Exclusive breastfeeding, means breast milk, and nothing else
Exclusive breastfeeding is the single most effective intervention for preventing child deaths, yet according to the Demographic Health Survey exclusive breastfeeding rates have dropped over the past decade. Today, only one third of Indonesians exclusively breastfeed their children for the first six months. There are many obstacles to breastfeeding in Indonesia, including family members and physicians who do not support the practice. Some women fear breastfeeding will be painful and unpractical, but one of the biggest obstacles is the misconceptions of the term ‘exclusive’.
In Aceh, for example, with some of the highest stunting rates for children under-five in Indonesia, the awareness of the importance of breastfeeding is there, but it’s in the term “exclusive” that the problem lies. Husnaini, who is now a grandmother, used to give her daughter Zahira bananas and honey when she was only three month old. Now Zahira, 26, thanks to midwives in Gampong Nusa Posyandu, Lhok Nga who go beyond their duties to communicate the messages, her perception of breastfeeding is changing, and her three month old daughter Kanza now only receives breast milk. “My mindset changed because of what I learned at the health centre,” Zahira said.
Breastfeeding offers a host of benefits. Breast milk is the ideal food for infants, providing the nutrients they need for healthy development and passing on antibodies against common childhood diseases like diarrhea and pneumonia, the two leading causes of child mortality in the country. But many women and family members are still unaware of the benefits of exclusive breastfeeding.
Women must sort through myths, misinformation, and mixed messages about breastfeeding. “The myth that breastfed babies need water in addition to breast milk is widespread in the country. Many families also believe formula milk can increase intelligence and improve health,” explains Sri Sukotjo, a UNICEF Nutrition Specialist. “Complementary food, including water, should only be introduced when they reach six months of age,” she added. Midwife Khairiyah also echoes the same message “When a baby cries, mothers associated it with hunger, that is why they think breast milk is not enough, and they start giving bananas too early,” said Khairiyah. “Appropriate and safe complementary food can only be given after six months with continued breastfeeding up to two years or beyond,” she added.
Now, a majority of the women in the village choose to exclusively breastfed. “But it was not easy,” explains Khairiyah, who is the only midwife in the village. Initially people in the village refused to listen to her, especially the grandmothers who value tradition and cultural beliefs, but now they understand and many young mothers like Zahira have come forward to help her promote breastfeeding in the village.
Successful efforts to promote good feeding practices should focus not only on the mother but on those who influence her feeding decisions, such as mother, mother-in-law, and husband. “What was hard was to convince my own mother,” said Zahira. But she was fortunate that when she was expecting her first born, Zahira and her mother spoke with the midwife at the health centre. It was midwife Khairiyah who taught her how to express milk, and explained to her mother the importance of exclusive breastfeeding.
UNICEF applauds steps taken by the government to improve breastfeeding rates, including new health regulations that prohibit promotion of breast milk substitutes in health facilities, and which have formalized the right of women to breastfeed. This law will enable the country to create an environment that empowers women to breastfeed exclusively for the first six months and continue to breastfeed for two years or more.