By David de Ferranti, Maarten van Herpen, and Kanika Bahl.
Meet Joyce. She’s a hairdresser. She has a newborn baby. She believes “breastfeeding is its right.” But sadly, that instinctive maternal belief isn’t supported by the day-to-day reality of her life.
Because there is another thing about Joyce: she lives in urban Kenya.
One could let the figures speak for themselves. In 2013, an estimated 106,000 children died in Kenya and the two leading causes were pneumonia and diarrhea. At the same time, according to UNICEF, exclusively breastfed babies are 15 times less likely to die from pneumonia and 11 times less likely to die from diarrhea.
The trouble is, running the numbers and saying ‘breastfeeding saves lives and more African women should do it’ is easy. Implementing strategies so that mothers not only know this fact but can also act on it is less easy.
One organization that is addressing this challenge is Philips, with its commitment to breastfeeding support and dedicated Philips Africa Innovation Hub. Supported by key stakeholders, they have created the Fabric of Africa report, interviewing 400 working mothers with children under age two, from three socio-economic groups (Middle Class, Floating Class and Bottom of the Pyramid, across Nairobi, Kenya and Accra, Ghana. Results for Development Institute served as part of an international advisory group formed to share guidance during this project.
Both Ghana and Kenya’s breastfeeding rates fall below World Health Organization recommendations. For example, around 58% of Kenyan mothers initiate breastfeeding within an hour of birth and 32% exclusively breastfeed for six months. In Ghana, 46% of mothers start early and continue to breastfeed exclusively for the first six months.
Why do these numbers fall so woefully short, and how we can change them?
Let’s start at the beginning, with the first question. In the hospital, right after birth, immediate skin-to-skin contact and early initiation of breastfeeding boosts a baby’s nutrition and immunity while stimulating the mother’s milk flow. Yet in the Philips study, while 70% of BoP and 71% of FC mothers started breastfeeding an hour after birth, only 58% of MC mothers did so.
The lower breastfeeding performance of higher-income mothers challenges the assumption that higher economic status always means better health knowledge and behavior. It also reflects the lower breastfeeding rates in many private maternity facilities in Africa, where many middle- and high-income women deliver.
With Africa’s high rates of female labor force participation, paid maternity leave and workplace support are critical to increasing the duration of breastfeeding. Most African countries offer three months of paid parental leave to the minority of women who work in the formal sector. For the vast majority of women who work in the informal sector, there is nothing. This helps explain why 52% of all the women in the Philips’ study reported returning to work within three months, and why 25% of lower income women returned within one month.
What is particularly hard to bear is the fact that these women face an impossible choice between earning an income and breastfeeding their baby. With limited or no access to breast pumps and refrigerators, pumping breast milk for their babies while they are at work is currently not an option for most. The Philips study revealed that many working mothers are sending their babies to informal daycare centers that have no capacity to store and provide breast milk, even if mothers were able to supply it. Nineteen percent of mothers in the Philips study reported using daycare services despite being concerned with the quality and hygiene. Many daycare centers are housed in slum homes with an average of 12 babies per caretaker.
This is where the UN’s Sustainable Development Goals (SDGs) come into play, specifically the pledge to reduce preventable newborn and child deaths to zero and eliminate child malnutrition by 2030. With the potential to prevent 12% of all child deaths and reduce stunting, breastfeeding has a special role to play in the achievement of these new global goals. But new strategies and approaches will be needed to increase breastfeeding rates to the levels necessary to achieve the SDGs.
To accelerate the development of breastfeeding innovations, a variety of groups including Philips, Results for Development Institute, the Millennium Development Goals Health Alliance, and many others have united to form a new Breastfeeding Innovations Team. With 100 active members, the team is growing fast as more organizations join forces to accelerate the innovations that will empower more mothers to breastfeed; especially mothers in countries that struggle with high newborn and child deaths and malnutrition.
Success is possible. The results of the five-year Bill and Melinda Gates Foundation-funded Alive & Thrive program has increased exclusive breastfeeding rates — from 19% to 63% in Vietnam, from 49% to 83% in Bangladesh, and from 72% to 80% in Ethiopia — by testing a variety of new approaches.
Philips is already exploring new models to support more African women to breastfeed. “Community Life Centers,” like the newly opened center in Kiambu County, use enhanced technology and services to make safer births possible for local women. They also can educate health workers on the value of instant skin-to-skin contact between mothers and newborns and can play a role in supporting women to continue to breastfeed. Other innovations could be more affordable, easier to clean, and easier to operate breast pumps, milk pasteurization solutions that lengthen the shelf-life of breast milk, better baby sanitizers to keep the breastfeeding environment clean, and more modern daycare centers so that mothers can not only store breast milk, but also have confidence that it will be given to their child properly. The rising tide of mobile phones can be leveraged too with breastfeeding apps, phone-based peer counseling (already proven by a Kenyan study to support continued breastfeeding) and ways for breastfeeding mothers to share tips and support each other.
These innovations can drive breastfeeding rates higher because they are based on meeting the needs of women like Joyce, most of whom need to work outside the home — a rising trend that will continue everywhere. Breastfeeding is an ancient and powerful skill, no doubt, but the realities of modern life mean that women increasingly will need improved support and an enabling environment to do what they want to do — give their child the very best start in life.
David de Ferranti is President and CEO of Results for Development Institute.
Maarten van Herpen is head of the Philips Africa Innovation Hub at Royal Philips.
Kanika Bahl is Managing Director at Results for Development Institute.
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