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Health workers build a network of support for new mothers in Uzbekistan

© UNICEF Uzbekistan/2010
Dildora Rakhmankulova, 24, holds her two-month-old son, Abdulaziz, in Gulistan, Uzbekistan.

By Nigina Baykabulova

GULISTAN, Uzbekistan, 18 August 2010 – Two-month-old Abdulaziz is sleeping quietly in the arms of his mother, Dildora Rakhmankulova.

Ms. Rakhmankulova, 24, is not a first-time mother. Her elder daughter, Diyora, was born in the same maternity hospital as Abdulaziz and is already three years old. While many things about raising the two children are the same, there is one striking difference: the way that the young woman is feeding her new infant.

Exclusive breastfeeding

Local health workers have advised Ms. Rakhmankulova to exclusively breastfeed Abdulaziz for the first six months of his life.

© UNICEF Uzbekistan/2010
Nargiza Rozikova, 30, (left) with her infant and a health worker at a maternity unit in Gulistan, Uzbekistan.

“I’m giving my son only breast milk, no other food, and no water,” she said. “I see that he is doing really well, especially in comparison to my daughter. He didn’t have a cold or any other illness so far.”

Ms. Rakhmankulova thinks that her son’s good health is the result of exclusive breastfeeding. “I am convinced that my breastmilk is the best and the most natural food for my child,” she said. “It makes him stronger and also helps prevent various childhood illnesses.” 

The situation is markedly different from the first few months of her daughter’s life. At that time, Ms. Rakhmankulova didn’t know how to breastfeed properly or who to talk to for advice. Her daughter often fell ill – so she was fed a mix of breastmilk, milk formula or medicines.

While it was not her intention to make her daughter sick, Ms. Rakhmankulova lacked good advice from well trained health workers. “I simply did what the doctors had prescribed and told me to do,” she said.

Supporting mothers

Health providers are essential to helping mothers breastfeed their newborns and infants. They watch women closely during their pregnancy, as well as during and after delivery, and are called on for expert advice. But far too often, health workers themselves lack up-to-date knowledge and skills and fail to guide new mothers correctly.

© UNICEF Uzbekistan/2010
Timely support from health workers in Gulistan, Uzbekistan helped Dildora Rakhmankulova, 24 (right), to initiate her son's early breastfeeding.

“For years, we have been taught to keep mothers and newborns separately, and feed infants not on demand, but according to the clock,” said Maryam Hojimatova, Chief Doctor of the maternity unit at Gulistan’s health department. “Similarly common was the practice of prescribing breastmilk substitutes – in fact, it was considered a progressive thing to do,” she added.

Dr. Hojimatova’s maternity unit was not actively promoting breastfeeding until just three years ago. But now it is taking major steps to change the situation in the region through the promotion of breastfeeding and the creation of a fully supportive environment for mothers.

“We seem to have long under-estimated the role of exclusive breastfeeding for both children and their mothers,” said Dr. Hojimatova. “We now understand that it lays the foundation for the future well-being of a child.”

Ten ‘baby-friendly’ steps

After taking part in a series of practical trainings, Dr. Hojimatova’s team became passionate advocates for breastfeeding among women and their families.

“It’s not easy to say ‘no’ to old practices if you are not convinced yourself,” admitted Dildora Mavlyanova, the team’s senior nurse.

This month, the Gulistan maternity unit was listed among 35 Uzbek health facilities which had successfully joined the UNICEF-supported ‘Baby-Friendly Hospital Initiative.’ This means that the unit now follows 10 internationally recommended steps for successful breastfeeding and promotes the practice to all mothers.

In Uzbekistan, as in many places around the world, women do not stay long in maternity wards. And a few days of counseling are often not enough to keep new mothers fully committed to the practice. They soon go out and enter a different world, full of contradicting messages and misinformation.

It is not surprising then that the national rate of exclusive breastfeeding stands at just 26 per cent, which is below the global average of 37 per cent – a number which experts agree is already too low.

Sustainable impact

To ensure that its new breastfeeding campaign has a lasting impact, the Gulistan maternity unit is reaching out to four family clinics and five rural health points in the area.

“We all receive the same patients, at one point or another,” said Dr. Hojimatova. “So we thought, why not work together to improve our women and children’s health?”

Mothers’ support groups are also part of this chain of influence. Led by nursing mothers, the local groups often enjoy a higher level of trust from families and communities. “A doctor’s advice may not always come through strongly,” explained Dr. Hojimatova. “Healthy babies of healthy mothers are a better proof of the value of breastfeeding.”

The collective effort is yielding some positive results. This year, the ‘connected’ rural health points are reporting fewer cases of diarrhoea and other routine illnesses among babies.

Meanwhile, the Gulistan maternity unit confirms that all deliveries this year have been safe ones.



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