ugrc 145: food and nutrition in everyday life · food and nutrition in everyday life session 10 -...

College of Education

School of Continuing and Distance Education 2014/2015 – 2016/2017

UGRC 145:

FOOD AND NUTRITION IN

EVERYDAY LIFE

SESSION 10 - BREASTFEEDING

Lecturer: PROF. MATILDA STEINER-ASIEDU, SBS, CBAS; University of Ghana, Email: [email protected]

Session Overview

Learning Objectives:

At the end of this lecture you should be able to:

• At the end of this session you should be able to

1. Discuss the benefits of breastfeeding

2. Explain why breastfeeding is a national asset.

Slide 2 Prof M. Steiner-Asiedu

Session Overview cont’d

• How breast-milk is made • Breast milk is the best food for the human infant • Benefits of breast-feeding for the infant and for

the mother • Difference between Human milk and Cow’s • Breast feeding in the context of HIV • Breast feeding trends in Ghana and Ghana’s

policy on breast feeding • Efforts to protect, promote and support

breastfeeding

Prof M. Steiner-Asiedu Slide 3

Session Outline

The key topics to be covered in the session are as follows:

• Topic One: Breastfeeding

• Topic Two: Assignment/Discussion For Next Session


BREASTFEEDING Topic One


MOTHERS’ PRIDE

Introduction

• All mammals produce milk and are used in feeding their babies.

• Have you asked yourself why mammalian

females where give the breast? • If no, ask yourself now and think why

that of the female breast develops to produce milk.


How is Breast Milk Made?

• The preparation for breast feeding starts in pregnancy with the mother laying down fat tissues (4 kg) to be drawn upon to supplement the energy needs during breast feeding.

• There is also the enlargement of breast tissues in preparation for breast feeding when the baby arrives.


How is Breast Milk Made?

• It is important that the nutrition of the mother

–BEFORE

–DURING

–AFTER

• This is to ensure the breast development and milk production is done well without compromising on the mother’s body tissues.


GOOD NUTRITONALLY

Breast Milk Production


Breast milk: let-down reflex


Production of Breast Milk

• The key stimulus to breastfeeding is infant sucking.

• The more the infant sucks the more milk the mother produces.

• On the average a well nourished mother will produce between 750-800mls of milk (2.5 water sachet) a day.

• The key lactation hormones are PROLACTIN and OXYTOCIN


Breast Milk: Infant Feeding

• Breast feeding on demand

–This means feeding

•any time (day or night)

–When the baby wants it, it is given; at any place.


Why Breast Milk is the best

food for the human infant

• Most impost is breast milk composition .

• Breast milk contains COLOSTRUM:

–This is the early milk or first milk produced in the first 3-4 days when lactation starts after the child is born


Characteristics of COLOSTRUM:

– It is thicker, yellowish in colour –Nutrient dense (vitamins, minerals,

proteins), –Rich in protective factors (eg. antibodies,

immunoglobulins) Thus –Colostrum is considered the infant’s first

immunization as it offers baby protection before baby’s own immune system develops.


Why Breast Milk is the best

food for the human infant

• After colostrum comes Mature milk

–Mature milk has the following Characteristics:

• It is whiter and not as thick as colostrum

•Also rich in protective factors needed to protect the baby


Benefits of Human Breast

Milk • Human Breast Milk (HBM) is richer in the brain forming

fat DHA – Docosahexanoic acid, than Cow’s milk.

• DHA is a major component of brain tissue.

“ Children who consume mother’s milk in the early weeks of life have a significantly higher IQ at 7-8 years than those who received no maternal milk” (Clinical Nutrition page 277)

• HBM has the proper balance and quantity of nutrients to meet the needs of the human infant.



Milk • HBM is easily digested by infant’s immature

gut. • HBM is hygienic • Requires no preparation, readily available at

the right temperature • Does not cause allergies for the infant

(mother’s own proteins)



Milk

• Psychological benefits: BF promotes bonding relationship between mother and infant.

• Choosing to breast feed over formula feeding has a significant economic advantage for families and the nation. (HBM is produced at no cost, but hard earned foreign exchange must be used to import infant formula).



Milk • HBM is a complete meal for the human infant in the

first 6 months of life. • There is no need to give any other food or fluids

during this period. So Exclusive Breastfeeding: is the rule by WHO and Ghana Health Services

What is Exclusive Breastfeeding: • Exclusive Breastfeeding is feeding only breast milk.

No other liquids; water, juices, porridges or solids) is allowed.

• Breastfed babies have a lower risk of becoming obese in later life. Obesity is associated with adult Non-Communicable Diseases.


+

Benefits of breastfeeding

to the mother

• Breastfeeding (BF) has contraceptive effect as it delays ovulation; mother must do Exclusive Breastfeeding to have this effect.

• BF helps mother to return to her non-pregnancy weight (prevents overweight/obesity)

• BF mothers have reduced risk of postpartum depression.

• Women who have lactated (breastfed) for longer period have reduced risk of breast cancer and other cancers than women who do not breastfeed.


Are there situations when a

woman should not breast feed?

• Yes, there are situations such as: • Mother with highly infectious disease such as TB. TB in

an infant can easily kill the baby.

• Mother on hard drugs (Cocaine, Heroine) these can find their way into breast milk.

• Mother on some medication may be advised by doctor not to breast feed during the period they are on the medication.


Difference between Human

milk and Cow’s (per 100 ml)


Nutritional Value Human Breast Milk Cow’s milk

Energy (kcal)

70

61

Carbohydrate ( g)

7.0

5.4

Protein (g)

1.03

3.3

Calcium (mg)

30

119

Iron 0.05 0.02

Difference between Human

milk and Cow’s (per 100 ml)


Nutritional Value Human Breast milk Cow’s milk

Vitamin A (ug)

48

31

Vitamin C (mg)

5

1

Immunoglobulin (Protective factors) S-IGA (whey protein)

++++ __

Source: Latham, M.C. (1997). Human Nutrition in the Developing World

Breast Milk/Substitute (1)

• Breast Milk/Substitute is any other

milk other than human milk

• “Cow’s milk is best for baby cows and human

breast milk is best for human babies” (Paul Gyorgy- A famous Pediatrician).

• Infant food companies are trying hard to

“Humanize” formula to bring it closer to HBM. The question is: why feed a substitute when you

can feed the real thing to your baby?


Breast Milk/Substitute (2)

• In the rare situation when an infant is unable to receive HBM, then infant formula will be the next best alternative.

• Remember, infant formula is not the same as HBM. Formula does not have the anti-infective properties and living cells found in HBM.


Breast feeding in the

context of HIV (1)

• Fact: HIV-positive mother can pass on the HIV through her breast milk to her infant.

• There is now strong evidence that ARV given to the HIV-infected mother or the HIV-exposed baby can significantly reduce the risk of transmitting the HIV through HBM.

• ARV= Antiretroviral drugs



context of HIV (2) • WHO Guidelines: (WHO 2010)

– National Health Authorities should decide

whether they will counsel and support HIV-Positive mothers either to: • Breastfeed and receive ARV or

• Avoid all breastfeeding (this strategy will most

likely give infants the greater chance of HIV-free survival)



context of HIV (3) • Ghana’s policy:

– Recommends that HIV-positive mothers breastfeed until 12 months with the provision of ARV given to the mother from 14th week of pregnancy until one week after breast feeding stops.

– Where replacement feeding (feeding of breast

milk substitute) is recommended, need to ensure that it is Affordable, Feasible, Acceptable, Safe and Sustainable (AFASS).


Ghana’s Breast feeding

policy

• EBF for the first six months (no water, juices, or other fluids are given)

• 6-24 months: continue breastfeeding but also give safe and nutritionally adequate complementary foods.


Breast feeding trends in Ghana

(GDHS reports)

EBF EVER BREAST FED

• 1993 2% 97.1%

• 1998 21.8% 97.4%

• 2003 38.9% 97.0%

• 2008 49.4 % 97.5%

These data show that almost all Ghanaian children are breastfed, but we still have a long way to go with EBF.


Reasons given by mothers for not

doing Exclusive Breastfeeding

• Insufficient milk

• Lack of confidence

• Baby cries a lot and therefore needs more food

• Pressure from husbands and other family members

• Working-mother has to start work and cannot take child along

• ARE THESE GOOD ENOUGH REASONS?


Prof M. Steiner-Asiedu

EFFORTS TO PROTECT, PROMOTE

AND SUPPORT BREASTFEEDING (1)

Because of the extreme importance of breastfeeding to child survival, national and economic development, every effort is made at all levels to protect, promote and support breastfeeding.

1. 27th World Health Assembly

“…reaffirmed that breast milk is the most appropriate and successful nutritional solution for the harmonious development of the child”

Prof M. Steiner-Asiedu

2. International Code on the Marketing of

breast milk Substitutes

◦ This code tries to address/prevent the

aggressive promotion of breast milk

substitutes by manufacturers.

EFFORTS TO PROTECT, PROMOTE AND

SUPPORT BREASTFEEDING (2)

Efforts to protect, promote and

support breastfeeding (3)

–An important article in the code:

• “There shall be no advertizing or other forms of promotion to the general public of products within the scope of this article”. The code bans advertizing, promotion or free distribution of breast milk substitutes.

• Ghana has adopted this code (Legislative Instrument [LI] 1667)


Efforts to protect, promote and


3. NGOs working to protect, promote and support breastfeeding Eg. GINAN- Ghana Infant Nutrition Action Network. They support the yearly celebration of the “breastfeeding week” every August.

4. Baby Friendly Hospital Initiatives (BFHI):

– This was launched in 1992 by WHO/UNICEF.

– Objective: To help protect, promote and support breastfeeding by addressing problems in hospitals that influence mothers to give formula.


To be Baby Friendly Hospital, you

must meet ten steps

1. Have a written BF policy that is routinely communicated to all health care staff.

2. Train all health care staff in skills necessary to implement the policy.

3. Inform all pregnant women about the benefits and management of breastfeeding.

4. Help mothers initiate breastfeeding within a half-hour of birth.

5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.


To be Baby Friendly Hospital,

you must meet ten steps

6. Give newborn infants no food or drink other than breast milk, unless medically indicated.

7. Practice rooming-in, allow mothers and infants to remain together 24 hours a day.

8. Encourage breastfeeding on demand.

9. Give no artificial teats or pacifiers ( also called dummies or soothers) to breastfeeding infants.

10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.


Efforts to protect promote and


5. Breastfeeding and employment legislation

International Labour Law (ILO) : “ recognizes that women have a right to maternity leave and a right to breastfeed their infants”

ILO Maternity protection:

– 12 weeks of paid maternity leave

– Two 30-minutes breastfeeding breaks

– Prohibition of dismissals during maternity leave

• Ghana has adopted this.


Myths about breastfeeding

• Milk in one breast is different from the other breast Not true, both have the same composition.

• Breast milk in the breast can ferment or go bad.

Not true. Breast milk is perfectly safe in breast.

• Amount of breast milk produced depends on size of breast. Not true.


ASSIGNMENT/DISCUSSION FOR NEXT SESSION Topic Two


Take home

• Find out from your community culture some of the myths, beliefs and taboos regarding breastfeeding.

• In your view are those sound?


Next week

• We shall discuss Food Faddism

• Make sure you read handout 8A & 8B to have an idea before class.


ugrc 145: food and nutrition in everyday life · food and nutrition in everyday life session 10 -...

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