Mali: promoting exclusive breastfeeding in "baby-friendly" maternities
SAHEL: Percentage of infants under 6 months who are exclusively breastfed: 17%
Clearly exhausted after a difficult delivery, Aminata Lea rests under a bednet in the maternity ward of the health centre in Djenné, 380 km northeast of Bamako, the capital of Mali. She has just given birth to a girl who is sleeping peacefully, nestled against her mother.
Aminata, a 20-year-old mother of two, does not want her daughter to undergo the same experience as her son, who was given date juice at birth. Her voice is weak, but she makes herself understood: “If my mother says we should give her date juice, I will tell her that date juice contains water and that you should not give water to babies younger than six months. In any case, breast milk already contains water.” At the Djenné health centre, which was named a Baby Friendly Hospital in 2005, Aminata has repeatedly been told about the importance of exclusive breastfeeding for an infant. A list of breastfeeding guidelines is posted on the door to the midwife’s office. One rule bans feeding bottles from health centre premises.
In Mali, exclusive breastfeeding during a child's first six months of life is slowly gaining ground. The proportion of mothers following this practice rose from 12% to 38%, according to the latest Demographic and Health Survey. But much remains to be done. Breastfeeding itself is not a problem – Malian mothers often breastfeed their children up to the age of two years and beyond – but exclusive breastfeeding is a stumbling block. Mothers and grandmothers traditionally give plain water, date juice diluted with water or herbal teas to infants.
It is a different story in the Djenné health centre, the Baby Friendly facility. According to Fatoumata Tolo Togo, one of the centre midwives, health agents urge mothers to put their baby to the breast in the first hour after birth. “In the maternity ward, mothers used to express their colostrum, even though the first milk is the best,” she says. “They don’t do it any more.” When mothers note that they themselves drank water as infants, Mrs. Togo explains that breast milk already contains water. This usually comes as a surprise. This midwife wastes no time in telling them that they need to change their ways. “Things move on,” she says. “The olden days are over. We have to change our old ways. The water our grandparents gave children was not safe to drink. That is why infants died.”
Supporting mothers to promote breastfeeding
At the Djenné health centre, the medical staff – made up of three midwives, two matrons and four doctors – are trying to tackle other bad habits, including the practice of feeding babies from both breasts in a single feeding. The mothers are told that they must feed from only one breast at each feeding and make sure it is quite empty to ensure that their infant gets the maximum benefit. It is no small matter, as switching breasts without properly emptying each one can have serious consequences, such as malnutrition, a condition that traditional healers might then aggravate by prescribing leaves, roots or herbs.
To convey the importance of feeding their babies from only one breast at each feeding, the health centre staff draws a comparison with cow’s milk. “At first, it is water, then it is milk, finally it is cream,” Mrs. Togo says. It is a colorful way of explaining that, when breastfeeding is done properly, breast milk is the only food an infant needs in the first six months of life.