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The e-tolling equivalent for babies
Our Department of Health has committed itself to dropping the infant mortality rate drastically. Did you know that more than 58 000 children died before their fifth birthday in South Africa in 2010? The reasons for these are varied and complex (including HIV/Aids, pneumonia and acute diarrhoea) but any infant death that is avoidable and preventable is unacceptable. So I applaud the Government for taking this on.
They propose to do it by promoting exclusive breastfeeding for the first 6 months of your baby’s life and extended breastfeeding until 2 years of age. This is also amazing and a good thing and completely in line with the World Health Organisation recommendations.
Breastmilk is the very best form of nutrition for an infant and plays a huge role in preventing pneumonia and diarrhea and other childhood illnesses that cause death. Exclusive breastfeeding is the obvious and best choice because it is not affected by poverty or lack of access to clean and sterile water.
Your body will nourish your baby even in the worst of circumstances – that is what makes breastfeeding the first and obvious choice. Optimal breastfeeding from birth to age 2 years can prevent 19% of all under-5 deaths, more than any other intervention. In developing countries, breastfed children are at least 6 times more likely to survive in the early months of life than non-breastfed children.
So why is it that in South Africa only 8% of mothers are still exclusively feeding by 6 months?
Let us look at the reality of a South African mom.
Firstly: we are a developing country. Most of us have to work. We only get 4 months of maternity leave (paid if you are lucky – or you have to face the arduous task of claiming UIF). So what happens when we return to work?
Breastpumping rooms at work
You can pump your milk assuming you work in an environment that supports breastfeeding, including allowing you a clean and safe space to pump and a fridge to store your milk in. While many companies have designated smoking rooms, I don’t know of any that have designated breastpumping rooms?
Feeding expressed milk to baby
And then how is that milk fed to your baby? For most it is via a bottle and not a cup. But under the new legislation, we will not be able to get any advertising information on what bottles are best for our baby or any educational information on how to use a bottle including safe practices on sterilisation and so on.
Baby not living with mom
What happens if you don’t live with your baby? Yes, like it or not, agree or not, not all South African moms live near their children. Many go home to have their babies in the outlying rural areas where they grew up and have to return to the cities to work, leaving their children behind to be raised by their grannies, aunts or combinations thereof.
Cultural norms
There are other considerations. How many of you have been told that your baby is crying because it needs food and your breastmilk is not enough? Truth of the matter is: babies cry. They communicate via crying and their tummies are tiny: the size of their fists – pretty tiny. So if you fill it with breastmilk, formula or maize meal it is still going to empty at the same rate. And they will be hungry. And they will cry.
So many moms are forced into feeding their babies solids before 6 months by their communities: this is a cultural reality that will not fade overnight and certainly not without the right information being passed on through clinic sisters or the media.
Breastfeeding difficulties
Even if you have chosen to breastfeed and are determined to do it, it may just not be working for you. Many moms want to quit time and again in the first few weeks of feeding. It is sore, it is challenging and not an easy task to get right. The only moms who manage to push through this time and continue feeding are those with access to the support and right information about breastfeeding.
We need access to a healthcare professional trained in latching techniques and troubleshooting common problems associated with breastfeeding including mastitis – a condition that would drive most women to quit. If we know about what to expect from feeding and how to ride out the early days, many moms persevere and do go on to successfully feed. But you have to have the resources available to you to get the right support and information.
HIV positive
What happens if you are HIV positive? This is a relatively new disease. So a while back all moms were told that formula-feeding is best for HIV positive moms to cut down on transmission of the disease. This is no longer the case. If a woman is on ARV’s she can exclusively feed her infant.
But here it gets a little trickier and every woman needs to know that by exclusivity that includes NO other substances including colic drops, gripe water or plain water – as this changes the lining of the infant’s gut and can cause the virus to pass into the baby. Again, a huge amount of information is needed as well as access to knowledge and ARV’s – not always the reality on the ground.
And even then, there is still a risk that a baby will be HIV infected via breastfeeding by 18 months and this small but significant fact seems to be being largely ignored by the government.
Adopted babies
What happens for adopted babies? While adoptive moms can be put on to medication to encourage milk: this could take up to 6 weeks and then there are question marks about the quality of the milk she will produce. So most healthcare professionals would recommend combination feeding anyway. Add to that the 60-day waiting period until placement: and you have to ask yourself if breastfeeding in this instance is the right thing to do or just more traumatic for these babies?
Medically unable, and just rightfully unwilling?
What happens for moms with medical conditions that are physiologically unable to feed? The percentage is low but they do exist. And what happens to women who choose not to breastfeed just because it is their right to do so?
So faced with these immense challenges is it any wonder our breastfeeding rate is still low? There are many things that have to happen before we restrict a mom’s access to information about infant formula or any other form of infant nutrition (remember this legislation is proposed on all foodstuffs up to 36 months so that includes cereals, baby rices, baby purees and so on).
What government really needs to do
Breastfeeding support
Firstly: maintain the 81% of women who have had their babies latched in the first few hours after birth. Make sure they get the right support and advice in the clinics and then ensure they get continuing support and advice once they are home. This would include funding organisations like the La Léche League or incentivising more women to train as midwives and lactation consultants and get these into the country at grassroots level.
Maternity legislation
Secondly: legislate companies to support breastfeeding. Relook maternity leave and UIF and the length of time our mothers get off. Look at countries in Europe who have amazing initiatives to support mothers on maternity leave. Maternity leave cover is also a great way to get new, less experienced learners in to the work place.
I would love to see a system where our moms get paid maternity leave from the government while their companies fund freelancers to cover their jobs: freelancers who walk away with great experience and something solid on their CVs.
More information, not less
Thirdly: More information is needed, not less. Instead of denying access to information on formula, rather increase the information on breastfeeding. But if a mom chooses to formula feed, I would far rather she has the information available to her on how to do it properly and indeed what formula to feed her child.
Implications
If this legislation goes through, formula labels will carry unsubstantiated warning statements that will tell you that formula increases the risk of your baby developing pneumonia, diarrhoea and could increase the risk of the death of your child.
Even the most educated moms will shy away from formula in this instance and the least educated moms will probably turn to flour, coffee creamers or maize meal as a substitute. It happens already with all the information out there – it will most certainly happen more with less.
And the labels won't carry any ingredient claims or telephone numbers of the manufacturers so moms can check for themselves any longer.
What you can do
This legislation’s heart is in the right place but the execution seems all wrong. Let’s all rather engage in fighting to increase breastfeeding in South Africa.
- Get the formula companies to sponsor breastfeeding clinics and programmes.
- Get the bottle manufacturers to provide breastpumps to clinics.
- Empower everybody to help get the information out there: breast is best, it can be done and should be done. But if you need an alternative, is a total information blackout and scare tactics really the right solution? And does this not go against all that our constitution is lauded for?
If you feel as I do make your voice heard, lodge your objection to the R184 legislation here:
Director General:Health
Private Bag X828
Pretoria 0001
(For the attention of the Directorate: Nutrition)
dg@health.gov.za
27 July 2012
