Helping mothers give babies the healthiest start in Sierra Leone

Sierra Leone: When Fatmata Conteh noticed that her two-week-old baby was weak and her stomach appeared swollen, she became concerned. 

At home, she gave her baby warm water, hoping it would help. But her condition did not improve. 

“My baby was weak,” Fatmata recalls. “I kept giving her warm water, but it did not help.” 

Worried, Fatmata took her baby to the hospital, where nurse Saudatu Sesay gently explained that babies under six months do not need water, even in hot weather because breastmilk provides adequate water and nutrients they need. 

 Saudatu also showed Fatmata how to position her baby for a good latch and breastfeed comfortably. 

"The nurse taught me to continue giving my baby only breastmilk," Fatmata says. "She told me not to give her warm water." 

Fatmata followed the advice. 

Today, she sees the difference. 

"My baby was weak before, but now she is becoming stronger." 

Her story reflects a challenge many families across Sierra Leone continue to face. Although the country has made significant progress in breastfeeding, misconceptions about infant feeding remain common. According to the 2021 Sierra Leone National Nutrition Survey, 19 per cent of infants under six months are still given plain water alongside breastmilk. Many caregivers believe breastmilk alone is not enough or that giving water helps babies stop crying, relieves discomfort or helps them sleep longer. 

From 1 to 7 August each year, the world marks World Breastfeeding Week, a global campaign led by the World Alliance for Breastfeeding Action (WABA), together with UNICEF, WHO and partners, to promote, protect and support breastfeeding. This year's theme, "Breastfeeding for a Sustainable Start in Life: Strengthen What Works," is a reminder that mothers are more likely to breastfeed successfully when they receive the right support from the people around them. 

For Saudatu Sesay, a healthcare provider at the Special Care Baby Unit at Makeni Regional Hospital, those conversations happen every day. 

"We meet mothers with different experiences and beliefs," she says. "Some think babies need water because of the heat. Others worry that breastmilk alone is not enough, especially if the baby cries often. Our role is to listen first, understand their concerns and then guide them with the right information." 

Every day, Saudatu and her colleagues support mothers with practical breastfeeding counselling, demonstrating proper positioning and attachment while building their confidence to breastfeed exclusively during the first six months of life.

"When mothers understand why breastfeeding is important and receive the support they need, they become more confident," Saudatu says. 

That confidence is reflected in Sierra Leone's progress. According to the Sierra Leone National Nutrition Survey, the proportion of babies who are put to the breast within the first hour after birth increased from 57 per cent in 2017 to 89.4 per cent in 2021. While the prevalence of exclusive breastfeeding among infants aged 0-5 months is 52.7 per cent, nearly one in five infants under six months is still given water alongside breastmilk, highlighting the need for continued counselling and community engagement. 

The support mothers receive is also being strengthened through the Government's Neonatal Nursing Programme, supported by UNICEF with generous funding from the Government of China, through the China International Development Cooperation Agency (CIDCA). The programme is equipping neonatal nurses with specialised knowledge and practical skills to improve health outcomes for newborns. 

At Koidu Government Hospital, neonatal nurses like Kadija Dujba are putting those skills into practice every day. 

One of the mothers she recently supported was Bintu Abu. Following the birth of her baby, Kadija demonstrated how to position her baby for a good latch, answered her questions and explained why breastmilk alone provides all the nourishment a baby needs during the first six months of life. 

The experience reflects the value of the specialised training Kadija received. 

"The training has strengthened my ability to engage mothers and even family members on the importance of breastfeeding," she says. "I now begin those conversations during antenatal care visits so mothers understand the benefits of breastfeeding before their babies are born." 

From antenatal clinics to maternity wards and neonatal units, trained health workers are helping mothers begin their breastfeeding journey with greater knowledge and confidence. 

Alongside the Neonatal Nursing Programme, the Government, with support from UNICEF and other partners, continues to strengthen breastfeeding promotion through community counselling and behaviour change efforts that help families make informed decisions about infant feeding. Sierra Leone has also strengthened the protection of breastfeeding through the 2021 Breastmilk Substitutes Act, which regulates the marketing of breastmilk substitutes in line with international standards. 

Across Sierra Leone, these efforts are helping more mothers receive accurate information, practical guidance and encouragement when they need it most. 

For Fatmata, one conversation changed everything. 

Today, when she holds her baby close, she no longer reaches for warm water. 

She reaches for the confidence that breastmilk is enough, giving her child the healthiest possible start in life.