Breastfeeding is beneficial for both mother and baby. PHOTO | SHUTTERSTOCK
Uganda has made significant progress in improving maternal and child health, but there is still a persistent gap in breastfeeding practices. According to data from the Uganda Demographic and Health Survey (UDHS) 2022, 87 percent of children under the age of two in Uganda are exclusively breastfed for the first six months.
The World Health Organisation (WHO), emphasises that exclusive breastfeeding for the first six months should be followed by continued breastfeeding along with appropriate complementary foods for up to two years or more. The consequences of not exclusively breastfeeding are severe, including an increased risk of malnutrition, diarrhoea, and pneumonia, which claim the lives of thousands of Ugandan children each year.
However, this gap can be addressed by overcoming cultural and social barriers, improving healthcare provider training, and establishing robust lactation services. These measures can help Uganda unlock the full potential of breastfeeding.
Dr. Sabrina Kitaka, a consultant paediatrician, defines exclusive breastfeeding as feeding infants only breast milk, either directly from the breast or expressed, with no addition of any other liquids or solids except for drops or syrups consisting of vitamins, mineral supplements, or medicine.
She emphasises that exclusive breastfeeding for the first six months of life effectively prevents infant morbidity and mortality. However, despite active promotion, many children in Uganda under six months of age are not exclusively breastfed.
While more than 90 percent of children in Uganda are breastfed at some point, the percentage of children exclusively breastfed decreases with age. It drops from 83 percent in infants below one month to 69 percent among those two to three months, and further to 43 percent among infants aged four to five months.
Globally, various factors are linked to infant feeding practices, such as income, education, wealth, and employment. Employment has been found to hinder exclusive breastfeeding when mothers return to work, especially if the work environment is not supportive of continued breastfeeding.
Some women also cite other factors such as insufficient breast milk, child's food demands, child rejecting the breast, and fear of transmitting HIV to their children.
Why breastfeed?
The benefits of breastfeeding are numerous. It protects children from infectious diseases, improves intelligence scores, and lowers the risk of dental issues, overweight, and diabetes. Exclusive breastfeeding provides essential nutrients and antibodies that safeguard infants from infections.
WHO Uganda recently stated, "Breastfeeding is one of the most effective ways to ensure child health and survival."
Mothers also benefit from breastfeeding as it lowers the risk of breast and ovarian cancer, improves birth spacing, and may also lower the risk of diabetes and overweight/obesity.
Dr Kitaka says among mothers working in the informal sector, the factors associated with exclusive breastfeeding include the number of antenatal care attendants, intention to exclusively breastfeed, proper breastfeeding practices, infant's age, and position at work.
The challenges
Some challenges to breastfeeding in Uganda include cultural beliefs and social pressures that discourage breastfeeding, such as the belief that colostrum is harmful. There is also limited knowledge about breastfeeding benefits and techniques.
Additionally, some healthcare providers may lack lactation management skills and knowledge, and there are few lactation consultants and support groups available. Many workplaces also lack breastfeeding-friendly environments and policies.
Gorrett Namugwe, an antenatal counsellor at Kitebi Health Centre in Kampala, says HIV-positive mothers may face challenges in breastfeeding due to concerns about transmission. Poverty can lead to inadequate access to healthcare and education, and mothers may struggle to breastfeed due to inadequate nutrition.
"Antenatal care services should focus on building the intention of the mothers to practice exclusive breastfeeding, which is a strong predictor of exclusive breastfeeding among women in the informal sector," she says.
Laws and policies
Women everywhere have the right to receive respectful breastfeeding counselling from trained healthcare providers and to have laws and policies in place to support them, such as maternity leave and paid time off when they return to work.
To address some of the challenges faced by mothers, the Ministry of Health has formulated breastfeeding policies, such as the Baby-Friendly Hospital Initiative, which aims to encourage breastfeeding by providing health education, maternity, and neonatal services.
The Employment Act of 2006 states that women are entitled to a 60-day paid leave from their employer following childbirth or miscarriage. Moreover, the parliament is advocating for workplaces to be breastfeeding-friendly by establishing breastfeeding rooms and allowing breastfeeding breaks for nursing mothers.
For a workplace to support breastfeeding, the employer should provide a private space with a locked door, access to clean safe water, time to express milk at work, education and professional breastfeeding support, and adequate refrigeration.
Although there is a breastfeeding facility in Parliament, not many organisations in Uganda have such facilities. In 2019, Sarah Opendi, the then State Minister of Health in charge of General Duties, mentioned that advocating for six months of maternity leave to allow for exclusive breastfeeding had not yet yielded results. She noted that the proposed six months’ leave could be disadvantageous to female employees due to the highly competitive work environment. She emphasised the need for employers to create breastfeeding areas for nursing mothers.
The Uganda National Breastfeeding Policy (2017) promotes exclusive breastfeeding for the first six months and the Uganda National Nutrition Action Plan (2018) includes breastfeeding promotion and support.
The Ministry of Health Breastfeeding Guidelines (2019) provides healthcare providers with breastfeeding guidance. Furthermore, the Labour Disputes (Arbitration and Settlement) Act of 2006 protects breastfeeding employees from discrimination.
Uganda's National HIV/AIDS Policy of 2011 supports HIV-positive mothers in safe breastfeeding practices, and the Local Government Act of 1997 allows local governments to promote breastfeeding through community initiatives.
Nutritional benefits of breast milk
According to my.clevelandclinic.org, breast milk contains everything your baby needs to grow and develop. It provides a unique and specific formula of vitamins, minerals and antioxidants.
Breast milk supports your baby’s health because it:
Is easy for their immature tummy and intestines to digest.
Contains antibodies that protect against infection and boost immunity.
Has the right amount of fat, sugar, water, protein and vitamins for your baby’s development.
Promotes healthy weight gain.
Changes in composition to meet your baby’s nutritional needs over time.
Contains substances that naturally soothe your baby.
