|Breastfeeding: from Biology to Policy (UNSSCN, 1998, 28 p.)|
The rates of optimal breastfeeding from around the world imply that national governments, even though they make pledges and set targets in international gatherings, make no real commitment to breastfeeding in the form of practical national policies and programmes. The question therefore is: how can governments and local communities be stimulated to accept breastfeeding and breastmilk as being crucial for the infant, mother, household, community and nation?
The challenge to SCN member agencies... is to be more aggressive through their specialized areas, to literally bring home the importance and benefits of breastfeeding to governments and their policy makers.
Relatively simple and practical programmatic interventions at the international level are invariably reflected in national programmes. An example of this is the UNICEF/WHO globally-adopted Baby Friendly Hospital Initiative (UNICEF, 1997b). The challenge to SCN member agencies therefore is to be more aggressive through their specialized areas, to literally bring home the importance and benefits of breastfeeding to governments and their policy makers.
Some suggestions are:
Colostrum on the immunization schedule - Expanded Programme on Immunization (EPI)
Due to its immunological properties, colostrum is often referred to as 'the first immunization'. The Expanded Programme on Immunization therefore seems to be the obvious place to start. According to the universal immunization schedule, BCG vaccine for the prevention of tuberculosis and polio should be given at birth. There is every reason for colostrum to be placed on the same schedule to be given to the infant immediately after delivery, and specifically, within the first hour of delivery.
High immunization coverage rates are often a matter of pride for most governments outlining their achievements in the health sector. The immunization schedule is well known to health workers and parents in most parts of the world. In The Gambia for example, immunization has been found to be a motivating factor for regular attendance at infant welfare and antenatal clinics.
This simple intervention would have a tremendous impact from the level of the policy-maker to the level of the mother and father. Imagine a situation where health workers would no longer refer to colostrum loosely as the first immunization, but would actually be able to show evidence of it on the schedule for the understanding of the common person. The inclusion of colostrum on the immunization schedule would require very little resources. When training health workers, a session should be included on the immunological and anti-infective properties of colostrum and the rationale for placing it on the schedule.
Breastmilk on the essential drug list
Oral rehydration solution (ORS) is a simple solution that saves lives by preventing dehydration due to diarrhoea. ORS is therefore on the WHO list of essential drugs. Breastmilk is a more complex liquid than ORS containing nutrients as well as antibodies. Breastmilk saves millions of lives of infants and young children. Given the protective and life-saving properties of breastmilk, it becomes justifiable to include it on the essential drug list alongside ORS. This would serve to highlight and emphasize the status of breastmilk.
Breastmilk on global and national food balance sheets
Breastmilk is a major source of food for nearly 3% of the world's population, i.e., over 140 million infants born each year (Huffman et al, 1992). Therefore, breastmilk makes a substantial contribution to global and national food security. Yet despite attempts from as far back as the 1970's, there still seems to be a reluctance to include breastmilk on global and national food balance sheets!
Human milk production in Sub-Saharan Africa has been estimated to equal 50% of the total cow's milk produced in the region between 1991-1994 (Hatloy and Oshaug, 1997). What more information or research findings are needed to reconfirm breastmilk's importance to food security?
If breastmilk's contribution to global food security were to be boldly acknowledged by the responsible international agencies, then governments could be requested and motivated to do the same at the national level. Huge investments are made by governments to increase and improve food production as an answer to food insecurity. What is the investment in breastmilk, perhaps the world's most basic and important food?
Breastmilk on the gross national product (GNP) - gross domestic product (GDP) estimates
Breastmilk is a natural resource which, unlike most other resources, is in global abundance regardless of geographical location. But just like most natural resources, governments have to invest for their countries to benefit fully from it. However, breastmilk is a marginalized resource and is not explicitly considered by governments as contributing to the national economy.
What is the economic value of breastmilk and how can one put a value on a combination of nutrition, care, protection and life saving qualities? Any economic value of breastmilk can only be an underestimation. However, attempts made to estimate the economical value (Levine and Huffman, 1990) indicate substantial national savings with breastfeeding. One study even shows that this may increase a country's GNP by more than 5% (as estimated for Mali: Hatloy and Oshaug, 1997).
Healthier and happier mothers and infants represent less private and public expenditure on health care. Since most countries do not manufacture infant formula but have to import it, governments save foreign exchange by encouraging the use of a natural resource, which is also far superior to artificial milk.
It is time for international agencies supporting economic-based interventions to include the protection, promotion and support of breastfeeding. They should not only request but also assist countries to establish the impact of breastfeeding on national economies.
Breastfeeding as foundation of sustainable human development
In a time of dwindling resources, it makes perfect sense for the world to make the optimal use of one of its most sustainable natural resources - breastmilk. Breastfeeding is the strongest possible foundation for nutrition and care (Armstrong, 1995). Breastfeeding is sustainable because breastmilk is naturally renewable as well as vital to human development. Therefore plans of action for sustainable human development should incorporate breastfeeding.
Breastmilk - an environment-friendly product
Tin plate, plastic, paper, glass, rubber and silicon are needed for the packaging of infant milk formula and the production of bottles and teats. This requires resources; it also poses the problem of waste disposal for some of these items. It is estimated that if every baby in the USA were bottle-fed, this would require 86,000 tons of tin plate to be used for manufacturing the required 550 million baby milk tins (Radford, 1992).
Breastfeeding is environment friendly, yet how many national environmental programmes have included the promotion of breastfeeding in their plan of action? If the global plan of action for the preservation of the environment were to incorporate breastfeeding promotion as one of its strategies, this could be reflected in national environmental action plans.
Breastfeeding - a family planning option
There is no dispute on the contribution of breastfeeding to child spacing, which has been known to mothers long before being confirmed through scientific research (Short, 1992). Yet the lactational ammenohrea method (LAM) as an early form of family planning is not an option in national family planning programmes except for a committed few.
Who benefits though, from breastfeeding being downplayed as a family planning option? Definitely, not the mother or her infant and, to take it even further, not the nation - especially one with limited resources, high fertility and low literacy rates.
It is now long overdue for international agencies concerned with population growth not only to make a firm commitment in recognizing breastfeeding's contribution to global population growth but also to include breastfeeding as a family planning option in their programmes. This commitment could trickle down to national population and family planning programmes.
Breastfeeding and breastmilk cut across all boundaries. Regardless of race, colour, socio-economic background, shape or size, the process is the same and the product is basically the same. Virtually all the major religions of the world support and encourage breastfeeding (UNICEF, 1994). Breastfeeding benefits the mother and her infant in both industrialized and non-industrialized countries.
In a recent editorial in the Lancet, it is rightly stated that: "Policy makers need to understand that provision of a warm chain for breast-feeding is as valuable as provision of a cold chain for vaccines and likewise requires adequate resources. Governments and funding agencies need to be convinced that the investment is worthwhile." (Editorial, 1994).
While individual UN agencies have been successful in focusing global attention on the protection, promotion and support of breastfeeding, a central coordinating mechanism within the UN system seems to be missing. Such a mechanism, if put in place and given the mandate, would no doubt maintain breastfeeding high on the global and national agenda. Most importantly, a central coordinating mechanism would link breastfeeding with the relevant programmes within the UN system.
Is there a role for the SCN in this?
...exclusive breastfeeding did not have a local name before the intervention and was regarded as a foreign concept. During the intervention, a new term in Mandinka was coined - susundiri timaringo -which translates literally as the 'complete breastfeeding'...