Efforts to promote exclusive breastfeeding in Somalia- Q&A with a trained counsellor
HARGEISA, Northwest Somalia “Somaliland”, 20 September 2011 – Kultan Hussein, Somali Red Crescent Society national health officer, is a trained counsellor advising mothers how to keep their young children healthy. She spoke to Mike Pflanz
PFLANZ – One of the main projects you manage is the Infant and Young Child Feeding programme, supported by UNICEF with funding from the European Commission Humanitarian Aid Dept. Key to its approach is promoting breastfeeding. Why?
HUSSEIN – It brings great benefits, you can see it, children are less frequently getting diseases, especially diarrhoea. It protects against infections, it provides good nutrients, all that a baby needs. Women here were already breastfeeding their children, but not breast milk alone. Even from birth, they would add water or milk from goats or cows, or powdered milk. This is what their mothers and grandmothers have been doing. Fathers also think this is a good thing. But that can introduce germs to the baby that they would not get if they were just breastfeeding, so we are trying to encourage that the baby is given nothing but breast milk, not even water, for its first six months.
PFLANZ – What, practically, do you teach mothers?
HUSSEIN – We show them how to put the baby on the breast and how to position the baby. If you put the baby the right way, it will feed, but if you do it wrong, it can refuse. Here that can mean that the baby gets called a name, even if it’s because the mother did not even know how to bring the child to her breast. We tell them about giving only breast milk for six months, and then when adding other foods after that, we teach them that hygiene is very, very important. That’s when they start using utensils and spoons and bottles, and germs can come. We tell the mothers about washing hands, washing plates and bowls, keeping their house clean, safe disposal of the child’s faeces and disposing of rubbish properly.
PFLANZ – How do you get the message out?
HUSSEIN – We train volunteers who go house to house in the villages, advising pregnant and lactating mothers, and who arrange public meetings where mothers can ask questions and talk to each other about their concerns. It’s a kind of support group. It is much more participatory than lecturing them about the subject. Communication has to flow both ways, or you will not win their support. We believe that if we repeatedly go to the community and visit them and give them information, we can change the behaviour. We can break the barriers.
PFLANZ – Have you come across any difficulties as you have expanded this programme?
HUSSEIN – The challenges were so many. The mothers were all very reluctant at first. They said, “We have been doing this this way since our mothers’ time, why should we change?”. There were some misconceptions about exclusive breastfeeding. Some mothers believed that they will not produce enough milk for the babies, but we say the more frequently she puts the baby to her breast, the more milk she will produce. Others said that in the middle of the day, when it is hot, all human beings should take water to cool down, even babies.
There were also grandmothers, these are influential people in the family, saying I did it this way, and you should do the same, or so-and-so mother who says she adds cow’s milk or water for her baby and he is growing very strong. Well, what we are saying is that cow milk is important for the calf, and breast-milk is important for the baby. Even fathers were a problem. It is a sign of a good father that they bring a gift of formula milk and feeding bottles the very first time he goes to see his new child. So we talk to the fathers too.
PFLANZ – So, how do you overcome that resistance to change?
HUSSEIN – We found that difficulties can be tackled if we continuously give mothers the right information, and go back again and again. One week of information is not enough to make a difference, we need to do it continuously. If that family refuses, then we have to come back and repeat and repeat again. It is working, because we are finding many mothers seeing their children stay healthy, and then they tell other mothers it is because of exclusive breastfeeding and better hygiene.