Don’t Stop!

The many benefits of breastfeeding after six months

Gabriel Reec
A mother holding her malnourished daughter
UNICEFSouthSudan/Reec
04 August 2020

Aweil, South Sudan -There could be a picture of Ading in the dictionary under the word undernutrition. She is too short (stunted growth) and weight too little for her age. Her arms are like twigs with a mid-upper arm circumference (MUAC) of 9.6 cm. Not only her body has changed, her eyes are sunken like the face of an old person. It all started with pew, which is cow milk in the Dinka language, and a story about a witch.

Before we get into that, let’s talk about breastmilk. It is often called the first vaccine as the mother is transferring her antibodies to the baby through the milk. It is also packed with nutrients and contains everything the baby needs. UNICEF and WHO recommend six months of exclusive breastfeeding of every baby to ensure the best start in life but encourage mothers to continue also after the six months have passed- especially in a country like South Sudan where food can be scarce.

Back to the cow and the witch. When Ading’s mother Awach Chan Dut stopped breastfeeding after six months it was to protect her daughter. When her first-born son Upieu was six months, she took him to the hospital because he had stomach problems. She was told “caa ace keek lowiic, aa cik pieth bii methke thuat” meaning that important nutrients have been removed from the breast milk by a witch and that is why the child has stomach problems. Further, she was advised to stop breastfeeding immediately because the breastmilk was dangerous.

It was the urge to protect Ading that made Awach give her third-born cowmilk and custard.

“Ading was stressed by the sudden halt in the breastfeeding and continued to demand for breastmilk. She cried a lot, but I refused to give in to protect her from dangerous breast milk,” says Awach.

A malnourished girl is looking at the camera
UNICEFSouthSudan/Reec
Ading sitting outside her home in Aweil. She is suffering from severe malnutrition

As soon as Ading was given cowmilk she started having diarrhoea and grew thinner by the day. She was admitted to a hospital and the runny tummy stopped and the girl was improving. “Even after, she continued to reach for my breasts, she wanted breastmilk,” Awach recalls.

But as any good mother she wanted to protect her daughter and continued with the cowmilk, which made Ading relapse over and over and became a frequent visitor in the local hospital in Aweil and the Gabat nutrition centre. When she was readmitted to the hospital as a 17-month-old in June 2020, she was 64 centimeters long instead of 80.3cm, that is 16.3 cm shorter than average for her age. She weighed only 4.3 kg, normal for a child one month old-and close to death.

Luckily, Ading was saved again and is now improving and moved from inpatient to outpatient care- hopefully for the last time.

“For the first time in the last one year, I can say my daughter is out of danger, I really appreciate the efforts of nutrition staffs in Gabat and Malualkon Stabilization Centre, for if they did not help, she would have died long time ago, said Awach Chan”.

“I think breast milk substitutes given to Ading after the breastfeeding ended after 6 months did not provide the nutrients the child needed," saying Akoon, a Nutrition Worker for ACF in Gabat Nutrition Clinic”.

"Knowing that this household is also struggling to make ends meet, might also be a major contributing factor to her continued health problems, as the mother is not able to purchase enough food from the market," says Akoon.

Ading’s mother has been attending UNICEF supported infant and young child feeding classes and is now aware that breastmilk is not dangerous for the baby. She has just given birth to a new baby and she will continue to breastfeed him after six months. She has also become a breastfeeding champion in her village, and she encourage mothers to take their children for help when they are malnourished.

One day when she came across a mother whose child was malnourished, she said “nyankaai, lare menhdu Gabat tene miguang adoor, abii lo kony cit men waar cik kek Ading kony.” This means; my sister, take your child to Gabat Nutrition Centre, they will help to treat him like my daughter.

Ading is doing well and can go to play with her brother together with children from neighboring houses. With support from her mother, she can stand up on her legs, something that was difficult just a few months back. Lack of continued breast feeding for the first two years coupled with malnutrition has not just affected Ading physically, but it might have tempered with her cognitive development. She is likely to perform poorly at school, she may earn less than her well-nourished peers later in life and may have higher propensity for chronic diseases.

To prevent children from becoming malnourished, UNICEF and partners targets the first 1,000 days in a child’s life, starting when the child is in the mother’s tummy to the child’s second birthday. The 1000 days is a window of opportunity for preventing undernutrition and its consequences. UNICEF promotes breastfeeding, educated caregivers on nutrition-rich foods for infants and children from 6 to 59 months and provide micronutrient supplements. UNICEF also supports treatment of acute malnutrition among pregnant and lactating mothers. By focusing on these first 1,000 days, UNICEF has helped cut the number of children badly affected by stunting by nearly 100 million since 1990.

Battling malnutrition is more than just ensuring nutritious food for every mother and every child. Access to clean water, sanitation and hygiene, protection from diseases and access to health care when sick is essential to reduce malnutrition in South Sudan. In 2020, UNICEF estimates that 1.3 million children will suffer from acute malnutrition in South Sudan.

UNICEF would like to thank our generous donors ensuring robust nutrition programmes for prevention and treatment of malnutrition
- in particular ECHO, UK Aid and USAID and the Swiss and German National Committees for UNICEF.