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

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20120

10

20

30

40

50

60

70

80

90

100

32

40

Percent Exclusively BreastfeedingInnocenti Declaration

Baby-Friendly Hos-pital Initiative

World Breastfeeding Week

UN Millennium Development GoalsILO Maternity Protection Conven-tion

Global Strategy for In-fant & Young Child Feeding

Expanded Innocenti Declaration

Lancet Under-nutrition Series

World Health As-sembly ResolutionLaunch of SUN & 1,000 Days Initiative

G8 Commitment to Reduce Undernutrition

UNICEF, 2013

Tracking Countries’ Progress on Exclusive Breastfeeding

Global Nutrition Report, 2015

Off course, reversal

Off course, no progress

Off course, some

progress

On course Missing data

020406080

100120

6

3010

32

115

Country Breastfeeding Status

Num

ber

of

Countr

ies

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 hungr

y

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 committedto 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 earlyo 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 grandmothersKavle, 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 feedingo Dispel misperceptions of insufficient breastmilk o Not prescribe herbal drinks for children < 6 months of ageo Not separate mother and newborn after childbirth – delays

initiation

• Provide guidance to health providers and community health workers o Stop prelacteal feedingo Dispel misperceptions of insufficient breastmilk o Not prescribe herbal drinks for children < 6 months of ageo 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 visitwww.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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