Breastfeeding: how we can break through barriers

My fixer and I arrived to meet our focus group whose members are already seated in blue plastic chairs in front of a local shebeen in front of dilapidated houses. This is Mukuyuni Ward in Nyamagana District of Mwanza City.

As we started our discussion on breastfeeding, some of the participants gave their accounts of why they weaned their babies too soon.

“I thought the breast milk was not enough, and I also had to go out to look for food for my other remaining children,” one participant said.

Globally, only 4 out of 10 women are able to begin breastfeeding within an hour of birth and practice exclusive breastfeeding up to six months.

And in Tanzania, Unicef reported in May that 700,000 children are not breastfed every year, as women fear their breasts will sag. It went further to point out that in 2014, 85,000 child deaths were linked to lack of breastfeeding-related complications. Inadequate breastfeeding undermines health and development of newborn, infant and young children, according to the World Breastfeeding Trends initiative.

Breastfeeding provides major benefits not only to babies, but to women’s health, and these various favourable effects eventually increase national productivity and economic growth.

In the focus groups in Mwanza and Dar es Salaam, women cited several reasons why they are not able to breastfeed as much as they should. Obstacles include short maternity leaves, the need to work in jobs, disapproval of breastfeeding in public places, fear of sagging breasts, lack of food, poor knowledge, various myths, health challenges, and poor socio-professional support.

Disapproval women get while breastfeeding in public

Tabasum Manji Ladha, mother to a 10-month old baby, is the head of Department at Regency Medical Centre in Dar es Salaam. Since she is an expert in nursing, midwifery, critical care and trauma, she answered as an expert on such issues raised during the interview.

“As a health professional, I would like to educate mothers who are very new to exclusive breastfeeding and are confused on how to go about it. I can testify that I had a tough time breastfeeding my child in public places,” she said. “Some people used to give weird stares that made me uncomfortable.”

“But with my husband and his family’s support, I managed it well. They encouraged me to keep going. They used to tell me, maybe you will inspire someone else to breastfeed in public,” she proudly stated adding that this was relatively easy for Muslim women like her since they cover their heads.

Short maternity leave and work

The participants in Dar es Salaam focus group discussion pointed out that the legal requirement for maternity leave – 84 days – is not enough for a woman to achieve optimal breastfeeding and have enough rest before resuming work.

Dr Miriam Noorani a paediatrician at Agakhan University Hospital, says milk production declines if a mother does not breastfeed enough. She encourages mothers to express milk even at work to stimulate milk production. She encourages women who do not have place for storage to carry cooler bags to work if possible.

Leah Linti, Deputy Medical Officer at Sekou Toure Provincial Referral Hospital, called on employers and the community to support breastfeeding mothers. Other participants said some employers do not abide by labour law, which permits women to take a total of two hours for breastfeeding breaks daily; they called on Health Minister Ummy Mwalimu and her Labour counterpart, Jenista Mhagama, to discuss this issue and come up with a more favourable policy for nursing mothers. They also called on the Minister of Health Ummy Mwalimu to lobby parliament to extend maternity leave.

Lack of breastfeeding rooms

Dr Richard Rumanyika, the chief gynaecologist at Bugando Hospital, a top referral health facility in the Lake Zone, called on the government to be more strict since mothers have difficulty breastfeeding because unfavourable conditions are unfavorable for pumping milk at work. This can cause their milk supply to run dry.

Jane Msagati, a programme coordinator and nutritionist at Partnership for Nutrition in Tanzania (Panita), urged employers to set up breastfeeding stations for working mothers as it is done in the Kenya.

Myths and culture

Many women don’t know they should breast-feed their babies exclusively until they are six months old. Some believe that children should be weaned by three months. “Mothers often get told off that ‘During our time, there was nothing like six months exclusive breast feeding, but you all turned out to be just as fine and healthy,’” one participant in Mwanza stated.

Denish Kashaija the Mwanza Regional Community-Based Health Coordinator, said proper public education would solve this challenge by fostering positive social attitudes toward breastfeeding and reinforcing a breastfeeding culture.

Gaps in skills and knowledge

Dr Elisha Osati, President of the Medical Association of Tanzania (MAT) and Internal Medicine physician at Muhimbili National Hospital, recommends scaling up awareness programmes, especially on the right way to express, store and handle breast milk.

“As health practitioners, we have a big role to play in giving mothers the right information,” Dr Osati stated, adding that comprehensive post-natal care would go a long way in reinforcing breastfeeding. Dr Rumanyika said, We must disseminate accurate information on the value of breastfeeding as a powerful intervention for health and development, benefitting both children and women.”

Entertainment and media industry

The media should emphasise the importance of breastfeeding and create awareness, according to Mwanza Regional Medical Officer Dr Thomas Rutachunzibwa, who adds: “The media should not only concentrate on breastfeeding week alone. We have so many activities around breastfeeding and child health so journalists should always follow up beyond events coverage to ensure they disseminate this information all the time.”

Lack of food/poverty

Ms Msagati roots for eating of inexpensive, locally available foods, as part of ensuring women to have balanced diets. She also calls for nutritional support at the family level to ensure nursing mothers get enough food. In most government hospitals, most women are taught to start saving and storing food during ante-natal visits so that by the time their babies arrive, they have enough food.

Formula industry

The good news is that formula industry influence on this practice seems to be low, as Tanzania adopted the WHO International Code of Marketing of Breast-milk Substitutes in 1994 in its National Regulations for Marketing of Breast-milk Substitutes and Designated Product. The regulations prohibit the promotion of infant formula, follow-up formula, growing-up milks and “any product marketed, or otherwise represented or commonly used for feeding of infants.”

Public transport challenges

In Dar es Salaam, the participants pointed out that rapid transportation buses (Mwendo kasi) have seats for nursing mothers. In Mwanza, daladalas give priority to pregnant women and nursing mothers. Perhaps Dar es Salaam daladalas can learn something and follow suit to ensure women are comfortable and can to breastfeed even during transit.

Lack of breast milk bank/donations

Janet Msagati, a nutritionist and programme coordinator at Partnership for Nutrition in Tanzania (Panita), suggests that Tanzania could also borrow a leaf from other countries that are establishing breast milk banks to ensure all children are breastfed adequately.

Health challenges

Dr Shafiq Mohammed, the Director of Msasani Peninsula Hospital says some mothers may suffer from sore nipples for first few days of breastfeeding. He says women should never hesitate to consult healthcare providers immediately as such discomfort could be a sign of incorrect latching or something more serious. He says mothers at his health facility are taught how to breastfeed and prepare their nipples for breastfeeding during ante-natal care visits.

Sagging breasts

Dr Rumanyika said, “It is not true that breastfeeding makes breast sag, it actually makes breast more turgid so it should be explained better to young women why they should breastfeed,” adding that breasts sag with age whether one breastfeeds or not. He cautions that breasts should not be considered sexual symbols but as baby food. He decries that care of mother and baby is compartmentalised in most healthcare facilities so care from gynaecologists is disjointed from care provided by pediatricians.

Family and community support

Joy T Mnzava who is part of a breastfeeding support group in Mabibo, Dar es salaam, said support groups play a big role in breastfeeding. They give mothers a chance to discuss their challenges and find help. She said support should start at the family level to ensure women breastfeed and receive whatever help they need.

Government’s role

Dr Rutachunzibwa said the Minister of Health has signed an agreement with all regional officers across the country to fight the problem of stunting. The first step is a campaign to promote breastfeeding for children until they turn two. He said he is optimistic the campaign will increase breastfeeding rates.

Cessy Mrema, Mwanza Regional Reproductive and Child Health Coordinator says so far they have been educating women during ante-natal and post-natal visits on the benefits of breastfeeding and have been calling on the community to support working mothers achieve optimal breastfeeding.

With a package of actions, policies, and programs to support mothers at health facilities, at home, and at work, breastfeeding rates can dramatically increase in Tanzania and have greatly improve children’s health and development.

This special project was produced with support from the International Centre for Journalists (ICFJ)

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