Breastfeeding for Survival, Health & Wellbeing

The right to the highest attainable standard of health, as well as the right to adequate food and nutrition are fundamental rights of every human being. Breastfeeding provides babies with the best start in life and is a key contributor for survival, health and wellbeing of infants and mothers. 

The Lancet Breastfeeding Series published in 2016 provides the most recent and detailed analysis of available research on breastfeeding. The Series confirmed that breastfeeding has numerous benefits – including decreasing the risk of infections and increasing the intelligence of children, and preventing cancers in mothers. There is also unequivocal evidence of breastfeeding’s protection from hypertension, type 2 diabetes, high cholesterol levels, and obesity in the long term.

Support for breastfeeding mothers is essential. In the light of the overwhelming evidence on the positive impact of breastfeeding on survival, health and well-being, coordinated global action is urgently needed.

WHO, UNICEF and 20 other prominent international agencies and non-governmental organisations have recently formed the global Breastfeeding Advocacy Initiative (BAI), to unify the voices of breastfeeding advocates and galvanise political, financial and social support for breastfeeding policies and programmes. The BAI aims to increase awareness of breastfeeding as a foundation of child and maternal survival, health and wellbeing – and to advocate to governments to invest in breastfeeding.

The Global Breastfeeding Advocacy Initiative (BAI) is consistent with the Every Woman Every Child (EWEC) Global Strategy for Women’s, Children’s and Adolescents’ Health. According to EWEC:

“Breastfeeding is a fundamental driver in achieving the SDGs as it plays a significant role in improving maternal and child health, survival and wellbeing. One year into the implementation of the SDGs, we must work together to level the playing field.” 

In the Global Strategy, breastfeeding is acknowledged as an essential driver in achieving the Sustainable Development Goals (SDGs). EWEC highlights breastfeeding as fundamental in improving not only nutrition, but also education, maternal and child health, survival and wellbeing. Together with the movement’s core partners, EWEC supports governments with strategic interventions in order to improve breastfeeding rates, to eventually reach or exceed the WHO global target of increased rates of exclusive breastfeeding in the first 6 months up to at least 50%.

We have all of the facts in black and white about the benefits of breastfeeding, and we have devoted advocates who fight for women’s and children’s right to the highest attainable standard of health. Grassroots participation and its potential to create massive impact from simple ideas seems to be at an all-time high – a trend that will hopefully continue as the need for even more multi-level and cross-sectoral partnerships increases.

In order to achieve the SDGs by 2030, partnerships are not merely helpful to improve the health and wellbeing of the present and future generations—they are essential.

World Breastfeeding Week takes place from 1 – 7 August 2017. Celebrating collaboration and sustainability, it will focus on the need to work together to sustain breastfeeding. World Alliance for Breastfeeding Action (WABA) has created an online platform with downloadable resources available in a range of languages to support individuals and organizations in their own campaigning and advocacy. 

 

#12 – Maternal Health Now: New Research from The Lancet

In this episode Julia Wiklander, Felogene Anumo and Zanele Mabaso introduce you to new research that was published just a few weeks ago in The Lancet’s Maternal Health Series. Girls’ Globe was in New York City at the launch of the series and Girls’ Globe blogger Zanele Mabaso from South Africa spoke with one of the authors, Dr. Oona Campbell, from the London School of Hygiene and Tropical Medicine.

The Maternal Health Series by the Lancet shines a light on the causes, trends, and prospects for maternal health in the current era of rapid demographic, epidemiological, and socioeconomic transition. It includes analysis of experiences from the past 25 years and shows us the growing threat to progress caused by poor quality care and inequity of access.

The Lancet Maternal Health Series reveals great disparities in quality of care for women during pregnancy and childbirth. In the past 16 years we have seen amazing progress – where maternal deaths have fallen by nearly half (44%) since 1990, yet some countries and some groups of women saw very little – if any – progress. Despite a lot of political attention on maternal health before the Millennium Development Goals were due to be achieved – they fell short on achievement in maternal health. The global goals for 2030 include a 68% reduction in maternal deaths – which will require tremendous action.

In sub-Saharan Africa, a woman’s lifetime risk of dying in pregnancy or childbirth remains at the horrifically high rates of 1 in 36 compared with 1 in 4900 in high income countries. Since 1990, the gap between the group of countries with the highest level of maternal mortality and those with the lowest has doubled in size!

Now, this is urgent business and an urgent human rights issue – because 210 million women become pregnant and 140 million newborns are delivered every year. Quality of care must be increased and disparities must be decreased.

The Lancet Maternal Health Series unveils two extremes that far too many women experience when accessing maternal health services: too little, too late or too much, too soon. And other women receive no care at all. These extremes show that far too much of maternal health care is not grounded in evidence.

Listen to the episode:

 

If you want to get involved, here’s what you can do:

  • Read the evidence from the The Lancet’s Maternal Health Series yourself
  • Read more about maternal health on Girls’ Globe
  • Watch this video interview about the problems of overmedicalization of childbirth with Professor Cecily Begley
  • FInd out what groups are vulnerable in your community and country. What are politicians, civil society groups or others are doing about it?
  • Get in touch with us at The Mom Pod by email – themompod@girlsglobe.org – to get involved with blogging or advocating at the international level.

Cover Photo Credit: Federico Mena Quintero (CC/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.

The Trauma of Stillbirths: A Midwife’s Story

By Kasule Ahmed, White Ribbon Alliance Uganda

“A stillbirth always traumatizes all of us: the midwife who wants to help the mother to successfully give birth to her child, and the mother who carries the pregnancy for a long time only to hear that her child is dead. As midwife and a mother, it makes me feel very bad.”

These are the words of Najjuma Kalule, a midwife in the Mityana District of Uganda. In Mityana Hospital where she works, 600 babies are born every month and of that number, between 10 and 20 are stillborn, with never a chance to take even a single breath.

“All midwives hate dealing with stillbirths,” says Kalule, “because of the deep feeling of discouragement it gives us. Some midwives – especially the junior ones – tend to refer such cases to their seniors, since the process recommended for handling a stillbirth case is quite long and needs extra supervision of a mother, including choosing the right words to comfort the mother.”

Najjuma Kalule 1

Kalule says that once it’s clear that the baby has not survived the pregnancy, a period of one and a half weeks is given before specific drugs are administered to induce labour. She adds that pushing a dead baby out is the most difficult time, because the midwife entirely depends on the strength of the woman who is already feeling devastated. “Some women are too distressed to push the baby out,” she says, “and end up having a C Section.”

Kalule sees malaria as the main cause of stillbirths in Mityana; other common causes include syphilis, poor nutrition and violence against women, together with accidents, diabetes, high blood pressure and HIV/AIDS.

Kalule adds that in order to avoid stillbirths, women should start attending Antenatal Clinics (ANC) from the moment they learn that they are pregnant and should attend all the four appointments: “It’s through ANC that these causes of stillbirths can be detected and treated, and also women can be given advice on what to do when a stillbirth is detected during pregnancy.”

Kalule believes that a midwife needs to be especially sensitive from the moment of breaking the terrible news of the death of the baby. “As midwifes handling stillbirths, we do our best to calm the woman by carefully supporting and counseling her.”

 


 

  • A global ranking published by this week by The Lancet, shows that the estimated stillbirth rate in Uganda is 21 per 1000 total births, with Uganda the 39th highest for stillbirths out of 186 countries. Iceland has the lowest stillbirth rates at 1.3 and Pakistan with the highest at 43.1, all per 1000 total births.
  • According to new research published in The Lancet on January 19th 2016, there has been little change in the number of stillbirths (in the third trimester of pregnancy) even though the majority are preventable. The Ending Preventable Stillbirth research series states the annual rate of reduction for stillbirths is 2.0%, much slower than progress made for maternal (3.0%) and child deaths (4.5%). It also reveals the hidden consequences of stillbirth, with more than 4.2 million women living with symptoms of depression, often for years, in addition to economic loss for families and nations.
  • The Ending Preventable Stillbirth Series includes a global analysis of risk factors associated with stillbirth, underlining that many deaths can be prevented by, among other interventions; treating infections during pregnancy – 8.0% of all stillbirths are attributable to malaria, increasing to 20.0% in sub-Saharan Africa, and 7.7% of all stillbirths are associated with syphilis, increasing to 11.2% in sub-Saharan Africa.

 

Stillbirths – A neglected global epidemic reports The Lancet

Despite the fact that the majority of stillbirths are preventable, very little progress has been made to bring down the number of stillbirths. In the past 15 years maternal and child deaths have halved, while 2.6 million stillbirths continue to occur every year – a number much too high to be accepted.

This “silent” problem – stillbirths (in the third trimester of pregnancy) – has been studied in a new series by The Lancet. Not only does the Ending Preventable Stillbirth Research Series shed light on global reduction rates and risk factors of stillbirths, but it highlights the neglected psychological, social and economic impacts of stillbirth on women and communities. New evidence shows that at least 4.2 million women are living with the effects of stillbirth – suffering from depression, stigma, social isolation, as well as an increased risk of violence and abuse.

“We must give a voice to the mothers of 7,200 babies stillborn around the world every day. There is a common misperception that many of the deaths are inevitable, but our research shows most stillbirths are preventable.”

– Professor Joy Lawn, London School of Hygiene & Tropical Medicine

Women in the most disadvantaged communities are at a much higher risk of stillbirth. Yet, progress to decrease the stillbirth rate remains slow in high-income countries too, where the number of stillbirths is often higher than infant deaths. Globally, the annual rate of reduction for stillbirths is 2.0%, which is much slower than the progress that is being made for maternal (3.0%) and child deaths (4.5%). Nearly all stillbirths – 98% of them – occur in low- and middle-income countries.

Half of all stillbirths take place during labor and birth, usually when a pregnancy is in full term, and research shows that most of these 1.3 million deaths are preventable with improved quality of care. The first global analysis of risk factors associated with stillbirth is included in the new series – showing how deaths can be prevented. The research shows that the most effective methods to reduce stillbirths include: treating infections during pregnancy (Malaria and Syphilis in particular), tackling obesity and non-communicable diseases (diabetes and hypertension foremost), ensuring access to quality family planning services – especially for older women and girls, who face a higher risk of stillbirth, and reducing inequalities.

Evidence shows that prevention is possible.

The Netherlands is making the fastest progress, with an annual reduction rate of 6.8%. The United States is one of the countries making the least amount of progress, with a reduction of 0.4% per year. Rwanda is outperforming its neighbours with an annual rate of reduction of 2.9% – making it the fastest progressing country in Africa and showing that change is achievable everywhere in the world.

The Lancet’s Ending Preventable Stillbirths Series includes five papers developed by 216 experts from over 100 organizations. This series presents compelling evidence that most stillbirths are preventable, providing a platform for action by politicians, health care professionals, parents and pregnant women themselves.

Let’s make sure that ending preventable stillbirths does not only get on the agenda of maternal and newborn health, but that necessary action is taken and enough resources are allocated to this issue for there to be real, lasting impact and change.

Featured photo credit: Hien Macline / United Nations Photo (Creative Commons on Flickr).

The Lancet Every Newborn Series: A healthy start to life – for every mother and child

BoEynJjIAAACOPLYesterday, the Lancet released its Every Newborn series, presenting the most up-to-date picture on progress and remaining challenges on decreasing newborn and maternal deaths around the world. The series continues from Lancet’s Neonatal Survival series, which was released in 2005, and is comprised of five papers:

The Series lays out the grim reality of newborn and maternal health and survival. Progress has been achieved  – since 1990, under-5 and maternal deaths have been halved globally largely due to the Millennium Development Goals – but despite the progress, 2.9 million newborn babies die and 2.6 million are stillborn every year. Though maternal mortality rates have declined 45% since 1990, there still were an estimated 289,000 maternal deaths in 2013 – nearly 800 per day. The issue of newborn and maternal mortality remains a largely unfinished agenda, and an issue that deserves and gravely needs more global attention and prioritization urgently.

According to the data presented in the Series, preterm births continue to rise, and while under-5 mortality has received notable attention globally, the issue of stillbirths remains largely ignored and invisible. In addition, as highlighted in the series,

Most newborns and nearly all stillborn babies enter and leave the world without a record of their existence

This means that most of the babies who lose their lives within the first 28 days after birth and almost all stillborn babies are never registered, and never receive birth certificates. Additionally, preterm babies are less likely to be counted or registered, even in wealthy countries. This points to low expectations towards the babies’ survival, and social acceptance towards neonatal and stillborn deaths as something that is inevitable and maybe even a natural part of life. Women’s and babies’ lives are too often viewed as expendable, and these deaths treated as  unpreventable – but, as stated by Professor Bhutta, one of the Series’ authors:

Our research shows that three million lives can be saved by 2025 if achievable interventions are scaled up to nearly universal coverage, and improving care at the time of birth gives a triple return on investment saving mothers, newborns and stillbirths.

The Series presents several concrete suggestions for dramatically improving the health and survival of mothers and newborns around the world, drawing also from the Every Newborn Action Plan. The fifth paper in the Series presents a path towards action, underlining the importance of the following shifts that need to take place at global, national and local levels:

  1. Intensification of political attention and leadership
  2. Promotion of parent voice, supporting women, families, and communities to speak up for their newborn babies and to challenge social norms that accept these deaths as inevitable
  3. Investment for effect on mortality outcome as well as harmonisation of funding
  4. Implementation at scale, with particular attention to increasing of health worker numbers and skills with attention to high-quality childbirth care for newborn babies as well as mothers and children
  5. Evaluation, tracking coverage of priority interventions and packages of care with clear accountability to accelerate progress and reach the poorest groups

Maternal and newborn deaths are not inevitable – and they are never, ever acceptable. Low cost and low-tech solutions can have a huge impact on child and maternal survival. As noted by one of the Series’ authors, Professor Joy E Lawn,

The fact that a vast majority of these [stillbirths and newborn] deaths – which have a huge effect on the women and families involved – are never formally included in a country’s health registration systems signifies acceptance that these deaths are inevitable, and ultimately links to inaction.

There’s simply no more time for inaction, because every day that passes means hundreds of women lost to preventable maternal deaths, and thousands of newborn deaths and stillbirths that could have been avoided. Research shows that the day of the birth is often the most dangerous for both the mother and the baby. The day of a child’s birth should be the happiest, most joyous and miraculous day for the mother, the baby and the other parent – and it should never, ever end in the untimely death of the mother or child.

Without healthy mothers and healthy babies, we cannot build healthy and prosperous societies. If protecting and saving the lives of mothers and babies isn’t worth all of our energy, time and attention – I really don’t know what is.

For highlights of the Lancet Every Newborn Series launch at UNICEF Headquarters in New York, check out the Girls’ Globe Storify of the launch!  Visit www.everynewborn.org for more information. 

Follow Girls’ Globe for our coverage of upcoming events such as the International Confederation of Midwives Global Congress (#ICMLive) and the Partnership for Maternal, Newborn and Child Health Partners Forum (#PMNCHLive), and the on-going World Health Assembly (#WHA67).

Add your voice to the conversation on Twitter with #EveryNewborn, and follow @every_newborn,  @TheLancet, @UNICEF and @PMNCH for latest news and information on maternal, newborn and child health!