Just give them breast milk

In this first series of our special project, we look at the link between breastfeeding and nutrition in Tanzania

Rains pounded the lakeside city of Mwanza, so Soko Kuu (the central market) is a bit muddy. We push our way through the crowds into the busy market, and in the vegetable section, we catch a glimpse of Fauzia Musa, 26, who is breastfeeding her baby behind a pile of tomatoes that she is selling. She quickly finishes and straps her baby on her back to attend to her next customer.

I approach her and ask her if she has eaten anything to boost her milk production, and she shows me an empty plate and water bottle as a confirmation that she indeed has eaten a balanced meal.

She is aware of the importance of good nutrition and breastfeeding despite her demanding work.

“I come with my 8-month-old baby to my workplace to ensure he breastfeeds on demand. At the antenatal clinic the nurses told us the importance of breast milk in a child’s health,” she meekly says.

Her neighbour in the next stall, Miriam Hassan, 50, usually offers to sell for her whenever she is breastfeeding or eating.

She says she understands the importance of breastfeeding to a child’s wellbeing and nutrition on the mother’s milk production though at times, she does not eat on time when she has many customers.

A very important aspect of community support that breastfeeding mothers need.

“As an older woman, I have to ensure they have both eaten,” she proudly states. As I chat with the two women, women who are selling vegetables in the adjacent stalls join the conversation.

Each suggests what she thinks is the right diet for breastfeeding mother. Their suggeststion range from porridge to vegetables and meat soup.

For Mariam Seneda, 31, who works as an accountant in Mwanza, exclusive breastfeeding was not possible.

“The nutritionist told me that the food I ate is what made my milk supply dry and gave my baby a running stomach. So I stopped breastfeeding at four months, ” she says, adding that her house help could not prepare for her a balanced diet.

Why breast milk

Despite the clear benefits of breastfeeding, many Tanzanians still do not understand the link between good nutrition, food security and breastfeeding.

According to the Tanzania Demographic and Health Survey for 2015-2016, only 59.2 per cent of Tanzanian children are exclusively breast-fed. This means about 40 per cent of children are not breastfed despite the clear advantages of breastfeeding.

Jane Msagati, a nutritionist and programme coordinator at Partnership for Nutrition in Tanzania (Panita), asserts that breast milk should be the first food of every child that comes into this world.

“Every child should be exclusively breastfed for six months, and breastfeeding should continue until they are two years old. This is because breast milk is the complete food. It has essential nutrients that a child needs for the first six months of life,” Ms Msagati emphasises, adding that these are the recommendations of the World Health Organisation (WHO).

“By exclusive, that means no water, glucose or formula should be given,” she firmly states.

According to her, breastfeeding has positive effects not only on babies, but on their mothers as well.

For babies, Ms Msagati says, breast milk is not only the most nutritious food. It also boosts their immunity from infections, allergies, some chronic diseases and even childhood cancers, and it is also a good protection against obesity in later life.

“It also strengthens a close bond through eye-to-eye contact and physical closeness between the child and mother,” she explains.

Each Tanzanian community has developed over the years its own local, balanced diet for nursing mothers.

“For instance, in Moshi there is mtori, which is cooked soft bananas blended with meat into a thick soup. In Mwanza, there is fish soup, ugali and mchicha (amaranth leaves). And in Bukoba, there is garden eggs (ntula), fish and bananas,” she says, while pointing out that people should go back to the old ways of eating. “Let’s eat what is locally available in our settings.”

According to the Encyclopedia of Early Childhood Development, the benefits of breastfeeding for mothers include lower levels of stress and fewer negative moods.

It also lowers the risk of obesity because it makes it easy to resume pre-pregnancy weight, and reduces the chances of getting osteoporosis and breast and ovarian cancer.

The role of health facilities

Dr Richard Rumanyika, a senior gynaecologist and obstetrician at Bugando Hospital, a top referral in the Lake Zone Region, says the benefits of breastfeeding in improvements in a child’s emotional, cognitive and psychosocial development last long after the child stops breastfeeding.

That is why the medical facility watches breastfeeding trends and helps mothers achieve optimal feeding for their babies.

“We prepare mothers for breastfeeding during antenatal and post-natal care, and we also stress the importance of good nutrition,” Dr Manyika states, adding that spouses are usually encouraged to accompany their wives to the clinic to ensure breastfeeding mothers get enough food, assistance with chores and emotional support at home and in the community attitude.

The medic adds that Bugando Hospital will do more research and training on breastfeeding to influence many women to choose it as the best option for their children.

“Many people are not aware that breastfeeding guards the baby against gastrointestinal and respiratory infections, and studies have associated it with reduced incidence of the onset of chronic diseases, such as diabetes,” he states.

Dr Shafiq Mohammed, the Director of Msasani Peninsula Hospital in Dar es Salaam and a consultant gynaecologist, notes that mothers who breastfeed exclusively have higher levels of maternal attachment with their children, and thus experience lower levels of stress.

“Breastfeeding does not only play a part in emotional and social development but also aids in development of central nervous system and affect children’s motor development. For instance, breastfed babies show ability to crawl faster,” says Dr Shafiq who is also a lecturer at Muhimbili University of Allied Health and Sciences (Muhas).

At Msasani Peninsula Hospital, they begin teaching mothers how to prepare their nipples for breastfeeding in the 28th week of antenatal care.

What can be done

Ms Msagati stresses that mothers should have balanced diets, adequate rest, and support at family level.

“A balanced diet should include locally available food – for instance, beans for protein, mchicha (amaranth leaves) for vitamins, bananas for carbohydrates and plenty of fluids, especially water,” she suggests, adding that the food and nutritional policy of 1992 is currently being reviewed by the Ministry of Health to make it one health policy which includes health and nutritional pact.

She also calls for exclusive breastfeeding awareness campaigns and changes of attitudes and mindsets, as well as a supportive framework at every level from family, community, public policy, law, and the health-care system.

Dr Rumanyika suggests that marketing of formula milk and infant feeding substitutes should be prohibted.

He also calls for further research on the impact of breastfeeding on child’s development.

Dr Shafiq suggests that health-care facilities should educate mothers on good breastfeeding techniques through a combination of prenatal education with postnatal outreach.

If all these are achieved, breastfeeding will be universally acceptable practice and a part of life in Tanzania and beyond.

The next article of this series will address breastfeeding challenges for working mothers drawn from focus group discussions and interviews. This special project on breastfeeding was produced with support from the International Centre for Journalists (ICFJ).

The author is an Early Childhood Development Fellow with International Centre for Journalists