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Tajikistan: Breastfed babies get best start in life

Nilutar Jamollidinova feeds her premature new born baby expressed breastmilk.

By Ruth Ansah Ayisi

DUSHANBE, Tajikistan, 1 August 2007 – Twenty-year-old Nilutar Jamollidinova carefully lifts her tiny baby out of an incubator. Her son, who is yet to be named, was born prematurely at seven months just a couple of hours ago. He weighs only one kilo and seven hundred grammes and is not strong enough to suck her breast milk.

Best chance of survival

However, his inability to suck is not going to prevent Nilutar from giving her baby the best chance of survival. He was given her breast milk within the first hour of his birth.

Encouraged by a nurse, Nilutar squeezes milk from her breast into a small medicine cup. When the cup is full she feeds her baby, cradling him tenderly in her arms.

Scientific studies show that when a baby is breastfed within the first hour of birth there is a dramatic reduction in the chance of neonatal death, particularly for vulnerable premature babies.

Crucial first hour

During that first hour, the mother’s body produces colostrums, a living fluid that builds a baby’s resistance to infection, helps recovery and accelerates intestinal maturation. It also stimulates the production of enough milk for the next feed helping set mother on the right track for exclusive breastfeeding for the first six months.

Giving a baby only breast milk for six months (known as exclusive breastfeeding) and no other fluids or solids during that period, continues to be one of the most effective ways of preventing infant deaths and childhood illnesses. Breast milk is more nutritious than artificial milk and promotes physical and cognitive growth, important for a country like Tajikistan, the former Soviet Republic with the highest infant mortality rate – 65 children out of every 1,000 live births will die in their first year.

Benefits for mother and baby

The act of feeding itself forms an early bond between the mother and baby and benefits mother’s health by preventing post-delivery hemorrhaging and inflammation of breast tissue due to infection.

Breastfeeding also makes economic sense. In addition to reduced medical costs it is also a free food source, important for a country like Tajikistan where there are high levels of poverty.

Baby-friendly hospitals in Tajikistan

However, despite all the benefits, Nilutar’s baby may not have benefited from breast milk if he had not been born at this “Baby-friendly” certified maternity hospital No 3, in Dushanbe.

Aslida Tashmatova, the Deputy Chief Doctor remembers when she first started working at the hospital in 1992 the situation was very different.

“Mothers and babies were kept in separate wards for the first couple of days and the babies were given artificial milk and dummies,” says Dr. Tashmatova. “There was no explanation given and the mothers just had to accept the practice.”

Today there are 21 baby-friendly hospitals in Tajikistan. This certification is only given to hospitals and clinics that pass a rigorous assessment by UNICEF. They must have policies in place to promote breastfeeding with staff trained in breastfeeding best practices. All mothers should be helped to initiate breastfeeding soon after birth and be shown how to breastfeed and maintain lactation even if they are separated from their babies.

Government passes law

In December 2006, the Government passed a law on Breastfeeding Protection that includes almost all provisions of the “International Code of Breastfeeding and Marketing of Breast Milk Substitutes” making Tajikistan the first Central Asian Republic to do so.

UNICEF has supported the training of nurses in breastfeeding practices and the production of literature and television spots in Tajik and Russian on the importance of early and exclusive breastfeeding.

Breastfeeding rates too low

Despite the achievements there is still a long way to go. A 2005 Multiple Indicator Cluster Survey (MICS) in Tajikistan shows that only 26 per cent of children below six months of age are exclusively breastfed.

Nilutar will have her own challenges back at home. The doctor promises they will follow-up on her as they do all premature babies, but she will have to make sure that she can stand up to family pressure. Her first son, Dadajon, now one year and seven months old, was born at this baby-friendly hospital, and she intended to exclusively breastfeed him for six months. “But my mother-in-law insisted that I should give him water too, so I did.”

So what happens if mother-in-law says the same again? “I will tell her that the doctor says I must not give him water,” she says, smiling coyly.

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