This is the fourth article in a five-part series on the impact of breastfeeding on child and maternal mortality in West Africa.
Ami Ouedraogo, 22, a mother in the northwest Burkina Faso village of Zincko showed what she did with the “dirty milk” following her pregnancy by squeezing her breast. “It [colostrum] was dirty and I needed to get rid of it in order to be able to feed my daughter correctly,” said the two-time mother, who imitated tossing liquid to the ground.
Her nine-month-old daughter, Ami, was being treated for malnutrition at a Red Cross nutrition clinic in Zincko.
World Health Organization (WHO) recommends mothers begin breastfeeding within the first hour of a child’s life in order to boost both the child’s and mother’s chances of survival: early breastfeeding produces a hormone that helps the mother’s uterus stop bleeding and colostrum packs high concentrations of antibodies and nutrients for the child, WHO nutrition department’s Carmen Casanovas told IRIN.
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UN Children’s Fund (UNICEF) reported on a 2007 medical study that found breastfeeding within the first hour can reduce newborn deaths by more than 20 percent.
Health clinic director Soumaïla Salembere of Ziga village in Burkina Faso’s northwest told IRIN he and two other health staff counsel expectant mothers about the importance of early breastfeeding. Yet, when IRIN asked a woman at the clinic who had given birth to twins 20 minutes earlier what mothers should do with colostrum, she replied: “We throw it out. It is not good for our children.”
It is not enough to simply tell women why early breastfeeding is so important, said WHO’s Casanovas. “If you just tell a mother she needs to breastfeed immediately after birth, she will not necessarily do it. Someone trusted needs to talk to her and work with her beliefs.”
Peer counselling and mother support groups have been able to get the message across when health workers can not, according to a 2008 multi-agency report on community interventions to change breastfeeding practices.
And when there are no trained birthing attendants or health workers, mothers in the community may be the only option, said Casanovas.
Some women do not know colostrum is milk, said nutritionist Marcel Daba Bengaly, who is working on a national study on why so few women in Burkina Faso follow international recommendations for breastfeeding. “If you ask them whether they gave their children the first milk [colostrum], the women reply yes because for them, the first milk is the more recognizable form of milk that follows the colostrum.”
More than one-third of surveyed mothers in Burkina Faso, 46 percent in Mali, 48 percent in Niger and 23 percent in Senegal reported breastfeeding within one hour of giving birth, according to the countries’ most recent demographic and health surveys, while 60 percent of women reported the same in a 2008 rapid nutrition assessment in Mauritania.
But national averages may be skewed if communities that do not normally breastfeed within the first hour are not included in the sample, said WHO’s Casanovas. Respondents included women who gave birth within the past five years.
Some women may inaccurately report how they breastfeed said WHO’s Casanovas. “Some of these surveyors are asking women years after a delivery. Mothers may not remember.” She said WHO is recommending survey improvements to increase reporting accuracy.
Casanovas added that a woman’s delivery experience may affect her perception of time. “If she had a good experience, she may think very little time passed before she breastfed, whereas someone else who had a painful delivery will think a long time lapsed before she produced breast milk. In both cases, their perceptions of time may be inaccurate,” said the doctor.