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Meeting the challenge of universal exclusive breastfeeding in Togo

Mothers deserve basic, accurate and timely information to adequately breastfeed

It is recommended that children between the ages of 0 to 6 months be fed exclusively with maternal breast milk. The micronutrients which pass from mother to child through exclusive maternal breastfeeding contribute to the healthy growth and development of infants. The antibodies present in breast milk also protect children from illnesses to which they are routinely exposed, particularly in more remote and disadvantaged regions.

Supporting mothers' health
« But in order for the mother to be able to fulfill her role, she requires a healthy and well-balanced diet. However to secure a diet sufficient in both quantity and quality is no easy task in a country where a food crisis already poses a considerable challenge. Now is the time to encourage pregnant and lactating mothers to take charge of their health, particularly in villages where the fight against poverty and malnutrition is already a pressing concern,” explained M. Vincent Maku, a member of UNICEF Nutrition team in Togo.

According to the results of the Multiple Indicators Cluster Study in 2006, the national rate of exclusive maternal breastfeeding in Togo is low (28%), and it is contributing to the problem of widespread malnutrition in regions like Savanes, Kara, and Maritimes. In Togo, 108 out of every 1000 children die before their 5th birthdays, and many of these deaths are related to malnutrition. In total, 14.3% of children under 5 are believed to be suffering from acute malnutrition. Exclusive breastfeeding is at a low 28%, thus contributing to widespread malnutrition
With the support of UNICEF, the Ministry of Health has established Maternal Breastfeeding Support Groups (MBSG) to bring together and empower women to go into their communities and promote improved nutrition for children and for pregnant and lactating women. These groups and their actions compose one element of the strategy designed to confront the nutritional crisis in the three regions most affected.

Peer support to promote exclusive breasfeeding
In Zowla, a village located 50km from Lomé in the Maritimes, a woman named Véronique is known throughout her community. While she works as a tailor, it is not for her dressmaking skills that she is renowned; rather it is for her dedication to her role as President of the local MBSG. Every week, Véronique sacrifices a day of work to visit pregnant women and mothers throughout her community. She ensures that the other members of her group have fully understood and can correctly explain to expecting and lactating mothers, the skills and advice needed to ensure proper breastfeeding practices. By extending their support to these mothers, the members of the MBSGs help women to leave behind certain traditional methods of feeding which can lead to malnutrition and unhealthy lifestyles.

Adjoko, 25, understands all too well the tough choices faced by Togolese mothers. After the birth of her child, pursuing exclusive maternal breastfeeding was a difficult decision. She had seen many mothers who supplemented their infants’ diets with water or porridge within the first 6 months of their children’s live. But thanks to the explanations and support provided by Véronique, she was able to persevere with exclusive breastfeeding. “Within the first few weeks, I could see results. My daughter, Emefa, was doing well, growing normally, and so far she has not had any health problems” Adjoko explained, while watching attentively over her daughter.

Changing behaviors and promoting good feeding practices
Today, Véronique tells us that nearly 7 out of 10 women are opting for exclusive maternal breastfeeding. But in Zowla, as in so many other villages, challenges persist.
In a town called Anfoin, just 3km from Zowla, a member of the local MBSG described the following. “When we go to visit pregnant and lactating women, we are not always welcome. If it’s not the elderly women accusing us of wanting to kill babies, it is the husbands who push us out the door. The problem is that people are having a hard time accepting that traditional practices can be bad for the health of babies. And since it is the women who must provide many of the household resources, they tend to abandon exclusive breastfeeding before their children reach the age of 6 months in order to free themselves to carry out their chores.”

But despite all of these difficulties, the members of the MBSG in Anfoin carry on with their efforts to advocate for exclusive maternal breastfeeding; and their perseverance is paying off. According to a local midwife, women are beginning to understand the advantages of practicing exclusive maternal breastfeeding. Women and the husbands who have supported them in the use of exclusive maternal breastfeeding have been very satisfied with the results.

“When my wife told me that the midwife had forbidden her from giving our son Paul any food but breast milk, I was very surprised, but I accepted. Since then, everything has gone well, and I am very happy because, given the rising cost of food, I don’t know how I would have afforded it if my son had gotten sick! It has been hard for my wife, but it has been worth it” one villager related.

Working with communities to manage and prevent malnutrition
Within Togolese communities, there remains much to be done in the struggle to bring about changes to traditional practices in order to improve child survival. To this extent, UNICEF in collaboration with the government of Togo will continue to direct many of its activities directly towards communities. The “Advanced Strategy for the Identification and Care of Malnourished Children”, launched in March 2008 in Savanes and Kara, is an example of one such activity. In implementing this intervention, nearly 30 000 children in 123 villages were examined, and 1333 malnourished children were provided with appropriate care.

But the work of the country office goes further. UNICEF Togo helps to provide nutritional rehabilitation centers with the goods and equipment they need to carry out their work, they collaborate with the World Food Programme and the National Nutrition Service to distribute therapeutic and other food-items, and they are working to build the capacity of Health Agents operating throughout the country.

Story by Essi Fafa Soule

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