Breastfeeding is a grey area for Ugandan mothers
Publish Date: Aug 01, 2009
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By Lydia Namubiru

BREASTFEEDING is nearly universal in Uganda. As established by the 2006 Uganda Demographic and Health Survey, 98% of the babies born benefit from breastfeeding at some time.

However, the devil is in how mothers breastfed. A good many mothers introduce their babies to supplementary foods too early while some wait too long to start these foods. When supplementary foods are introduced, in many instances they are not the right kind or not given in the right amounts.

Grace Ayio is a 19-year-old mother living in Naguru Go-down. Her baby Peter Rwoth is a chubby four- months-old boy. Asked whether she breastfeeds exclusively, Ayio says she does. On further probing however, she reveals that she gives him cow milk once in a while. “I gave him cow milk only twice,” she says defensively when friends around her laugh.

She knows it is too early to start supplementing her baby’s diet but she has done it anyway. She is not the only one cutting corners. UNICEF and WHO recommend that babies be breastfeed exclusively for six months but 40% of Ugandan babies get breastmilk supplements before this age. In fact at Rwoth’s age of four months, 66% of babies are no longer being exclusively breastfed, the majority are receiving other milk as a supplement to breastmilk.

Early supplementation of breastmilk is discouraged for a number of reasons that exposes the baby to germs and therefore infection, decreases the frequency with which the baby suckles and therefore decreases the production of breast milk and the supplementary foods are usually nutritionally inferior to breastmilk.

Nevertheless, Ayio is doing better than her neighbour Sharon Apolot who has just fed her one-day-old baby on almost half a mug of sugar water. “I don’t have breast milk,” she laments. Like Apolot’s baby, more than half (54%) of new born babies in Uganda are given pre lacteal feeds like milk, sugar water or fruit juice.

However breastfeeding advocates discourage prelacteal feeding as it delays the ‘coming in’ of milk into the breasts as a result the baby is denied their first breastfeed for longer than is healthy. According to the demographic survey, about 34% of Ugandan babies miss to breastfeed on their first day of life despite the fact the health experts recommend that every baby be breastfed within their first hour of life.

Flavia Atim’s one year old girl is well beyond the age for exclusive breastfeeding and indeed eats food in addition to breastmilk. However, the food she eats is not exactly the kind WHO would celebrate about. “For her, she just eats anything. When she sees someone eating, she joins them,” Atim says of her daughter Lawino. Asked whether she ever gives her child any of the foods that breastfeeding advocates recommend for weaning babies, Atim reveals that she would like to but cannot afford them.

“Some old ladies who come here tell me to give her soya but I only give her once in a while. If I get money to buy it, I give her but most times, I don’t have. So I just give her what I eat,” she says. Whether it is because of parents cannot afford to or otherwise, the majority of children in Lawino’s age group do not meet the basic feeding requirement.

Nutritionists recommend that after six months, babies should be given two or three meals a day in addition to breastmilk. These meals should consist of at least three food groups. Unfortunately, according to the demographic and health survey, only 24% of Ugandan babies meet this standard. Some mothers actually delay giving babies these food all together. Upto 23% of babies age 6-8 months do not receive these complementary foods. About one in every ten will continue to be exclusively breastfed, 4% will receive only plain water in addition to breastmilk while the other 7% will receive either only juice or another kind of milk in addition to breast milk.

As a result of all these incorrect practices among breastfeeding mothers, the nutritional status of children in the breastfeeding ages is very poor even among the youngest babies meant to be exclusively breastfeeding but is worst among the post exclusive breastfeeding ones.

“The percentage of children who are underweight almost triples from 11% in children under 6 months to 30% in children aged 9-11 months. Weaning foods are typically introduced during these ages and increased exposure to infection as well as inappropriate and/or inadequate feeding practices may contributing to faltering nutritional status among children in these age groups,” the survey report says.

Indicators of poor feeding in Ugandan children rise steadily from the age of six months, peaked at about 9-11 months and remain high afterwards. Between 10 -20% of babies in the weaning ages 6-23 months are either too short for their age, too light for their age or height.

Why do poor baby feeding practices persist?

“The main reasons are lack of knowledge, poverty and social cultural beliefs,” says Barbara Tembo, a programme officer at the International Baby Food Action Network. She says many of the practices that compromise baby feeding are deeply rooted at household and individual beliefs.

For example, the best and most nutritious food is given to the father. Most mothers also believe that weaned children can only eat porridge and so that is all they give them.

She, however, believes that some of the poor feeding results from parental negligence. “A mother will simply give the baby food and leave. We are saying to mothers; practice active and responsive feeding. Do not just put food before the baby, watch them and make sure they eat,” Tembo says.

In addition, she points out, some parents like Atim are too poor to buy their babies good food or, like Ayio and Apolot, do not have the knowledge on what the right feeding practices for their children.

Tembo says that numerous efforts are currently being directed towards improving infant feeding practices.

“The Ministry of Health and NGOs in the communities are sensistising mothers on proper feeding.” That may be but mothers remain largely unaware of these practices.

She believes that reaching enough households to change these beliefs will take more resources than is currently committed to educating grassroot people on infant feeding practices.

To every mother with a baby, Tembo offers this advice for feeding babies who are making the transition from exclusive breastfeeding to eating the family meal;

  • Frequency of feeds: The recommended minimum number of feeds is three times a day in addition to frequent breastfeeding.

  • Thickness: “Most times mothers make baby food like porridge too light,” she says.

  • Variety: Baby food should consist of at least three food groups.

  • Active and responsive feeding: Either feed the baby yourself or watch them feed and make sure they have had enough

  • Amount: Babies should be allowed to eat to their fill.

  • Hygiene: Mothers should personally ensure their babies feeding and cooking utensils are always clean.
  • For babies below six months, breast milk is, as nutritionists say, the only correct and safe food to give. After six months, give supplements, but continue to breastfeed as frequently as possible.

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