The unseen struggles of breastfeeding mothers in Kyangwali

“I gave birth to a baby girl in 2022 when I was 17. At first, I was happy but then, I realised my breasts were not producing milk. I did not know how or what to feed the baby,” she recalls. 

READ: Govt reports 20% increase in exclusive breastfeeding

Desperate and in pain, the mother of two resorted to giving her baby cow’s milk in the first two weeks of her life. She was also grappling with the relentless challenge of inadequate food supply in the settlement. 

“I could not breastfeed my baby because I would fall sick every few days. By the time she was six months, I was pregnant with my second child. I started giving her porridge and fish to supplement the breast milk,” Polepole says.

The World Health Organisation (WHO) recommends exclusive breastfeeding for the first six months of life to achieve optimal growth, development and health. Breast milk contains all the nutrients an infant needs in the first six months of life and protects against common childhood illnesses. 

Barriers to exclusive breastfeeding

However, several obstacles in Kyangwali Refugee Settlement stand in the way of new mothers exclusively breastfeeding their babies. One of them is lack of food.  

“When I got pregnant the second time, my parents told me to go and live with the father of the baby. He did not have a job, so paying rent and getting food to eat was a challenge. I decided to leave him and return to my parents’ home. But, there is no food here as well,” Polepole says. 

Although she has received training from health workers at Rwenyawawa Health Centre III on how to breastfeed her child and how much she should eat to produce enough milk, Polepole is still struggling.

“We were told that a breastfeeding woman should eat four times a day. But, when I go home, there is no food. The bag of porridge we are given does not last more than two weeks. A refugee is given Shs12,000 per month, which is not enough to live on. It is now 2pm and I have not eaten anything since the food I had yesterday. Sometimes, I can spend a day without eating,” she says. 

Royas Nayebare, a nutritionist at Kyangwali Health Centre IV, says failure to eat frequently affects the ability of a nursing mother to produce nutritious breast milk.

“We have educated the mothers and they know they are supposed to breastfeed exclusively for six months. However, most of them are practising mixed feeding. At four months, they introduce the baby to porridge, water, fish and other foods,” she says.

Nayebare blames this practice on myths and cultural practices passed down from generation to generation. 

“Some of them have grandmothers and mothers who tell them to give the baby water, glucose or tea before they initiate the baby to breastfeeding. Some mothers leave the baby at home and spend eight hours in the garden digging. The other siblings will feed the baby porridge,” she says. 

Mary,* who is 14, is not only a survivor of displacement but is now a mother to a three-month-old baby. Her journey into motherhood has been fraught with difficulties. 

“Last year, while in Primary Three, I got pregnant. The birth of my child brought many challenges since I could not breastfeed him,” she says. 

Because she did not know how to properly attach the baby to her breast, Mary developed cracks on her nipples, which became very painful. 

“Instead of milk, a yellow liquid would come out of my nipples. When that liquid got into the wounds on my nipples, breastfeeding became very painful. I eventually stopped feeding my son,” she says.  

 Unable to treat the infection in time, Mary resorted to feeding her baby cow's milk, porridge and other complementary foods, a decision far from ideal for a newborn.

Infrequent breastfeeding, due to a mother’s lack of food or due to myths, has an impact on the amount of milk she produces. 

“Mixed feeding affects the child in many ways. For instance, if a mother is HIV positive and practising mixed feeding, she will increase the risks of infecting the baby with the disease. Mixed feeding also damages the intestinal lining of the baby, causing diarrhoea and vomiting. This in the end causes the baby not to gain weight,” Nayebare says.

Naomi Louise Mave, a 19-year-old first-time mother faces the daunting task of balancing her economic needs with the demands of breastfeeding her child. She sells merchandise in the Maratatu Market, leaving her baby in the care of her 35-year-old mother, Marian Njale who lives three kilometres from the town centre. 

“My daughter’s absence during the day means her baby often goes hours without breastfeeding. The baby is now crying because she wants to breastfeed but the mother is not yet back from the market," Njale laments.

The baby, initially weighing 2.7 kilogrammes at birth, has gained only 0.3 kilogrammes in three months. The physical toll on Mave is also evident. She suffers from painful breast engorgement, sometimes needing to express milk merely to relieve the discomfort.

The way forward

To remedy the situation, the health centre formed care groups, which have a lead mother and a village health team member to support breastfeeding mothers in the Settlement.

“They teach us about the types of food we can give children of all ages. We are also given seeds of vegetables like sukuma wiki, cabbage and tomatoes to plant and supplement our diets,” Polepole says.  

When they visit the health centre, new mothers are also taught how to breastfeed their babies correctly. 

“Many teenage mothers do not know how to attach the baby to the breast and they end up with cracked nipples, which are painful. We give them individualised and group counselling, then we assign them a lead mother who will support them when they go back home,” Nayebare says.

Other challenges that new mothers face include mastitis, which is the inflammation of the breast tissue that causes pain. Mastitis most often affects breastfeeding women. 

Despite these hurdles, breastfeeding remains critically important, especially in a refugee setting. It provides essential nutrients and antibodies that protect infants from common infections, which is crucial in environments where healthcare is limited. Breastfeeding also fosters a unique bond between mother and child that can provide emotional comfort and stability in an otherwise turbulent setting.

 Addressing these challenges, the Lutheran World Federation Uganda (LWF) and the World Food Programme, have been a beacon of hope. For the past six years, LWF has established safe breastfeeding spaces known as Infant and Young Child Feeding Corners. Here, mothers can learn proper breastfeeding techniques and receive nutritional support to enhance their milk production.

 "We provide education, counselling and support to breastfeeding mothers. Additionally, we supply food relief and cash support to help these mothers meet their nutritional needs, which is crucial for them to produce sufficient breast milk,” says Henry Tirinawe, a nutritional officer with LWF, adding that the project is targeting the first 1,000 days of a baby’s life. 

“We extended cash relief of Shs50,000 per month to 7,176 individuals drawn from 1,801 households. The cash is given to the most vulnerable households. The determinants of vulnerability include protection needs, food insecurity, education needs, poor shelter, and limited access to health care,” he says. 

LWF’s cash support runs for a minimum of six months, helping pregnant and breastfeeding mothers to acquire necessities and support their breastfeeding efforts.  

“We also offer mental health and psychosocial support. We recognise that breastfeeding is closely linked to the mental state of the mother, given the unrest in the Settlement and the trauma of living in a foreign land,” Turinawe adds.

Furthermore, community efforts led by local leaders have begun to shift cultural norms that traditionally placed the entire burden of child-rearing on mothers. Musafiri Manja, the chairperson of the Refugee Council II, says nowadays, more husbands are supporting their breastfeeding wives, highlighting a significant change that could help alleviate some of the burdens these women face.

“In Africa, child-related responsibilities are typically seen as the mother's duty. That is the prevailing mindset among men. However, despite this traditional view, we are actively engaging in sensitisation and educational efforts to shift this mindset. We encourage them to actively support their wives in overcoming the challenges of exclusive breastfeeding,” he says.

As we observe Breastfeeding Month, it is crucial to spotlight the unique struggles faced by refugee mothers in settlements like Kyangwali. The stories of these mothers are tales of resilience and unwavering dedication to providing their children with the best start in life through breastfeeding. Their efforts not only nurture their children but also sow the seeds for a healthier, more informed generation of refugees and ensure their children thrive against all odds.

*Name changed to protect the identity of the source.