Sisterhood Unfulfilled: How all the Eggs Ended up in Her Basket

This is the second blog post of a three part series: Written by Abby Tseggai

It was a beautiful summer morning as Fana and her older brother, Kifle, skipped to their neighboring town, happy, emitting a love that siblings who suffered together feel.

It was now two years since the stillbirth of the little sister Fana wanted so badly. On a brighter side, it was two years that solidified an unbreakable bond between Fana and her big brother. They were getting ready for another big change –Kifle would soon be moving to America to complete his senior year of high school with the hope of attending college there too. Fana and Kifle did not have any immediate blood-cousins, and since Kifle was the only living boy, their parents put all their eggs in his basket, to use a popular expression. They expected him to nurture their family name and legacy, and therefore encouraged his quest to attain a better education, far away from their homeland, Eritrea.

It was always Kifle’s responsibility to pick up fresh eggs for their family every Saturday morning, and that summery Saturday morning was no different. Knowing that her big brother would soon be leaving, Fana wanted to take advantage of all the memories they could create, so she happily joined him. One mile into their journey to the market, they decided to race. Much to their surprise, Fana won. Basking in the glory of her victory, Fana did not realize her brothers cough was abnormal. Kifle did not think anything of it either. He stopped running and skipping and took the opportunity in that time, to express to Fana the anxiousness and fear about moving to a foreign land so soon. Fana joked it off. “Shut up! You are lucky,” she said.

The whole next day, Sunday, Kifle didn’t feel well, but didn’t bring the weak feeling he was experiencing to his parents’ attention. On Monday morning at school, Kifle’s teacher found Fana in the courtyard where the students ate lunch and told her that her brother was not feeling well and that she needed her help getting in contact with their parents.

Fana did not panic initially, forgetting all about how badly he was coughing during their race. She assumed he must have had a tummy ache or headache. She did not understand the severity of his teachers concern until the teacher said “You need to leave right now and bring your parents to the school immediately. “ In a panic now, Fana told the teacher that their father was in another country and that her mom was probably home, in which the teacher responded with “Ok, run home and bring her here quickly.”

She ran as fast as she could. Sadly Kifle died from pneumonia the following day. Never in a million years could Fana imagine, that the Saturday prior would be her last, amazing day with her brother. The last time she’d ever be someone’s sister. Her parents responded to the tremendous agony of losing another child – the fourth child they’d have to bury — by now placing all the eggs in Fana’s basket instead. The opportunity to attain an education in America to nurture her family’s legacy was now her duty to pursue. People in Fana’s village and some of her family had a difficult time respecting her parents’ decision; sending a girl to a foreign land was frowned upon.

This was a time in history where gender roles were very traditional and girls were raised to be women whose sole responsibility was to become great mothers and caregivers to the elderly. Education was an investment made in boys, so they could become the financial support for their families. Fana was the first girl amongst her peers to be afforded the same opportunity as the boys.

The irony that hindered her healing is she was only given the opportunity due to an infection that sacrificed her last sibling’s life.   Pneumonia is most common in younger children, particularly under the age 2; however adolescents may experience other constitutional symptoms, such as headaches and abdominal pain. Fana now, understood the same anxiety and fear Kifle tried to talk to her about. She never said, “Shut up” again.

 

Cover Photo Credit: Manzur Fahim, Flickr 

 

 

 

The Tricky Subject of Breastfeeding – Why We Do It and What We Need!

I am one in the 16% of mothers in Sweden who are still breastfeeding their baby at 12 months, compared to 34% in Norway and only 1% in the UK. The numbers are over 80% in low and lower-middle-income countries. Breastfeeding has a wide range of positive benefits for both mom and baby, regardless of whether you are rich or poor. So, what is it that determines a mother’s choice to breastfeed?

A friend of mine who recently had her baby in Sweden, came back from the children’s clinic a bit confused after being told by a doctor (who didn’t ask about her breastfeeding intentions, practice or routine) that if her baby doesn’t gain more weight in the next few weeks she should start giving her breast-milk substitute (a.k.a formula).

Despite the strong evidence of the benefits of breastfeeding (see below) and WHO’s recommendations to breastfeed exclusively for 6 months and continue for the first 2 years, women around the world do not have the support they need to breastfeed – and the Swedish doctor above is just one example of that.

The Lancet’s new research on breastfeeding shows that gaps in knowledge and skills among healthcare providers is one reason why women decide not breastfeed.

Breastfeeding is difficult, especially if you are caring for your first child. Often it is highlighted as a “free” option for feeding a child, but it comes with several costs and challenges. And for a woman to outweigh the positive with the negative, she needs a village of support around her. The Lancet research series states that a mother is 2.5 times more likely to breastfeed where breastfeeding is protected, promoted and supported.

Social norms in our families, communities and cultures also have a strong influence on breastfeeding choices. There have been several times when I have wished that I didn’t breastfeed – during the tiring nights when my growing infant demands so much more milk that feeding seems like an endless physical burden; when I have breastfed my baby in public and avoided unwanted judgemental looks from strangers; and when I have avoided to tell family and friends that “yes, I occasionally still breastfeed my 14-month old at night” because some people think it just isn’t normal. 

For other women limited or nonexistent maternity protection policies prevent them from breastfeeding. Short maternity leave of around 6 weeks (like in the US) increases the odds of not breastfeeding or stopping early by 400%!

Healthcare providers also have an essential role in supporting mothers who face difficulties during breastfeeding. Women need to be able to seek advice from health personnel with lactation training, who offer continued support. For this support to be effective it needs to be woman-centered and baby-centered – too often it is just one or the other, and not both. Too often women leave the hospital or clinic without proper follow up or support in the initiation of breastfeeding and beyond.

To make the situation even more complex, the formula market is a powerful industry that undermines breastfeeding. It is estimated that the global breast-milk substitute industry will grow in sales from $45 billion to $71 billion between 2014 and 2019. Breastfeeding does not have the same possibilities to market itself to expecting and new mothers and the communities they are in.

So, given the constraints – why should mothers choose to breastfeed?

Evidence shows that if breastfeeding was the “norm” 823,000 deaths of children under five and 22,000 deaths from breast cancer could be prevented every year! Breastmilk is a personalized medicine with benefits for both mother and child regardless of economic status. There is growing evidence that breastfeeding decreases the prevalence of obesity and diabetes later in life. It also benefits mothers’ health, decreasing the risk of breast cancer by 6% for each year of breastfeeding and also reducing the risk of ovarian cancer. These health improvements given by universal breastfeeding would translate to substantially reducing health care costs.

Breastfeeding does much more than supply children with necessary nutrition.

 

Breastfeeding is also associated with higher intelligence and increased future long-term earnings and productivity. The Lancet’s new series has estimated the costs of lower cognitive ability associated with not breastfeeding amount to about $300 billion annually (high-income countries losing more than $230 billion annually).

“Findings from epidemiology and biology studies substantiate the fact that the decision to not breastfeed a child has major long-term effects on the health, nutrition, and development of the child and on women’s health. Possibly, no other health behaviour can affect such varied outcomes in the two individuals who are involved: the mother and the child. Findings from immunology, epigenetic, microbiome, and stem-cell studies done over the past two decades that elucidate potential mechanisms through which breastfeeding can improve outcomes will probably be followed by other, even more exciting discoveries on the exquisite personalised medicine provided by human milk.”
The Lancet Breastfeeding Series

This article is not a pat on the back for mothers who choose to breastfeed nor a pointing finger aimed at those who don’t – it is a call for more support, education, information and policies that enable women to choose to breastfeed and to continue to do so when difficulties arise – and it is a scream to normalize breastfeeding, in homes and in public. The discoveries of the benefits of breastfeeding are amazing – and I hope that even in a society as gender equal as Sweden, we will understand these important benefits and support women (as a part of their rights) to initiate breastfeeding and continue to nurse for as long as they want, if they choose to do so.

Finishing the Unfinished Agenda for Mothers and Newborns

The Global Maternal Newborn Health Conference is the first major global meeting after the Sustainable Development Goals were agreed upon in New York last month. As such, it plays a pivotal role in signposting the dawn of a new era – an era within which we have unprecedented momentum and opportunity to move forward in the global maternal and newborn health agenda.

At tonight’s welcome event in Mexico City, President of the University of Miami, Julio Frenk looked back and reminded the 400 organizations and 70 countries represented in the audience the Millennium Development Goals (MDGS) were successful in focusing the attention of the global community on the health of mothers and newborns. He looked forward to the Sustainable Development Goals with a reminder we simply can not afford to lose focus on “finishing our unfinished agenda”.

An overarching message was that success in health never has a concrete end point – it is a moving target. The MDGs allowed us to improve the health of women and children around the world, but they also highlighted the many outstanding priorities still to be addressed.

Geeta Rao Gupta, Deputy Director of Programmes for UNICEF, told us maternal mortality has fallen by 45% between 1990 and 2015. She reminded the audience progress continues to favour the most fortunate and leaves behind those who have the least; the most impoverished and the least educated.

As the challenges facing mothers and newborns worldwide continues to shift, our response and our strategy must be maliable enough to shift alongside. We must take what we have learned in the last 15 years and apply it carefully to give the most vulnerable women and babies the chance to survive and the opportunity to thrive.

For Christopher Elias from the Bill and Melinda Gates Foundation, data is key. We must consider how we measure success and monitor implementation in a way which does not overburden or overwhelm. In his eyes, we need to “measure fewer things better” and focus on  the most relevant information.

Alongside data, equity and leadership were both cited as critical components to creating lasting change, and in the coming days we will hear more on each of these areas from experts within the field. This week, hundreds of individuals have a unique opportunity to learn together. We must align our energies so all babies, mothers and mothers-to-be can have the life they deserve.

Continue to follow #GlobalMNH and Girls’ Globe on Twitter, Instagram and Periscope for engaging coverage! 

Cover Photo Credit: GMNHC

Girls’ Globe speaks with Tikhala Itaye!

We have launched an interview series with health professionals and youth advocates with the purpose to highlight the work they are doing to improve the lives of women, children and adoloscents around the world. Yesterday, Girls’ Globe’s Vice President, Diane Fender “sat down” with youth advocate Tikhala Itaye, Vice President of AfriYAN Namibia and Co-Founder of Her Liberty Namibia. Tikhala is a passionate leader and young person creating amazing change for young people and communities in Namibia.

Diane and Tikhala

Did you miss the hangout? Watch it here: