Outline
• Global progress on exclusive breastfeeding, within the context of SDGs and the World Health Assembly goals
• Key barrier to exclusive breastfeeding – insufficient breastmilk • Findings from Egypt • Top 3 strategies to improve exclusive breastfeeding
• Malnutrition takes many forms: children and adults who are skin and bone, children who do not grow properly, people who suffer from imbalanced diets and those that are overweight and obese.
• Malnutrition takes many forms: children and adults who are skin and bone, children who do not grow properly, people who suffer from imbalanced diets and those that are overweight and obese.
• Tackling barriers to exclusive breastfeeding is one key in meeting SDG targets
• Tackling barriers to exclusive breastfeeding is one key in meeting SDG targets
• Malnutrition affects all countries and 1 of 3 people on the planet.
Sustainable Development Goal (SDG) Target: Ending All Forms of Malnutrition by 2030
Global Nutrition Report, 2015
Little Progress in Exclusive Breastfeeding Rates Since 1990
UNICEF, 2013
32 40
0
10
20
30
40
50
60
70
80
90
100
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Percent Exclusively Breas2eeding Innocen7 Declara7on
Baby-‐Friendly Hospital Ini7a7ve
World Breas2eeding Week
UN Millennium Development Goals ILO Maternity Protec7on Conven7on
Global Strategy for Infant & Young Child Feeding
Expanded Innocen7 Declara7on
Lancet Undernutri7on Series
World Health Assembly Resolu7on Launch of SUN & 1,000 Days Ini7a7ve
G8 Commitment to Reduce Undernutri7on
UNICEF, 2013
Tracking Countries’ Progress on Exclusive Breastfeeding Global Nutrition Report, 2015
6
30
10
32
115
0 20 40 60 80
100 120
Off course, reversal
Off course, no progress
Off course, some progress
On course Missing data
Num
ber
of C
ount
ries
Country Breastfeeding Status
Egypt
World Health Assembly Global Target by 2025: Increase the rate of exclusive breastfeeding to 50%
Global Nutrition Report, 2015
Perceptions of Insufficient Breastmilk is a Major Barrier to Exclusive Breastfeeding
Perceived insufficient breastmilk
Baby thirsty
Baby hungry
Lack of knowledge of breastmilk
nutrients
Lack of knowledge of lactation physiology
Interpretation of baby’s behavior: fussy,
continuous crying
Perceived health problems of baby – stomach ache, colic
Coping with health and
nutritional needs of baby
Feeding too early: food, liquid, herbal
teas
Balogun, 2015, Kavle, 2014, 2015, Matsujama, 2013, Fjeld, 2008
Egypt Study: Objective and Methods
Primary Objective: Understand cultural beliefs, perceptions, behaviors in relation to infant and young feeding practices and stunting in Lower Egypt and Upper Egypt
Methods: • 120 in-depth interviews - mothers of children 0-23 months of age, using Trials
of Improved Practices (TIPs) methodology • Conducted in Arabic, audio-recorded, transcribed, translated into English • Dominant themes identified and a coding scheme developed • Qualitative analyses carried out using NVIVO 10.0
Kavle, 2014 & 2015
Mothers are committed
to breastfeeding and understand its benefits. Yet, only 25% of Egyptian mothers were exclusively breastfeeding in the first 6 months of life.
“I had a natural delivery at a private doctor’s clinic. The first breastfeeding session was 2-3 hours after birth. When I went home my mother gave my baby herbal drink using a syringe as prescribed by my doctor. I gave her herbal drink for about two days, once in the morning and once at night until my milk came in and the baby was able to latch on.” - Mother, Lower Egypt
Breastfeeding is Valued, Yet Prelacteal Feeding is Common
Kavle, 2014 & 2015
Herbal Drinks and Teas Delay Initiation of Breastfeeding. Continued use makes Exclusive Breastfeeding
Difficult in the First 6 Months • Prescribed herbal drinks in first days of life
• Believed to stop child from crying -mother initiates breastfeeding or until milk “comes in”
• Separation from infants after birth is common • Continued use of herbal drinks to “help babies sleep at night”, sooth “cries of hunger”
• Breastmilk is “not enough” - supported by grandmothers
Examples of baby herbal drink
Kavle, 2014 & 2015
“I knew he was ready to eat when he kept crying at four months. I told the mother - your breastfeeding is not nourishing him, and the child is a human like us who needs to eat - what will your milk do for him?”
- Grandmother, Lower Egypt
Breastfeeding is Valued as a Natural Choice Only if Mothers Have Enough, Good Quality Breastmilk –
“Thick and Heavy, Not Weak and Light, or Little”
• Infants “not nourished enough” by breastmilk alone and are “still hungry” – main reason for introducing food and liquids early o Some combine breastfeeding with infant formula
o Feed “light and simple” foods as early as 2 months
o Initial screening of foods to assess readiness to eat
o Encouraged by some doctors and grandmothers
Kavle, 2014 & 2015
• Engage lactation consultant associations to work with health providers to ensure initiation, duration and exclusivity of breastfeeding for the first 6 months of life
• Engage lactation consultant associations to work with health providers to ensure initiation, duration and exclusivity of breastfeeding for the first 6 months of life
• Use community support groups to strengthen knowledge at the community level, involve grandmothers and fathers
• Provide guidance to health providers and community health workers o Stop prelacteal feeding o Dispel misperceptions of insufficient breastmilk o Not prescribe herbal drinks for children < 6 months of age o Not separate mother and newborn after childbirth – delays initiation
• Provide guidance to health providers and community health workers o Stop prelacteal feeding o Dispel misperceptions of insufficient breastmilk o Not prescribe herbal drinks for children < 6 months of age o Not separate mother and newborn after childbirth – delays initiation
Strategies to Improve Immediate and Exclusive Breastfeeding - Learnings from Egypt
• Use community support groups to strengthen knowledge at the community level, involve grandmothers and fathers
Kavle, 2014 & 2015
For more information, please visit www.mcsprogram.org
This presentation was made possible by the generous support of the American people through the United States Agency for International Development (USAID), under the terms of the Cooperative Agreement AID-OAA-A-14-00028. The contents are the responsibility of the authors and do not
necessarily reflect the views of USAID or the United States Government.
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