By Zambia CSO-SUN Alliance and World Vision Zambia
Zambia recently joined other countries in commemorating the World Breastfeeding Week, celebrated from the 1st to the 7th of August each year, since 1982. This is a special event that allows the government, partners, families, health workers, civil society, employers and the media, an excellent opportunity to support breastfeeding mothers and appreciate them for their role in nurturing and raising healthy children.
As a country, Zambia, also shares in the common commitment to better the lives of children. Promoting, protecting and supporting breastfeeding is fundamental in the fight for the survival and development of children around the globe. Breastfeeding is the best way of providing safe, free, ideal food for healthy growth and development of newborn babies. Breast milk is the natural first food for babies, it provides all the energy and nutrients that infants need in the first six months of life, it continues to provide up to half or more of a child’s nutritional needs during the second half of the first year, and up to one third during the second year of life.
However, breastfeeding is constantly under threat from sub-optimal care practices arising from cultural myths, false claims from advertisers, marketers of infant formula and other breast milk substitutes. These are some of the challenges that undermine our mothers’ confidence and capacity to breastfeed successfully and also contribute to the high rates of illnesses and deaths among infants.
Early initiation and exclusive breastfeeding in the first six months of an infants’ life plays a critical role in preventing illness and death in early childhood. Babies not exclusively breastfed in the first six months of life are seven times more likely to die from diarrhoea, and a five times more likely to die from pneumonia compared to infants not exclusively breastfed. Exclusive breastfeeding for the first six months and continued breastfeeding up to 24 months could potentially reduce child deaths by 13%.
This year’s theme ‘breastfeeding support: close to mothers’ highlights the need for breastfeeding peer counseling. There are different circles of support that have influence on a mother’s decision to breastfeed and to have a positive breastfeeding experience. The presence or absence of support impacts on the women directly. These circles of support include: Family and social network; Healthcare system; workplace and employment; and government legislation.
Family and friends are the immediate front liners for a continuous support network. For instance, supportive networks reduce stress while support during labour and delivery increases the mother’s confidence in her ability to breastfeed longer. The spouse is the closest partner to the woman, and therefore he should not be aloof about issues of breastfeeding. Men need to engage in issues of breastfeeding as a way of supporting their partners.
New mothers are usually bombarded with misleading information and advice from people around them, as well as from aggressive commercials by formula manufacturers. Information from such sources can lead to adoption of poor health care practices. We need to protect our mothers from such influences. It is for this reason that the Government should enforce and ensure that Breast Milk Substitutes (BMS) regulations are adequate in order to prevent violation in order to protect breastfeeding mothers. Government must consider increasing taxation of harmful and unhealthy food products and having a 15% of these taxes earmarked specifically for nutrition-sensitive interventions (Agriculture, Education, Social Protection and Water, Sanitation and Hygiene).
Political will and government commitment are critical in promoting and supporting breastfeeding. In a recent statement on the occasion of the World Breastfeeding week, UNICEF referred to a review of six countries which demonstrated the important role of a supportive national environment. According to UNICEF, the right mix of supportive government policies, comprehensive childhood feeding programmes, trained health care workers and community outreach significantly increased breastfeeding rates, especially among individuals with the lowest access to healthcare and education, and those living in the poorest and mostly remote communities.’ While appreciating the government legislation on marketing of breastmilk substitutes, it is important to review this legislation to combat aggressive marketing of breast milk substitutes.
The health care system is another source of support for a woman before and during birth, as well as during the postpartum and postnatal care period. Supportive health care facilitates bonding and optimal infant feeding. Consideration for supporting and promoting breastfeeding should also take into consideration working women both in the formal and informal sector. Women in the formal sector who need to return to work after maternity leave face many challenges and require support to succeed at both breastfeeding and working. Part of the support could be through provision of baby friendly work environments as well as addressing the issue of maternity leave entitlements.
The World Health Organization and the International Labour Organization (ILO) in their statement affirmed strong support to working mothers in the formal and informal sector for adequate maternity leave. These organizations emphasized that upon return to work, mothers need to be able to breastfeed their babies in line with ILO Convention 183. The Maternity Convention 2000 (No.183), is the most recent standard accompanied by the Maternity Protection Recommendation, 2000 (No. 191). Convention No. 183 broadens the scope of coverage to all employed women, no matter what occupation or type of undertaking, including those women employed in atypical forms of dependent work who often received no protection as well as extending entitlements to 14 weeks (98 days) of leave. Recommendation No.191 suggests that this period be at least 18 weeks (126 days). Expanding the scope of maternity protection as foreseen in the Convention No. 183 is of crucial importance in ensuring the health and well being of greater numbers of women workers and their children worldwide.
Currently Zambia has two laws for maternity protection: (1) the employment act CAP 268 and (2) statutory instruments (SI) 56 and 57 of 2008. The employment act provides for 90 days maternity leave for workers in formal employment while the SI provides 120 days for vulnerable workers who have no collective agreement or not unionized.
If indeed we are going to achieve higher breastfeeding rates in Zambia, government must ensure that, the ILO Convention No. 183 and recommendation 193 which accompanies it, is ratified and domesticated in our labour laws. Given that paid work is central to the lives of all men and women, protecting women’s employment and economic security during maternity are vital elements for safe pregnancies, healthy mothers and newborns. Government, therefore, need to promote laws and mechanisms that enhance implementation of maternity protection in Zambia.
The two categories of maternity leave of 90 and 120 days are not adequate to allow women to exclusively breastfeed for the first six months of a child’s life in line with the scaling up nutrition program that the government is implementing. The Zambian government must enact laws on maternity leave that support exclusive breastfeeding. Absence of exclusive breastfeeding may lead to undernutrition. Undernutrition causes more than one third deaths of children under 5. Many of these deaths occur in the first year of life and are associated with inappropriate breastfeeding practices. Every year, poor nutrition is the underlying cause of at least one third of all deaths of children under five. When Children do not get the right food or enough food in the first 1000 days (-9 to 24 months) of their lives they are essentially handed poor future. This is because this period is critical for their growth and cognitive development. Malnutrition is due to both inadequate dietary intake and infectious diseases. These children are weaker, grow poorly, and have a higher risk of illness, and consequently will have lower educational and income-earning protects.
This year’s world breastfeeding week is very unique and provides further opportunities to support and protect breastfeeding. First and foremost, this is a year when government has launched the first 1000 most critical days programme that aims at reducing stunting. Breastfeeding promotion is one of the high impact interventions that supports the first 1000 most critical days programme.
While the government and other key stakeholders have demonstrated commitment to better the lives of children through breastfeeding and other interventions, maternity protection is key to the effective implementation of the First 1000 most critical days programme in Zambia.