Babies Get A Better Start in Life
By Ruth Ansah Ayisi Grimacing in pain after giving birth just a few hours earlier, twenty-year-old Nilutar Jamollidinova carefully lifts her tiny baby out of an incubator. Her son, who is yet to be named, was born premature at seven months due to an infection of Nilutar’s placenta. He only weighs one kilo and seven hundred grammes and is not strong enough to suck her breast milk. Yet, 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. A nurse encourages Nilutar as she 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 before laying him again in the incubator. Scientific studies have proved that breastfeeding introduced within the first hour of birth dramatically reduces the chances of neo natal deaths, particularly important for premature babies who are especially vulnerable. During that first hour, the mother produces colostrum, a living fluid rich in a variety of live cells that builds a baby’s resistance to infection, helps recovery from infection and accelerates intestinal maturation. It also stimulates the production of enough milk for the next feed, and helps to set the mother on the right track for exclusive breastfeeding for the first six months. Exclusive breastfeeding for six months – meaning the baby is only given breast milk, 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. Breastfeeding is also more nutritious than artificial milk and promotes physical and cognitive growth. The act itself forms an early bond between the mother and baby. Breastfeeding also makes economic sense, as apart from reducing medical costs due to sickness, it is also free, important for a country like Tajikistan, the poorest of the former Soviet Republics. Despite all the benefits, Nilutar’s baby may not have gained from breast milk if her baby was born in another hospital or before this maternity hospital No 3 in the capital Dushanbe, was certified “Baby-Friendly” in 1999. (It was re-certified as “baby friendly” in 2003.) Hospitals or clinics are given a Baby Friendly Award when they pass a rigorous assessment by UNICEF staff, which ensures that policies to promote breastfeeding are in place, and that all staff who come into contact with mothers have been trained in breastfeeding best practices. This includes their helping mothers initiate breast feeding soon after birth, showing mothers how to breastfeed and how to maintain lactation even if they are separated from their babies, and giving no artificial teats or dummies to breastfeeding infants. The hospital should also help set up breastfeeding support groups and refer mothers to them on discharge from the hospital. Aslida Tashmatova, the Deputy Chief Doctor at maternity hospital No. 3, remembers how 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 Tashmatova. “They were only allowed to see their baby on the third day. There was no explanation, and the mothers just had to accept.” Acceptance of the hospital orders by the mothers could have cost some of them the lives of their children, or at least put their babies’ health and normal development at risk. Breastfeeding also benefits the mother, preventing post delivery hemorrhaging and mastitis, an inflammation of breast tissue due to infection. “We had lots of problems with diarrhoea and mastitis among the mothers,” says the doctor. UNICEF programme assistant for health and nutrition, 33-year-old Safina Abdulloeva, a mother of three children, remembers the battles she faced to breastfeed her babies. When her first son, Tabriz, was born in 1995, she was separated from him for two days. “When they brought him to me on the third day it was only for three hours to breastfeed. I was then told he would also be put on bottled milk because I was not producing enough breast milk. He often suffered from diarrhoea as a baby.” Her second son, Tal’at, was born in 1998. “I fed him breast milk and artificial milk for three months, because I was told again that I didn’t have enough milk. He suffered a lot from allergies.” Abdulloeva was even a medical student at the time. “We just did not learn about the importance of breastfeeding on the course,” she adds. However her third boy, Rif’at, was born last year in a baby friendly hospital and despite some advice to the contrary, she has exclusively breastfed him. “My mother said I should get a breastfeeding schedule because she was worrying it was too much for me.” And when Abdulloeva developed a fever, a doctor wrongly advised her to stop breastfeeding otherwise she would “contaminate her baby.” Fortunately, she ignored the advice. Rif’at, now eight months old, appears to have reaped the benefits of six months of exclusive breastfeeding. “He has been healthy and is doing everything earlier than the others,” says Abdulloeva. There are now a total of 21 baby friendly hospitals in the country, four of which are in the capital. UNICEF has supported training of nurses in breastfeeding practices and has supported the production of literature and television spots in Tajik and Russian on the importance of early and exclusive breastfeeding. In December 2006, the Government also 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. Tashmatova, the Deputy Chief Doctor, explains that during their short stay in hospital, the new mothers receive support on the right way to breastfeed and additional help for any difficulties they encounter. Once discharged, they can benefit from a lively breastfeeding mothers’ support group, which meets three times a week. Tashmatova is especially excited that breastfeeding was introduced in the curriculum at the medical school in 2002. “We will have a new generation of doctors with good knowledge on breastfeeding practices.” Despite the achievements there is still a long way to go. A 2005 Multiple Cluster Survey (MICS) shows that only 26 per cent of children six months of age or less are exclusively breastfed. This probably contributes to the fact that Tajikistan has the highest infant mortality rate out of the former Soviet Republics. Some 65 children out of every 1,000 live births will die before they celebrate their first birthday. Almost 27 per cent are stunted and 9 per cent are severely stunted. Nilutar will have her own challenges back home. The doctor says they will follow up on her as they do with 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 said I should give him water too, so I did.” So what happens if her mother-in-law says the same again, “I will tell her that the doctor says I must not give water,” she says, smiling coyly.
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