Giving children the right start in life
Giving children the right start in life
Loulli has just woken up from her nap, eager to play with her older sister and cousins. At eight months, she is full of energy and easily responds to her playmates’ clowning around with a giggle, and tries to stand on her feet. But just three months ago, her story was very different.
At five months, Loulli was getting recurrent fevers, and her mother Khamvilay started to worry she weighed less than the other children in the neighbourhood. After bouts of fever and lack of appetite, Loulli was diagnosed with Moderate Acute Malnutrition (MAM) at the Xepone District Hospital.
“She was really healthy and growing taller,” – or so she thought – “but had little appetite whether for breastmilk or for other food,” Khamvilay says; adding she had little to worry about since she was breastfeeding her. She simply attributed Loulli’s low weight to her poor appetite.
After the MAM diagnosis, Khamvilay doubled her effort to breastfeed her daughter, and introduced into her diet rice porridge mixed with mashed vegetables, and SuperKid [a mix of vitamins and minerals added to food to prevent micronutrient deficiencies], provided by UNICEF to local health centres.
Along with advice on feeding Loulli, doctors and nurses at Xephone Hospital monitored Khamvilay’s health to be sure she was also healthy – especially because while pregnant she had repeated fevers and allergy attacks. She initially suspected her daughter’s condition was caused by her inability to produce enough milk or the little girl’s poor appetite, but Maternal and Child Health staff assured her this was not entirely the problem, and could be addressed with proper complementary feeding.
Now that Loulli is well on the way to recovery, she has gained 1.3 kilograms in just three months, growing from 5.8 kg to 7.3 kg now. “Still slow compared with other children,” says Somsanouk, MCH nurse who attended to Loulli at the clinic, “but I am confident she is on a steady recovery – especially with the way she responds to stimuli around her environment, and her level of energy.”
If left untreated, Loulli could have suffered in the long run – including irreversible effects on brain development, weak health and immunity making her susceptible to infections and diseases, poor performance in school, and less productivity as an adult. Even worse, around 45% of the deaths among children aged below five globally are linked to undernutrition, according to WHO (Malnutrition Factsheet, February 2018).
Nutrition is linked to GDP growth: the prevalence of stunting declines by an estimated 3.2% for every 10% increase in income per capita, and a 10% rise in income translates into a 7.4% fall in wasting. In Laos, the cost of undernutrition in terms of loss in economic productivity is $197 million annually – or around 2.4 per cent of its national GDP, according to the Ministry of Planning and Investment report ‘The Economic consequences of Malnutrition’ (2013).
Khamvilay now vows to continue breastfeeding Loulli, although she says she may have to stop when her daughter reaches 18 months, still below the recommended two-year threshold, because she will have to return to her job as a secondary school teacher. Somsanouk reminds her to continue breastfeeding, especially if Loulli still has the appetite for it, to ensure her optimal health and growth.
For working mothers like Khamvilay, there are ways to go around this: she can either take advantage of the Government policy of an hour-break to return home and feed Loulli, or she can express milk in advance and keep this in the freezer or cold storage facility at home – or even in her office.
For mothers like Aht, however, who toil in the farms every day in a remote village, this is a challenge. A mother of a three-year-old and seven-month twin boys, she has to juggle working in the field all day, caring for her boys, and breastfeeding her twins.
But because she does not have any form of maternity leave, most of the time she has to leave her boys at home with her mother-in-law, feeding the young twins with rice porridge, tenderised meat, and vegetables while she works. Only when she’s home can she breastfeed them.
One of the twins is frequently sick, and I don’t understand what medicine the health workers give. So I just try to breastfeed them as much as I can,” she says. The boy has slowly recovered, but she still worries he’s a little smaller than his twin brother.
Although she goes to the village health centre for post-natal care, family planning advice and regular tests, the distance and amount of time she spends on the journey is time lost from work. Going is also not a decision she solely makes: as practised in her ethnic community, her husband and mother-in-law hold influence on her choice to go or whether she has the need to.
As a result, there is wide disparity in access to maternal and child health care in Laos, and women from poorer, rural villages often do not have these options. For example, about half of the women in rural areas are able to visit health centres. As per the Lao Social Indicator Survey, LSIS-II, Antenatal Care rate (at least four visits) among rural women stands at 55 per cent, while for women in urban areas it is 90 per cent. Often, the centres are too far away and women cannot afford to take the time off work or have no means of transport. In other cases, their family members may hold influence over the decision to seek professional medical care.
Prevailing social norms also hinder poor mothers from seeking safe childbirth. Fueang, head of the Lao Women’s Union in Naluang Noy village for nearly 30 years now, says “many still give birth at home or don’t seek care at clinics because they live far away, are too poor to travel or have no means of transport, or simply choose to remain working in the fields.”
UNICEF supports the Ministry of Health to organize integrated outreach activities in key target provinces to facilitate the access of mothers and their children in disadvantaged communities to key health and nutrition services, including antenatal care, immunization, and counseling and awareness raising on infant and young child feeding practices and breastfeeding among others. In addition, UNICEF has helped the Government to develop and implement a Multisectoral Social and Behaviour Change Communication Strategy for Nutrition and a parenting package to be rolled out in 2019.
While she has seen progress in the number of women in ethnic groups giving birth in health centres and seeking advice on nutrition – “they feel the centres are clean and have trained staff,” she says – common beliefs still prevail. One of this is supplementing breastmilk too soon because they feel they are not producing enough milk or their lactation is delayed. “They panic when their babies cry so they feed them with rice, cereals, or infant formula. They stick to this notion because they were taught or fed by their own mothers this way,” she laments.
Fueang raises this issue at local council meetings, reminding mothers to breastfeed their newborns, seek maternal and child care regularly, and be conscious of what they feed them. With an increasing number of health centres in villages, she has become an active advocate in changing many long-held notions, especially among ethnic groups.
So apart from keep on investing in facilities and health centres, especially in remote areas, and increasing the number of skilled health workers – equally important is to keep mothers informed of the services that are available to them, and changing the attitudes that prevent them from providing proper nutrition to their newborns.
Aht is lucky as she is one of only 25 per cent of rural women to give birth in a health facility assisted by a health worker and to get the services to somehow monitor her and her twins’ health. But there is a long way to go to close this divide. After all, optimal health and development is not only every child’s fundamental right, it is the moral responsibility of everyone in the community, including the local government, health workers, and families.