Focus on Anemia Prevention and Breastfeeding promotion to improve mother and child health in Azerbaijan
by Sarah Marcus
BAKU, Azerbaijan, 2010 - Anemia, though easily preventable and treatable, is one of the most serious threats to the health of children and a factor in maternal mortality. In Azerbaijan, anemia levels are worryingly high and the results are impairment of the growth and development of children, their learning skills, as well as cognitive disorders and a decrease in the overall productivity of the population.
Anemia is a recognized hazard to reproductive health, connected also with maternal and perinatal mortality, premature childbirth and low birth weight, which considerably contributes to infant mortality.
Azerbaijan’s anemia figures are stark: over half of infants aged six-23 months suffer from anemia while its prevalence among 6- 59 month-old children is 39 per cent.
37 per cent of fertile- age women, 45 per cent of pregnant women and over half of breastfeeding women are affected by anemia in Azerbaijan.
According to Nigar Akhundova, the Chief of the Clinical Department at the Research Institute of Gynecology and Obstetrics in Baku (also a working maternity hospital), 90 per cent of maternal deaths in Azerbaijan are due to blood loss.
This too relates to anemia, because, explained Dr Akhundova, Azerbaijani women can afford to lose less blood than their counterparts in some other countries.
‘In Azerbaijan there are generally low levels of hemoglobin in the blood. In other countries, for example in the Baltic states, according to the World Health Organisation (WHO), there are higher levels of hemoglobin – this is partly to do with the location of the country,’ said Dr Akhundova.
‘So for women from the Baltic countries, to lose 500 grams of blood is normal, whereas for us Azerbaijani, that would be dangerous, 300 grams is the limit for us,’ she added.
In Azerbaijan a key reason for high anemia levels in children is low breastfeeding rates.
According to the most recent Azerbaijan Demographic and Health Survey (DHS), conducted in 2006 by the State Statistical Committee of the Republic of Azerbaijan, 15 per cent of children had never been breastfed, only one third experienced early initiation of breastfeeding within 1 hour after delivery, and bottle feeding practices are widespread, with over half of infants under two months being fed this way. As a result, only 12 per cent of children under 6 months are exclusively breastfed – a vital method of preventing anemia.
‘The iron in mother’s milk is present in a way which is easy for babies to absorb,’ said Dr Akhundova, explaining that iron in supplements is less easily absorbed.
The way forward
As a result of UNICEF advocacy, the Cabinet of Ministers of the Government of Azerbaijan and the Ministry of Health has prioritized the necessity of tackling core nutrition issues, with a focus on anemia prevention and improving infant feeding practices.
The positive outcomes that such an approach promises are already visible at Baku’s Research Institute of Gynecology and Obstetrics. Here anemia is decreasing rapidly, and Dr Akhundova attributes this to awareness and strict control in pregnancy.
20-year-old Khayala Habibova smiles tenderly as she returned her eight-day-old son Javidan to a nurse in the intensive care unit of the Institute. He was taken here two days after he was born because he had an infection and a high temperature.
Nonetheless, Khayala comes here several times a day to breastfeed him – previously breastfeeding of babies in intensive care units was strictly forbidden in Azerbaijan hospitals.
‘I think breastfeeding is very good for infants, the main thing is that natural food is better than supplements,’ said Khayala.
‘I had some awareness about breastfeeding but the doctors here explained more about it to me,’ she continued.
Making sure that as many women as possible breastfeed, even if their babies are ill or in the resuscitation unit, is a central plank of this Institute’s policy and practice on infant feeding.
‘Even after giving birth by Caesarean section, a baby is brought to the mother for breastfeeding immediately. Before we would give these women injections for the pain of the operation, but now we find that if they start breastfeeding they don’t feel pain or even that they’ve had surgery,’ said Dr Akhundova.
She explained that a lot of success in breastfeeding has to do with how quickly the baby is brought to the mother after birth – if a mother is reluctant to breastfeed then the first day of the baby’s life is particularly crucial to show her that breastfeeding is possible and can be done in small amounts at regular intervals.
The Institute also aims to raise awareness on breastfeeding at antenatal consultations where they work to educate women who are reluctant to breastfeed for various reasons including fear of passing on Hepatitis B or C (these will not be passed through breast milk if the woman is not an active carrier of the diseases) or a fear that the practice will cause the breast to become permanently misshapen.
Attached to the Institute is a centre for antenatal training which gives guidance on breastfeeding and Dr Akhundova said that there are several such schools in Baku.
Once expectant mothers arrive for their stay at the hospital they will find a room in the maternity ward dedicated to breastfeeding, full of posters, videos and leaflets answering every conceivable question on the subject. The establishment and equipment of this room was supported by UNICEF.
Doctors estimate the breastfeeding rate in the Institute at 98-99 percent, and walking round the maternity unit one can see mother after mother breastfeeding her baby.
In one room is Arifa Ismailova, 31. She already has a two-year-old daughter and has just given birth to healthy triplet boys. She is breastfeeding them all with the aid of supplements, as she does not quite have enough milk for three hungry boys!
‘Mother’s milk is a guarantee of a good immune system till the end of a baby’s life,’ she says.
In addition to the work the Institute does on breastfeeding and anemia control with its own patients, it operates a mobile team of experts which travels to Azerbaijan’s regions to act as educators and trainers. They also provide advice to regional doctors through the internet and the doctors come to Baku for courses.
Levels of anemia in particular are a more acute problem outside Baku, mainly because pregnant women do not tend to visit a medical professional as regularly as they do in the capital. The reasons for this are various – poverty, bad roads, reliance on midwives who are inadequately qualified, but the Baku Institute’s mobile team is operating as part of a Ministry of Health campaign on ‘Safe Motherhood’ designed to combat such problems throughout the country.
Safer motherhood and healthier childhood through continued work on breastfeeding and anemia
The situation throughout Azerbaijan could look as positive as that at the Baku Institute looks if breastfeeding and anemia prevention practices improve countrywide. As far back as 1999 Azerbaijan’s Ministry of Health adopted a program on breastfeeding and in 2003 the parliament endorsed a law on protection of breastfeeding which incorporates principles of the International Code of Marketing of Breast-milk Substitutes. These policy level commitments were supported by building the capacity of local health staff in the implementation of UNICEF’s ten steps for successful breastfeeding.
But as breastfeeding and anemia are still problematic issues in Azerbaijan, UNICEF, together with the Ministry of Health and the Heydar Aliyev Foundation, is planning an expanded communication campaign on both issues. An assessment of the current situation with regard to infant and young child feeding is taking place and policy, guidelines and standards updates which will be in line with WHO/UNICEF standards are being developed.
Simultaneously the ground is being laid for establishment of a solid policy base for tackling anemia. All these measures, if implemented, should deliver positive results for Azerbaijan. Much lower anemia rates will mean healthier children and a more productive population.
And, as to breastfeeding, in the words of the triplet’s mother Arifa, ‘Mother’s milk is simply magnificent!’