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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