|Nawaal Mohamed Nur attends a counselling session on breastfeeding with a SAACID worker.|
By SAACID and Eva Gilliam
MOGADISHU, Somalia, 9 December 2011 – Nawaal Mohamed Nur, a 34-year-old mother of nine in the Shingani District of Mogadishu, has had a harrowing several months. In June of this year, her daughter Amira was diagnosed with acute malnutrition.
They were referred to a community-based therapeutic care programme operated by the Somali NGO and UNICEF partner SAACID (pronounced say-eed, meaning 'to help' in Somali), which provided 17-month-old Amira with medicine and therapeutic foods.
By mid-August, Amira’s body was beginning to heal. Yet as she approached her final days of recovery, her mother was approaching the final days of a pregnancy.
Once more, the family received assistance from SAACID, this time from Shamso Abdullahi, a counsellor in Infant and Young Child Feeding (IYCF) practices.
Through counselling, Ms. Nur learned about the importance of breastfeeding to protect her next child from the malnutrition that had afflicted Amira.
Breast is best
Exclusive breastfeeding for at least the first six months of life is recommended by UNICEF and the World Health Organization. Breast milk provides all the nutrients newborns need for healthy development and also provides important antibodies against common childhood illnesses. Exclusive breastfeeding also prevents babies from ingesting contaminated water that could be mixed with infant formula.
The difference between breastfeeding and formula feeding is tremendous: Breastfed children have at least a six-fold greater chance of survival in the early months than non-breastfed children.
Still, many Somali women do not exclusively breastfeed, instead feeding their infants camel’s milk, tea or water in addition to breast milk.
“In Somalia, most mothers do breastfeed their infants,” at least some times, Ms. Nur said. “However, the common practice is to also feed babies other infant formulas. In rural areas, women often return to strenuous work in the fields within days after giving birth, so it is especially difficult for mothers to follow recommendations regarding breastfeeding.”
Famine and drought take a toll
Ms. Abdullahi says the drought and famine have also taken a toll by driving many rural women to the capital, where bottle-feeding is common.
“Many of the women from the countryside usually do breastfeed, even up to one year, even if the lactating mother is malnourished,” she said. “But when these women come to Mogadishu, they see the women here bottle-feeding with formula, and believe it is better. Then they start changing their ways.”
Making matters worse is the abundance of infant formula in camps for the displaced, much of it donated by people around the world who believe malnourished mothers are unable to breastfeed.
“While this is well-meaning, we strongly discourage this,” said Dr. Osamu Kunii, Chief of Child Survival and Development in the UNICEF Somalia office. “Infant formula should only be used in extenuating circumstances where infants have lost their mothers, or the mother cannot produce milk and no wet-nurse can be found. It should never be used if breastfeeding is an option.”
Dr. Kunii went on to explain that the donations can actually increase child mortality, as mothers may choose to forgo breastfeeding in the belief that infant formula is better.
Changing habits to save lives
But programmes like SAACID are helping to change this perception. Supported by UNICEF and the World Food Programme, SAACID operates 15 centres across Mogadishu, treating malnourished children and providing nutrition counselling and assistance to pregnant and lactating women.
“What we do in the IYCF programme,” said Ms. Abdullahi, “is explain why breastfeeding is so important, as well as explain the risks to the child if breastfeeding is not exclusive.”
She also encourages mothers to initiate breastfeeding within one hour of birth to ensure infants receive their mother’s first milk, known as colostrum, which is antibody-rich and higher in protein than ordinary milk.
Amira did not receive colostrum when she was born, and she was exclusively breastfed for only two months. After the IYCF counselling, Amira’s mother made other plans for her next child.
Ms. Nur has since given birth to baby Ayan, whom she fed colostrum immediately after giving birth. Ayan is also being exclusively breastfed, and Ms. Nur is helping to promote breastfeeding to other community members.
“There are two important things that I have learned that I will not forget for the rest of my life,” she said. “The first thing is that you can feed your baby with breast milk even during pregnancy. The other thing is that you should feed your baby with breast milk for the first six months without any other milk or food.”
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