Breastfeeding and Childcare: Community Support and Participation

"If breastfeeding did not already exist, someone who invented it today would deserve a dual Nobel Prize in medicine and economics. For while “breast is best” for lifelong health, it is also excellent economics. Breastfeeding is a child’s first inoculation against death, disease, and poverty, but also their most enduring investment in physical, cognitive, and social capacity"- The Lancet Breastfeeding Series

"The first years of the child's life are critical for the healthy development of the brain. During those early years, almost 1000 brain cells connect every second -a pace never matched again" -Anthony Lake, Former Executive Director of UNICEF (2010-2017)

The "back and forth" interactions between the baby, the breast milk, and the carer help to build the developing baby's brain, which is not mature at birth, prevent diseases, and prepare them for life. The major player in the nurturing of a healthy baby and rapid brain development is nutrition in the first 1,000 days of life. Breastfed babies tend to have fewer incidences of ear infections, respiratory illnesses, allergies, diarrhoea, and vomiting.

According to The Lancet, a non-breastfed child is 14 times more likely to die in the first six months than an exclusively breastfed child.

"Something as simple as better breastfeeding could save a million children a year." - Anne M Mulcahy

Human breast milk is the healthiest form of milk for babies; it gives them everything they need and costs only what it takes to feed the mother. Breast milk has the exact combination of protein, fats, vitamins, minerals, enzymes, and sugars needed for the human infant at various stages of his or her growth and healthy development of the brain. In addition, it contains 90% of the humoral secretory IgA that provides mucosal protection against infection. It also contains lactoferrin. More so, breast milk has an easily digestible protein component (whey to casein ratio of 60:40). More so, it contains an easily digestible carbohydrate (lactose) in a higher concentration. These also reduce the chances of allergies. Due to the digestibility of breast milk, breastfed babies are rarely constipated.

"Mother's milk, time-tested for millions of years, is the best nutrient for babies because it is nature's perfect food." - Robert S. Mendelsohn

Early initiation of breastfeeding (which is within 30 minutes to an hour of delivery following spontaneous vaginal delivery and caesarean section, respectively) encourages bonding, which is the process of developing an emotional connection between mother and baby. In addition, babies are also afforded the opportunity to get colostrum, which is produced within the first 48 hours of delivery and serves as the baby's first immunisation. Another benefit of early breastfeeding initiation is that it prevents postpartum haemorrhage. This is because of the fact that sucking releases oxytocin, which in turn, leads to contraction of the uterus, which in turn prevents postpartum haemorrhage. Furthermore, sucking on the mother’s breast by the baby stimulates breast milk production, which by extension reduces the risk of breastfeeding difficulties and failure of breast milk production.

"A newborn baby has only three demands. They are warmth in the arms of its mother, food from her breasts, and security in the knowledge of her presence. Breastfeeding satisfies all three." - Grantly Dick -Read

Some of the highlighted benefits of breastfeeding for babies include;

It is hygienic, safe, readily available at the right temperature, needs no preparation, and comes free of charge.

It prevents children from getting frequent infections such as frequent diarrhoea, childhood pneumonia, and recurrent ear infections.

Breastfed babies have a lower risk for obesity, diabetes, and allergies such as asthma and allergic rhinitis.

The sucking process of the breast helps in the development of the facial muscles of the baby.

It exposes the baby to a variety of tastes through the sucking of the mother's milk.

Breastfed babies have been noted to have better overall dental health than formula-fed children.

Some benefits of breastfeeding for mothers include:

Breastfeeding mothers are less likely to have puerperal depression.

Breastfeeding reduces stress, enhances return to pre-pregnancy weight, promotes family planning, and saves money.

Mothers who breastfeed their babies are less likely to have breast and ovarian cancers, as breastfeeding lowers the risk of these malignancies. It also protects against type 2 diabetes mellitus.

More so, for the family, it saves money and reduces financial exploitation from the use of breast milk substitutes.

The first 1000 days are the period in which the brain is most sensitive to positive and negative environmental inputs. Breast milk is a vital source of nutrition for infants, especially during the first 1,000 days of life. This period, which spans from conception to a child's second birthday (270 days being 9 months of pregnancy, the first 365 days, and another 365 days until complete 2 years of age), is critical for growth and development, and breast milk plays a crucial role in supporting healthy brain development. Breast milk contains essential nutrients and bioactive components that support the growth and maturation of the brain. Studies have shown that breast milk can improve brain development in the weeks after preterm. https://www.thousanddays.org/wp-content/uploads/1000Days-Nutrition_Brief_Brain-Think_Babies_FINAL.pdf. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0272125

According to the World Health Organization (WHO) Expert Consultation on the Optimal Duration of Exclusive Breastfeeding in 2001, it recommended what should make up optimal breastfeeding for every newborn baby except otherwise medically contraindicated;

• Adequate nutrition of pregnant and lactating women
• Exclusive breastfeeding (breast milk only with no addition of water or other substitutes) in the first 6 months with initiation within the first hour of birth
• Appropriate complementary feeds starting from 6 months (local and nutritious food).
• Continued breastfeeding for up to 2 years and beyond
• Nutrition complemented with early childhood care and development interventions (health, social services, early learning).

"Contrary to popular belief, attaching the baby on the breast is not an ability with which a mother is born; rather it is a learned skill which she must acquire by observation and experience"- Woolridge M. The “anatomy” of infant sucking

"Breastfeeding is an instinctual and natural act, but it is also an art that is learned day by day. The reality is that almost all women can breastfeed, have enough milk for their babies and learn how to overcome problems both large and small. It is almost always simply a matter of practical knowledge and not a question of good luck." -La Leche League

It is a costly assumption that mothers will assume the natural role of breastfeeding after delivery without the support of health care providers and the community in general. This ignorance on the part of mothers and carers necessitated the initiation of the breastfeeding hospital initiative. The Breastfeeding Hospital Initiative (BFHI) was launched in 1991, following the Innocenti Declaration adopted in 1990 by the WHO/UNICEF Policymakers Meeting. The overall aim was to encourage mothers to practise exclusive breastfeeding for 6 months and continue breastfeeding for up to 2 years. The specific goals were to protect and promote breastfeeding as well as ensure the proper use of breast-milk substitutes when necessary. The importance of breastfeeding and its critical role in the first 1,000 days of life was further emphasised in 2001 and 2006 by WHO and UNICEF, respectively. They reported that breastfed infants are better provided with superior nutritional content for immunity and a reduction in future healthcare spending for that particular child.

In other to achieve optimal breastfeeding for every child, WHO initiated the following ten steps to successful breastfeeding, such that every facility providing maternity services and care for newborn infants is mandated to follow the ten steps as highlighted below;

• Have a written breastfeeding policy that is routinely communicated to all health care staff: A policy-making breast milk the standard of care, keeping track of the supports for breastfeeding, not promoting artificial formula, bottles or teats
• Train all health care staff in skills necessary to implement this policy: This involves training and retraining staff on supporting mothers to breastfeed successfully.
• Inform all pregnant women about the benefits and management of breastfeeding: This includes preparing them on how to feed their babies. Every mother is educated on the benefits of breastfeeding through antenatal breastfeeding classes, one-on-one breastfeeding education.
• Help mothers initiate breastfeeding within a half-hour of birth: Hospitals encourage skin-to-skin contact between mother and baby soon after birth and help mother to put the baby (ies) to the breast within 30 minutes to an hour after delivery.
• Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants: Healthcare providers help mothers to achieve successful breastfeeding through practical steps after delivery. They help the mother to properly position the baby for proper attachment to the breast and suckling.

• Give newborn infants no food or drink other than breast milk, unless medically indicated. Mothers are encouraged to give only breast milk unless medically indicated. Help mothers practise safe formula feeding.
• Practise rooming-in —allowing mothers and infants to remain together—24 hours a day. Hospitals let mothers and babies stay together day and night. Also, make sure mothers stay close to their sick babies.
• Encourage breastfeeding on demand by educating mothers on their babies' hunger cues and not limiting breastfeeding frequency and duration.
• Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants. Mothers are counselled on the demerits of bottle feeding and the use of teats and pacifiers.

World Breastfeeding Week is celebrated from August 1–7 every year in recognition of breastfeeding as the foundation for life.

• Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic. Hospitals work with communities to enhance breastfeeding practices among mothers. Optimal breastfeeding is the collective effort of every one of us in society. The need for community support is further emphasised by the celebration of World Breastfeeding Week from August 1–7 every year. This was initiated by the World Health Organisation in recognition of breastfeeding as the foundation for life.

"The key to best breastfeeding practices is continued day-to-day support for the breastfeeding mother within her home and community."- Saadeh RJ, editor. Breastfeeding: the Technical Basis and Recommendations for Action. Geneva, World Health Organization, pp. 62-74, 1993

Our lawmakers can support breastfeeding through legislation that ensures a minimum of 4 months of paid maternity leave in both the private and public sectors and a flexible work plan for another 4 months. In addition, ensure employers provide a nursery room for mothers to breastfeed and express breast milk at work. And finally, prevent discrimination against breastfeeding mothers in the workplace.

The employers of breastfeeding mothers do have a role to play in community support of breastfeeding by respecting national laws on paid maternity leave, non-discrimination, and on-site childcare for those who bring their babies to work. They can also provide flexible work plans for nursing mothers, such as teleworking from home or part-time work.

Co-workers can encourage breastfeeding mothers by showing understanding, a cheerful outlook of acceptance, and non-discrimination, and also by providing opportunities for flexible time to breastfeed their new babies. The support of co-workers certainly makes a huge difference for breastfeeding mothers.

Fathers of newborns can support breastfeeding by helping to do house chores and helping to burp the baby after feeding; the father’s chest is great for this procedure. Fathers can also help change diapers and bathe babies. And most importantly, this, in turn, has great economic benefits for fathers who would have spent so much money buying breast milk substitutes weekly.

Breast is the best and breast milk is the best milk.

According to The Lancet on breastfeeding Series and I quote "If breastfeeding did not already exist, someone who invented it today would deserve a dual Nobel Prize in medicine and economics. For while “breast is best” for lifelong health, it is also excellent economics. Breastfeeding is a child’s first inoculation against death, disease, and poverty, but also their most enduring investment in a physical, cognitive, and social capacity."

"God is the inventor of breast milk, he made it free, brand new and original and without a competitive market for the gift of mankind from the cradle; He also placed the desire in the newborn baby to suck and grow to full physical & mental capacity. God desires not Nobel prize but the Glory due Him by advocating for optimal breastfeeding." -Promise Monday

You, Lord, brought me safely through birth, and you protected me when I was a baby at my mother’s breast -Psalm 22:9 CEV

As the greatest teacher and leader in the world history was teaching on the beautiful attitude on the mountain…" a certain woman in the crowd raised her voice and said to Him, Blessed (happy and to be envied) is the womb that bore You and the breasts that You sucked!” Luke 11:27 AMPC. The woman apparently linked the sound cognition of Jesus Christ to the optimal breastfeeding He had as a child.

"Breastfeeding is not a choice that mothers make; it is a basic responsibility of nurturing that mothers give to their children. We betray the ethics of the profession as health care providers when we make mothers believe there is greater good in not breastfeeding their children" - Promise Monday on advocacy for optimum breastfeeding (25th August, 2018)

"While breastfeeding may not seem the right choice for every parent, it is the best choice for every baby." - Amy Spangler

In conclusion, breast milk is an important source of nutrition for infants during the first 1000 days of life. It provides essential nutrients and bioactive components that support healthy brain development. Mothers of infants should be encouraged to breastfeed if they are able to do so, as this may offer the best chance for healthy brain development. As healthcare providers and community members, we all need to support mothers' right to breastfeed anytime, anywhere. Yes, we can make our society breastfeeding-friendly for the benefit of all.