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A reason to celebrate breastfeeding in Nigeria

By Wasiu Afolabi, Infant & Young Child Nutrition Project in Nigeria

This week is World Breastfeeding Week, and we have a major reason to celebrate the occasion in Nigeria. My country recently came to a consensus to promote and protect breastfeeding for HIV-positive mothers by adopting the 2009 World Health Organization (WHO) recommendations on infant feeding and HIV. I have high hopes that this decision will prevent the transmission of HIV from mothers to children and save many lives.

The consensus follows WHO’s international guidance by promoting exclusive breastfeeding for the first six months of life and continued breastfeeding with appropriate complementary feeding for at least 12 months. National nutrition stakeholders and the prevention of mother-to-child transmission of HIV (PMTCT) community worked together to reach the consensus, making sure that national policies will not only aim to prevent transmission of HIV but also benefit the long-term health and survival of our HIV-affected children.

It is a significant achievement because breastfeeding has not been the norm in Nigeria. Despite efforts to improve nutrition behaviors by offering infant feeding support in health facilities and communities, still only 13 percent of mothers practice exclusive breastfeeding for the first six months of life.1 Poor breastfeeding practices contribute to high rates of malnutrition, an underlying cause of Nigeria’s staggering infant mortality rate (75/1,000 live births).1

Part of the problem has been mixed messages about infant feeding that leave health workers and mothers confused. In the absence of consistent national messages, many health workers, worried about mother-to-child transmission of HIV through breast milk, mistakenly advise HIV-positive moms to avoid breastfeeding or to shorten their usual duration. Although replacing breast milk with infant formula or stopping breastfeeding early can reduce HIV transmission, evidence shows that babies face an even higher risk of mortality due to common childhood illnesses like diarrhea and pneumonia.

I have seen the toll that poor breastfeeding practices can take on communities. In one village in northern Nigeria, deeply ingrained cultural practices led mothers to give babies water and animal milk in addition to breast milk during the first six months of life. Time and time again, more babies in this community became malnourished and sickly compared with children who were breastfed exclusively.

The good news is that there is now clear evidence that HIV-exposed children can greatly benefit from breastfeeding, as other children have. Exclusive breastfeeding for six months not only reduces the risk of HIV transmission compared to mixed feeding, but it also improves a child’s chances of surviving and remaining HIV free. On the other hand, replacing breast milk with infant formula increases mortality by as much as six times,2 and stopping breastfeeding early can have a three-fold increase on mortality due to other causes.3

This evidence tells us that it is not enough just to prevent transmission of HIV from mothers to babies by avoiding breastfeeding or stopping early. Nutrition and PMTCT policymakers and program implementers in other countries can follow Nigeria’s example by working together to ensure the long-term health and survival of children who are vulnerable to HIV.

Now that we have a clear national consensus, we can fill the gap between the compelling evidence for breastfeeding and the knowledge and practices of health workers and communities. Nigeria’s significant action to protect breastfeeding gives me hope for our mothers and children—and that’s a great cause for celebration.

Learn more about World Breastfeeding Week.

View a summary of current research on infant feeding and HIV.

1National Population Commission (NPC) [Nigeria] and ICF Macro. 2009. Nigeria Demographic and Health Survey. 2008. Abuja, Nigeria: National Population Commission and ICF Macro.

2Kagaayi J, Gray RH, Brahmbhatt H, et al. Survival of infants born to HIV-positive mothers by feeding modality in Rakai, Uganda. PLOS ONE 2008; 3:e3877.

3Kuhn L, Aldrovandi GM, Sinkala M, et al. Effects of early, abrupt cessation of breastfeeding on HIV-free survival of children in Zambia. N Engl J Med 2008; 359:130–141.

Better nutrition is central to addressing hunger and food security

By Denise Lionetti, IYCN Project Director

I saw the effects of the global food crisis during my recent trip to Kenya, where a prolonged drought coupled with high food prices have left significant numbers of Kenyans vulnerable to hunger and malnutrition. High food prices have continued to reduce access to food for significant numbers of people in poor countries.  

As new global food security policies take shape to help Kenya and other countries cope with future shocks and food price increases, the global community needs to take a comprehensive approach to addressing hunger and food security—and nutrition programs should be part of any strategy. It is critical for policies and programs that aim to improve access to food go hand-in-hand with efforts to improve the quality of available food and promote better nutrition practices—especially for mothers and children two years old and younger.

A food for work beneficiary works in on a farm in Ruhengeri, Rwanda.

The need for prioritizing good nutrition is clear: just because families have food does not mean that they are getting the nutrients they need to keep them healthy. We, in the global health community, have seen this reality through our work in many different country situations. In Kenya, malnutrition persists among children even in the country’s food secure Western Province. Although access to food has not been considered a problem compared with other areas in the country, a recent assessment conducted by the IYCN Project revealed that many kids do not get the right kinds of foods frequently enough to ensure good nutrition—leaving them vulnerable to malnutrition and more prone to illnesses. In order to effectively reduce hunger and malnutrition, food security programs should include proven, low-cost nutrition interventions such as counseling to improve infant feeding practices.

In the US, many non-governmental organizations and policy makers agree that nutrition should be an important part of an integrated food security strategy. In February 2009, more than 40 relief and development organizations launched a report, A Roadmap for US Leadership to End Global Hunger recommending a comprehensive strategy to promote global food security. It specifically outlines that a food security strategy should include emergency response, nutrition, safety nets and agriculture development. Influenced by this report and advocacy efforts by the NGO community, bills have been introduced in Congress that address the fight against hunger and include nutrition as an important component.

It is encouraging that the Obama administration’s new food security initiative appears to address the need for a comprehensive approach to fighting hunger. On September 26, Secretary Clinton unveiled the plan by outlining five pillars—the first is to comprehensively address the underlying causes of hunger and undernutrition. In advance of the announcement, USAID issued a new fact sheet further explaining the role of nutrition in the administration’s food security initiative: “A comprehensive food security strategy integrates nutrition, and improving maternal and child nutrition should be a key measure of success.”

Over the coming months, US policy makers will move forward with commitments. Policy makers are also discussing food security in developing countries. I encourage all of our nutrition colleagues to actively join the discussions to make sure that nutrition is addressed along side improvement of agriculture development and climate change. In addition, agriculture development should address food and nutrition security at household levels recognizing that women must be included.  Women are the primary workers on small holder farms and they, along with young children, are most vulnerable to poor nutrition. Engage your colleagues in the ministries of agriculture, finance and planning and donors to emphasize the critical role of nutrition.

We must continue to ensure that efforts to improve nutrition—especially during the first two years of life—are more fully incorporated and emphasized in all of our anti-hunger and food security programs. Now is the time to participate in these discussions to help ensure that that we effectively reduce the hunger and malnutrition that contributes so substantially to infant and child morbidity and mortality in the developing world.  

Send us your comments. Tell us about your thoughts on this article by sending an email to info@iycn.org. We will post selected comments on this page.

Read a Q&A with Bread for the World’s Eric Munoz to learn more about proposed US food security legislation.  

Read A Roadmap for US Leadership to End Global Hunger.

Learn more about IYCN activities in Kenya.

Photos: Aurelio Ayala III, PATH/Carib Nelson, WFP/ Tom Haskell, Oluseyi Akintola