Around the world, medical experts recommend breastfeeding exclusively for the first six months. However, despite the overwhelming evidence of its benefits, many women are still bottle-feeding their babies.
For some, medical and living issues make breastfeeding impossible. But for others, according to health experts, the choice to turn to the bottle is influenced by a number of factors— from working conditions to life experiences— making it difficult for them to get the best out of breastfeeding.
Globally, nearly two out of three infants are not exclusively breastfed for the recommended six months, a rate that has remained steady for the past two decades.
The World Health Organisation recommends exclusive breastfeeding for children until they are six months old and continued breastfeeding with appropriate complementary feedings until children are two, for optimal growth and development.
Breastfeeding not coming naturally? You are not alone. For one Mactilda (not her real name), the milk just dried up four months into breastfeeding.
She felt like she was the worst mother in the world and blamed herself since she could not understand what happened.
For the three months she was on maternity leave, there was surplus of milk but immediately after reporting to work, the milk dried up. This, she attributed to stress and too much work.
She would struggle to pump milk and would manage only two bottles of 90 millitres a day. This was never enough for her baby.
Mactilda ate all types of food to influence the production of milk but it was not working.
“I changed my diet. However, my baby was not getting enough milk, he was constantly crying and irritable and losing weight,” says Mactilda.
To make the child comfortable and to have rest at night, she reluctantly gave in and started supplementing her feeds with formula. The change was immediate: her behaviour improved but still, Mactilda was not so sure whether she made the right decision.
“I felt very bad that I was not able to give my child the best. I had plans of exclusively breastfeeding him for seven months. I don’t know if this will affect my child in the future,” she says.
The baby is seven months now.
Mactilda represents thousands of urban working mothers who despite wanting to breastfeed exclusively for six months, are unable to do so because circumstances cannot allow them.
A study done in six counties looking into challenges among Kenyan women around this natural practice revealed work as a barrier to optimal breastfeeding and that it cut across social classes.
Work was a leading barrier followed by lack of food, poor knowledge, myths and misconceptions, health-related issues and poor social and professional support groups.
Dr Paul Mitei, a gynaecologist and obstetrician, says stress can lead to low milk production and that when mothers are under a lot of strain they do not function normally.
“It is better for a nursing mother to seek counselling or have someone to talk to when they suddenly experience low milk production,” Dr Mitei said.
He also said birth control methods with high levels of estrogen can impact the ability to produce milk. Birth control methds can cause hormonal imbalances.
“It is always advisable not to get into family planning with estrogen immediately after giving birth because of the negative impact it may have. When trying to breastfeed, it is advisable not to use birth control drugs, says Dr Mitei.
Just as birth control can affect milk production, certain medicines, vitamins or herbs can cause similar damage. Pseudoephedrine, which is in many over-the-counter drugs, can cause milk production to drop.
“It is best to ask your doctor if you are taking medicines and worried it may be causing low or no milk supply. Alcohol will also prevent your milk from coming in. Hard drugs are a major no-no when breastfeeding,” Dr Mitei said.
Affect milk supply
He also noted that a woman’s lifestyle could also affect her milk supply. Having a stressful job and home-life can also interfere with the flow of milk.
“The foundation of successful breastfeeding requires physical and mental wellbeing and therefore breastfeeding parents should have the emotional, domestic and financial support to be able to nurse their baby for as long as they want,” he advises.
But what is stressing Mactilda might not be what is distressing another mother who is ready to breastfeed— the milk is available yet the baby has refused to suckle.
For Maureen Kemunto (not her real name), her baby breastfed for only two months and stopped, although the flow of milk was good.
“There is nothing as tormenting and traumatising as having milk yet the baby does not want to breastfeed. All I had in mind when I gave birth was to exclusively breastfeed my child for six months but this was short-lived
“After delivery and the first 24 hours, he breastfed so well only for him to stop at two months. All he would do was to play with the nipple and not to suckle.
“My child lost weight and this weighed me down. I consulted and the only option was to place him on formula. He had a serious stomach upset because of poor digestion. This really affected me and I had to resign from my job to look after my baby,” she said.
According to Dr Walter Otieno, a pediatrician in western Kenya, babies normally stop breastfeeding when they are unwell. For instance, a cold or stuffy nose can make it difficult for babies to breathe during the exercise.
“A mother needs to be keen, at times the babies can refuse to breastfeed, say when they are growing a tooth.
"A cold sore can cause mouth pain during breastfeeding and an ear infection can also cause pain during suckling. An injury or soreness from immunisation might cause discomfort in a certain breastfeeding position,” he said.
Dr Otieno says the situation can be uncomfortable for both mother and baby and advises women to be patient while managing a baby’s eating habits.
Ms Josephine Karoki, a lactation expert, said lack of support to the women forces them to end breastfeeding early and start weaning their children.
Ms Karoki says to prevent engorgement and maintain milk supply, nursing mothers whose babies have refused to breastfeed should pump milk on the same schedule of breastfeeding and feed them with a spoon or bottles.
She adds: “Nursing mothers should try different feeding positions and where there are no distractions, for instance in a dark and quiet room.”
She also advises mothers to have skin-to-skin contact with their babies since it might renew their interest in breastfeeding.
“If a breast-feeding strike lasts more than a week, consult your baby's doctor for a review,” she said.
“Breastfeeding can be awkward, uncomfortable, and unproductive in the beginning,” says Ms Karoki.
She advises that governments should focus on how to better help women achieve the six-month mark of exclusive breastfeeding.requiring that a baby is fed nothing, not even water, for the first six months of life.
“Lack of support from employers forces many women to choose between their careers and their families. Many choose work, which can be stressful at times. The process can affect breastfeeding,” said Ms Karoki.
Gladys Mugambi, the Head of Nutrition and Dietetics at the Ministry of Health said there was a need for women to join the lactating support group and consult an expert whenever they experience any problem.
“Joining the groups might be very helpful since they will get to interact with mothers who have gone through the same process and help them. It is also advisable to get in touch with an expert in case the problem persists,” she says.
Kenya has seen a remarkable growth in exclusive breastfeeding for children under six months. A study done by he United Nations Children’s Fund (Unicef) in 2016 ranked Kenya number 20 in the world, attaining a 61 per cent exclusive breastfeeding rate.
The achievement, according to Health Cabinet Secretary Sicily Kariuki, is because of a massive drive to promote breastfeeding. Two of the programmes set up by the Kenyan government are the Baby Friendly Hospital Initiative and the Baby Friendly Community Initiative. One promotes breastfeeding in hospitals at the time of delivery and the other breastfeeding in the community.
Kenya is still ahead of other African nations and is among countries that have been able to achieve the World Health Assembly target of increasing exclusive breastfeeding in the first six months to 50 per cent by 2025.
But this is not reflected in all the counties. In Turkana and Baringo for instance, mothers are not breastfeeding their babies within the one hour of delivery simply because of some aspects of culture.
In the counties, it is still a taboo to breastfeed a baby before a naming ceremony. This is only adhered to when a mother gives birth at home and in the rural setups.
When they deliver in a hospital which most of them are turning to, they are forced by the health workers to breastfeed their babies
According to a joint data by the World Health Organisation and Unicef, two out of five newborns in Kenya are not breastfed within an hour of birth as recommended, putting them at risk of falling ill or dying before the age of five. Globally, three out of five or 78 million babies are not breastfed within the first hour of life
New-borns breastfed within the first hour of life have fewer chest infections and other health problems in childhood, and are less likely to die before the age of five. Moreover, they are less likely to develop diabetes or become obese in adulthood.
Even a delay of a few hours between birth and initiating breastfeeding could pose life-threatening consequences. Moreover, colostrum, the first thick, yellow milk is rich in nutrients and antibodies, serving as a baby’s first vaccine.
“Breastfeeding gives children the best possible start in life. We must urgently scale up support to mothers be it from family members, healthcare workers, employers and governments, so they can give their children the start they deserve,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus.
The WHO and Unicef-led Global Breastfeeding Collective also released the 2018 Global Breastfeeding Scorecard, which tracks the progress of breastfeeding policies and programmes.
Breastfeeding in the first 1,000 days of a child’s life is critical for child growth, well-being and survival and future productivity.
Kenya needs to do more to ensure the rights of mothers and children are realised.
"People tend to underestimate what milk is," says Katie Hinde, a biologist and associate professor at the Centre for Evolution.
Nutritionally, breast milk is a complete and perfect food, an ideal combination of proteins, fat, carbohydrates, and nutrients.
Colostrum is engineered to be low in fat but high in carbohydrates and protein, making it quickly and easily digestible to newborns in urgent need of its contents.
“It also has a laxative effect that helps a baby pass its momentous first poop, a terrifying black tar-like substance called meconium,” says Dr Hinde.