My Journey of Political Courage, Resistance & Solidarity

Earlier this year, I was glad to be present to support a close friend in the miracle that is child birth. I stood by her through her unmedicated birth plan navigated by calculated breathing and back rubs, and through the eventual contractions that culminated in the birth of a beautiful baby girl.

Being an afternoon of many firsts, I also guided them in their first bonding experience between mother and child – breastfeeding. Having gone through this myself (my daughter turns four next month!), I am glad to be able to support my friend and her baby through the recommended 6 months of exclusive breastfeeding and beyond.

Great news indeed, but the journey of breastfeeding is still laced with many social, economic and political challenges to be overcome. Culture remains a great influence on the uptake of positive breastfeeding practices, especially in the African context. Positive social and cultural beliefs and practices which associate breastmilk with intellectual development and general good health encourage breastfeeding. On the other hand, long-standing myths and misconceptions weaved through cultural beliefs continue to be perpetuated from one generation to another and influence breastfeeding outcomes.

I confronted many myths in my own breastfeeding journey:

Myth 1: Breast milk alone is not enough to support optimal growth

According to WHO, exclusive breastfeeding is the practice of feeding only breast milk (including expressed breast milk) and no other liquids or solids with the exception of drops or syrups consisting of vitamins, mineral supplements or medicine and oral rehydration solution(ORS). When I was breastfeeding my daughter, I often received unsolicited advice on why breast milk was not adequate. For example, I was advised to supplement breast milk with water so that the baby does not get dehydrated or wean her off at 3 months to reduce and/or prevent colic.  What we know, though, is that breast milk’s composition changes from one feeding to another to meet baby’s physical, growth and developmental needs. Even over a single feed – it is higher in water content at first to quench the baby’s thirst and then the nutrient composition increases with time.

Myth 2: Breastfeeding is old fashioned & for poor people who cannot afford infant formula

I encountered social pressure from friends who felt that breastfeeding was old-fashioned and some wondered whether it was because we couldn’t afford infant formula. This meant that I received tins upon tins of infant formula with every visit. Needless to say, both baby and I boycotted any such offers – much to the chagrin of the gift bearers. The role of corporations in advancing aggressive marketing strategies that undermine breastfeeding and mothers’ confidence must be checked. The International Baby Food Action Network (IBFAN) (which monitors countries’ compliance with the International Code of Marketing of Breastmilk Substitutes) indicates that the world’s largest baby food companies are violating the Code which demands all communication to be ‘honest, truthful and not misleading’. Closely connected to this marketing gimmick is messaging that some mothers naturally do not produce enough milk. What this means is that a lot of young mothers ‘think’ they are choosing to breastfeed and then formula feed but in reality, they are actually responding to ‘profit-driven’ marketing strategies through advertisements and manipulation of health workers by corporations that eventually become passed on as culture.

Myth 3: ‘Evil eye’ if you breastfeed in public

Being the extrovert I am, this is a myth I encountered frequently! According to some African traditions, it is believed that if you breastfeed in public you could be watched by people believed to have an ‘evil eye’ –  basically a glare associated with witchcraft. Apparently, this can result in breast milk production stopping prematurely or mothers developing breast sores. This, coupled with disapproving looks I had to contend with when breastfeeding in public, meant that I had to premeditate my movements and compromise on which functions I attended – especially if I was planning to go with baby. For most mothers, this may prompt them to avoid breastfeeding or stop altogether, especially when attending public gatherings or generally being in public.

The female body is too often considered public domain open to ogling and scrutiny. On top of this, breastfeeding within a hypersexualized culture reduces female breasts to sexual objects and the mere act of nursing is laced with sexual undertones. The combined effect is another common belief among young mothers – that breastfeeding for prolonged durations will make their breasts sag and consequently unattractive.

Not all mothers are able to breastfeed their babies for a huge variety of reasons and the choice to breastfeed ultimately rests with the mother. For me, the choice to breastfeed was an act of resistance to the hold of patriarchy and capitalism has on our minds, bodies, and lives. I contend that in addition to public health interventions to promote breastfeeding, it will take political courage, resistance and solidarity to truly interrogate the preconditions under which women can freely decide to breastfeed.

#13 – Midwives Providing Safe Birth in Humanitarian Settings

 

“(Midwives) give support to women whether they are in labour or not, they are social solidarity players in the local communities, not only the providers of health services for women & newborns.” – Mohamed Afifi, UNFPA

Welcome back to The Mom Pod! In this episode Julia Wiklander connects us with midwives and advocates about maternal and newborn health in humanitarian settings, at the 31st ICM Triennial Congress in Toronto, Canada. The midwives that we meet work in Mexico, Somalia and Afghanistan and share experiences from their work and talk about the challenges they face to deliver care.

With a world in constant political change and with the largest number of displaced people in history, ensuring that every mother and every child has access to a midwife during pregnancy and birth, is a difficult promise to keep. The world needs more midwives.

“They’re not refugees, they are not citizens – they are migrants. We need to start to name this as a public health issue.” – Cristina Alonso, Midwife working in Mexico

Our conversation is also broadened by UNFPA Reproductive Health Specialist for the Arab States, Mohammed Afifi, who tells us that in the region, midwives is the cadre of health professionals that are committing to delivering care, despite conflicts that push away many of their colleagues.

Safe Birth Even Here is a Campaign run by UNFPA to raise awareness of the high rate of maternal deaths in emergency situations and increase support for services to protect the rights of the women and girls living in humanitarian and fragile settings. Johnson & Johnson is one of the partners supporting the campaign, and has committed to supporting health professionals at the frontlines of care. We speak to Joy Marini at Johnson & Johnson about why the company is investing in the health of women & children in humanitarian settings and what they are doing to ensure that midwives receive support in their important work. 

In this episode, Young Midwife Leader, Massoma Jafari from Afghanistan, interviews Jane Philpott, the Canadian Minister of Health and asks her what action Canada is taking to support midwives in Afghanistan. Philpott gives the young midwife advice and promises new connections. A meeting that hopefully sparks further engagement by the Canadian government to invest in midwives. 

Listen to the full episode here.

During the ICM Congress, Johnson & Johnson launched their new initative – the GenH Challenge. This exciting opportunity hopes to encourage midwives to see themselves as innovators with the power to help to create the healthiest generation in human history – “GenH”. The GenH Challenge is looking to discover brand new ideas from the front lines of care that can change the trajectory of health. If this sounds daunting, don’t worry! The competition welcomes ideas in their earliest stages, and it welcomes small ideas that have the potential to create great impact. You can apply any time until 4 October 2017. Full guidelines are available at www.genhchallenge.com.

See all of the Girls’ Globe LIVE coverage from the 31st ICM Triennial Congress in Toronto, Canada here

Fathers’ Role in Achieving Gender Equality

Women in OECD countries spend, on average, 4.5 hours per day doing unpaid work such as cooking and caring for children. This compares to about 2 hours for men. Even if the division of unpaid labor has become more equal over the years, women are still doing more, and this results in unequal health outcomes for everyone.

“Women, even full-time working women, spend fewer hours on average doing paid work than their husbands or partners do. That may be due in part to the fact that there’s this expectation or default arrangement where they are doing more of the child care or housework.” – Kim Parker, Pew Research Center

When I attended WABA’s Global Breastfeeding Forum in October 2016, I was a struck by Duncan Fisher’s (Family Initiative UK) enthusiasm towards fathers’ role in advancing breastfeeding progress globally.

In this year’s International Confederation of Midwives (ICM) Congress, I was pleased to see that Fisher was invited to a plenary session on women’s rights where he spoke about engaging fathers in maternal and newborn health, and the impact this has on advancing gender equality. Because, as Fisher put it, “the unequal sharing of caring roles is a major global driver of gender inequality”. And we know for sure that gender inequality damages both the physical and mental health of millions of women and girls worldwide.

Fathers are interested, they want information and they do want to be close to their children. Why then are women still the ones taking on the majority of the responsibility, and what consequences does this have? According to Fisher, there is a lack of public information and services directed at the fathers. They simply don’t know about all the benefits of engaging in caring for their children.

The evidence is out there – and it’s abundant!

Everyone wins when fathers engage, both in the short and long-term:

  • a father’s testosterone levels drop after the baby is born if he is physically present with the baby (i.e. cuddling!)
  • his oxytocin levels rise and so does the baby’s
  • breastfeeding rates increase
  • maternal mortality rates reduce
  • the mental health of mother and child improves
  • access to services improve
  • violence and abuse decrease

Fisher spoke about the neurobiological impact involvement has not only on the father’s brain, but also the mother’s. Caring for babies changes the brains of both parents, and the change lasts for the rest of their lives. And the more a parent cares for their baby, the more their brain changes. As if this wasn’t evidence enough: the more the parents’ brain changes, the better the child’s social skills are when they reach school.

Fisher also stressed the importance of midwives in fathers’ engagement, and said that midwives play an imperative role in encouraging fathers to cuddle skin-to-skin with their babies within the first few hours of life, and in informing men of the benefits of their involvement.

The unequal division of the responsibility of caring for, managing and educating children is unsustainable, and it undeniably affects mothers’ and babies’ health. Mothers should not be solely responsible for caring for their families – fathers must engage in order for us to achieve optimal health for women and children, as well as gender equality.

I am certain that the redistribution and reduction of unpaid care work and improved gender equality at home will improve quality of life, not only for women, but also for children and men. It most certainly is a win-win situation.

Family Initiative UK have launched an online course delivered by midwives and trainers which explores these issues. If you’re present in Toronto at this year’s ICM Congress, make sure to visit Family Initiative UK’s booth and learn more about the course! 

Girls’ Globe is at the 31st ICM Triennial Congress in Toronto, Canada. See all of the Girls’ Globe LIVE coverage here

Babies are Born. Then they Breastfeed!

The baby let out a wild cry the moment it came out. We felt triumphant. After a four week period of intensive supervision, the mother had finally delivered a healthy baby. I was a resident doctor in obstetrics and had stayed up for several long nights, struggling to help this woman to complete her nine months – complications constantly threatening to sabotage our plans. But now there was relief and joy as it had all turned out ok.

Or so I thought.

The next day, I found the new mother anxious. Desperately, she said: “I am unable to breastfeed. I don’t know what to do.” I tried giving her some tips but immediately realised I was as unable to get this baby to breastfeed as she was. Giving out a few customary instructions I moved ahead, knowing I had hardly made any difference to her anxiety.

The following day, the baby was in the Intensive Care Unit, having convulsed due to low sugars. I knew that meant potential for future intellectual disability. I glanced through the glass windows of the ICU and saw the mother standing besides the incubator. I had a sick feeling which I could neither deny nor escape; I had failed her. We had all failed her. Our moment of triumph was now no more. We had poured in all our collective efforts pre-delivery to bring forth a ‘healthy’ baby, but had ignored her post-delivery struggle with breastfeeding. We all assumed that it just happens naturally; every mother just knows how to do it. But this is far from true. They all need personal support and guidance.

I was suddenly acutely aware of my deficient skill set. As resident doctors, there had been more important things to update ourselves on; the newest infertility treatments and best ways to deliver high risk pregnancies. Breastfeeding was not something we were told to consider actively in our rounds or spend hours training ourselves in. Our singular focus as obstetricians had become to help deliver a ‘healthy live baby’ and as neonatologists, to ace resuscitation protocols when babies weren’t breathing at birth and then get busy with the incubators. With doctors’ alternative priorities and nurses’ preoccupation with injections and clerical work, whose job was it to look at breastfeeding?

The void in lactation support was glaring. I was restless. How can we make breastfeeding a breeze for mothers; a joyful journey of bonding and nourishment rather than a nightmare? That’s when our lactation consultant asked me to try ‘Breastcrawl’, a term I had never heard before.

Apparently, just like newborns of all animals, our babies have an innate capability to seek out the breast and feed; if left undisturbed and ‘skin-to-skin’ with the mother for the first crucial hour after birth. This is called ‘early initiation’ through Breastcrawl. I felt stunned by the potential behind this beautiful miracle of nature. It seemed to have all the answers for a successful start and continuation of breastfeeding! I attempted it in our labour room and sure enough, the baby crawled up from the mother’s abdomen to the breast, latched on its own and smoothly drank its first precious drops. Its reflexes were the only coach it needed. What a perfect start it was!

Breastcrawl has deep implications on health of newborns. As I started following up these ‘Breastcrawled’ babies in the wards, I saw that even the first time mothers breastfed with the confidence of a woman who had just had her third child! Science supports the impact of this technique way beyond just nutrition – sensory-neural development, immune priming, bonding, temperature control and more.

Photo credit: Dr Taru Jindal
Every mother and newborn deserve this experience. But in our hurry to complete paper work and protocols, we had been thoughtlessly separating the mother and baby in those critical first moments and preventing this beautiful miracle from manifesting itself. Our support had been inconsistent and ill-timed. We were either getting in the way of mothers when we needed to step aside or we were simply too far away for help when mothers were desperately seeking us.

The experience with breastfeeding in my residency taught me how ‘lactationally illiterate’ I was. I learnt that supporting mothers in breastfeeding is as critical as doing a perfect caesarean surgery. Ensuring a ‘live birth’ was indeed just the first step.

As WABA keeps reminding us so rightly, babies are born, what do they do next? They breastfeed!