Uganda’s wake-up call on breastfeeding, donor milk and newborn safety

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OPINION 

By Tracy Ahumuza

The recent recall of newborn formula products has triggered understandable anxiety among parents and health workers. The Ministry of Health, in an article in The Weekend Vision of March 14-15, said it was “on alert,” noting that the affected brands are widely sold through supermarkets, pharmacies, private traders and may even circulate through some health service channels.

Across Europe, reporting has linked the recalls to possible contamination with cereulide, a toxin associated with Bacillus cereus, which can cause vomiting and other gastrointestinal symptoms, and is described as heat-stable (meaning it will survive the hot water you mix it in).

But while the recall is urgent, the deeper lesson is long-term: we must stop treating infant feeding as a consumer choice managed by global supply chains, and start treating breastfeeding support and safe breast milk donation as health system priorities.

I felt that lesson in a personal way recently. I picked up my niece’s book, Children’s Visual Dictionary: 9000-word Vocabulary Builder, and while we were perusing through its icons and pictures, chanced upon the “Pregnancy and Childhood” section expecting to see the basics: a breast, a baby at the breast, a mother expressing milk, maybe a pump; something that normalises how most babies are biologically designed to feed. Instead, the only visual indicator of infant feeding was a bottle, labelled “baby formula” and “nipple.” No breastfeeding. No expressing. No donor milk. No vocabulary for breast milk at all.

Granted, she lives elsewhere in the world where their health systems are robust, and the culture has been very different for a long time. Yet, even high-income countries now acknowledge that breastfeeding support is urgent, having seen the long-term consequences of neglecting it, including rising obesity and other chronic conditions. And yet, just like the formula that recently left Ugandan parents anxious, these books are also imported into our homes. They shape how our children see the world.

I won’t go down the rabbit hole about why what we put in children’s books and everyday imagery becomes our “normal.” When a bottle is the default icon of infancy, we teach the next generation, girls and boys, that feeding a baby is primarily about products and purchases and not bodies and support. A man’s post on Instagram was praising all women who are able to breastfeed because they reduce household expenditure, provide nutrition that is not replicable and reduce hospital bills.

Sometimes, this is what support starts with, but it also means recognising that it takes a village to support a mother to breastfeed. She needs people to do everything else while she breastfeeds. The family members, maids and husbands of today’s village must enable her to nourish the baby in peace, and they, too, must be encouraged and supported.

To be clear, formula has a place. It has saved lives and fortifies breast milk in some situations for good, where a newborn, for example, is failing to thrive or lactose intolerant. In these situations, families deserve compassion. A recall of this scale, however, reminds us how fragile the formula dependency pathway can be, especially for newborns, pre-term babies and infants already in neonatal units.

The global news shows how quickly risk can travel across borders through ingredients and supply chains. Reuters has reported precautionary recalls that began late last year and expanded early this year, with investigations and alerts across multiple countries.

In the same The Weekend Vision article, the health ministry spokesperson said they are not able to do an assessment on the affected batches in the country because it might require a lot of finances, and that the ministry only has control over health facilities and not private sector suppliers.

Families are being left to interpret international batch codes, juggling rumours on WhatsApp, and wondering whether the tin on their kitchen shelf is safe. Regulation and enforcement are harder when products enter through informal markets, exactly the channels many of our Kampala and other city households rely on.

What is the resilient alternative?

First, we must strengthen breastfeeding support as a standard part of care, not an optional extra. That means skilled lactation support in antenatal care, immediate postpartum support (especially after caesarean delivery) and hands-on help for mothers (and their village) with sick or pre-term babies whose feeding journeys are rarely straightforward.

It also means protecting mothers’ time and mental well-being. A mother who is frightened, exhausted, in pain or alone is more likely to struggle to establish breastfeeding, yet those are precisely the realities many women face after childbirth, particularly with sick newborns. I know this firsthand.

Second, Uganda should scale safe donor breast milk pathways for the most vulnerable infants. The World Health Organisation recommends that low-birth-weight infants who cannot be fed their mother’s own milk should be fed donor human milk, where safe milk banking (low cost) facilities are available or can be set up.

It’s not all gloom and doom. We already have a donor milk bank in Nsambya set up in 2021, another in Mbale in 2023, and finally, ATTA Breastmilk Community has been championing breastfeeding and breastmilk donation since early 2021. It is, however, going to take a lot of community effort to make newborn feeding and postpartum breastfeeding support a national priority.

These kinds of innovations should be protected, standardised and expanded, especially for neonatal units where the consequences of unsafe feeding are immediate and severe. Because our newborns go home while still in a fragile state, it means that community support also has to be prioritised.

Third, we need honest public communication that respects parents. We need public messages that also restore confidence in breastfeeding and normalise donor milk as a safe option for fragile newborns, not as something mysterious or shameful.

Finally, we must change what we teach at home, in schools and in society. If the children’s dictionary can show a bottle labelled “baby formula,” it can also show a baby breastfeeding. It can name the breast. It can introduce “breastmilk,” “lactation,” “expressing milk,” and “donor milk” as ordinary vocabulary. Because when language is missing, support is missing too.

The formula recall will pass, and the market will move on, if it hasn’t already. But our newborns cannot live at the mercy of global supply chains and late alerts. This moment should push us to invest in what is most local, most proven and most protective for babies: stronger breastfeeding support for every mother and safe, regulated breast milk donation systems for the infants who need it most.

If we don’t, we will join some parts of the world in teaching our children that the bottle is the beginning and end of infant feeding, and yet this is a risk Uganda cannot afford.

The writer is the founder of ATTA Breastmilk Community