Policy issues

The success of the BFCI pilot project resulted in it being recommended for expansion nationally within the next five years (The Gambia Health Action Plan 1999-2003). The cost implications of the expansion are limited mostly to the training, retraining and evaluation of the village support groups. There are no external resources required for the dissemination of information by the support groups. They decide how and when to disseminate information. The cost to them is their time, which they are willing to give by accepting the nomination from their communities. A motivating factor, however, is the status attached to being pioneers of a community initiative, adapted from a global initiative.

Maternity protection

The Gambian example shows the importance of maternity protection measures for all working mothers whether in the formal or informal sector. These measures include adequate maternity leave, nursing breaks and cres at workplaces. In some countries, paternity leave is an option for fathers, giving them the opportunity to provide support for the mother and her infant from the beginning.

The ILO's Convention No. 3 from 1919, recommended at least 12 weeks maternity leave for women in commerce and industry. The updated version from 1952, Convention No. 103, was expanded to include coverage for non-industrial and agricultural workers, including women wage earners working at home⁴. However, this did not really change anything, since Article 7 in the same Convention (103) gave countries the option not to include these categories of workers. Moreover, the Convention was ratified by only 33 countries.

⁴ See Women's Rights to Maternity Protection, Information for Action by the American Public Health Association (APHA), Clearinghouse on Infant Feeding and Maternal Nutrition; 1996.

The Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW) from 1979 also called for maternity protection and was ratified by 146 countries as of October 1994. Yet, maternity protection is still an issue that needs to be addressed since in most countries it is either inadequate or women do not utilize it fully through lack of information. There are still some countries which do not satisfy even the minimum requirement of 12 weeks paid maternity leave. Other countries, e.g., Norway, far exceed this requirement, with up to 52 weeks maternity leave (80% benefits) which includes optional paternity leave (UNICEF, 1997b).

Therefore, the call for governments through the Innocenti Declaration (1990) to 'enact imaginative legislation, protecting the breastfeeding rights of working women and establish means of its enforcement', is still relevant to most governments. It is, however, encouraging to note that the ILO is now engaged in a global review of maternity leave and will hopefully do everything possible to encourage governments, including the private sector, to pay heed to the above call.

Most women around the world work outside of the home but not in the formal sector. Many of these women are engaged in farming activities. While maternity protection should encompass all women regardless of the type of work they are doing, in reality, these women are excluded. Yet they are advised to practice exclusive breastfeeding for 6 months! Local communities should be encouraged and assisted to find solutions which are compatible with their traditional beliefs and practices. These should be supported by national and local policies.

Adequate and appropriate information at all levels; breastfeeding is the business of every individual

If the universal practice of optimal breastfeeding is to be achieved, adequate and appropriate information must be given at all levels of a society. Information, however, is usually targeted only at mothers and community health workers. Each given situation must be assessed to identify the barriers to optimal breastfeeding and in so doing identify who needs what information and why.

It is important to include all levels of health workers as they can, in some cases, create the biggest hindrance to optimal breastfeeding due to conflicting information they give mothers. Men need to also learn about breastfeeding to enable them to provide the necessary support and encouragement for the mother and her infant.

Strategies to promote breastfeeding must not, however, be limited to only technical information. The self-perceptions and social relations of the target person to be influenced must be taken into consideration (Obermeyer and Castle, 1997).

Care and adequate nutrition during pregnancy and lactation

Breastfeeding ensures adequate food and care for the infant. The mother also needs special care, and should be ensured the same. Care during pregnancy and lactation should include ensuring an adequate diet for the woman, reducing her workload, and counseling her on family planning options for adequate child spacing. This would not only enhance the mother's health but also her wellbeing. The mother needs to feel that she is as important as her infant is!

Guidelines on breastfeeding and HIV/AIDS - infant feeding options for the HIV positive mother

Breastfeeding and breastmilk may seemingly be under threat at the moment, with estimations indicating a 14% additional risk of the HIV virus being transmitted to the infant through breastmilk (Dunn et al., 1992). This can be interpreted in two ways depending on who is doing the interpretation. Firstly, for advocates of breastfeeding the risk may seem small, and options to further minimize this risk may be sought. On the contrary, for those who would benefit from the decrease in breastfeeding, this risk could be exaggerated and instead used to justify why women should not breastfeed.

All HIV infected mothers should have the chance to make an informed choice in the feeding of their infants. Therefore infant feeding recommendations for HIV-infected mothers should consist of options. These must be clear, specific and concise. Examples are: heat treatment of mother's expressed breastmilk, the traditional practice of wet nursing or expressed breastmilk from a wet nurse, with the option of feeding with artificial milk only where it is affordable and safe. However, more urgent efforts and resources need to be put into finding solutions, which would not jeopardize the breastfeeding of infants anywhere.