To breastfeed or not to, that 's the question on everybody's lips after the Breastfeeding Consultative Meeting. (SABC)
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Health experts say they are unhappy over the media’s "sensational" reporting of the outcomes of the National Department of Health Breastfeeding Consultative Meeting.
They say Health Minister, Dr Aaron Motsoaledi, never said that milk formulas should be banned but rather they should be prescribed by health practitioners, to encourage women to breast feed their children in a bid to end the scourge of infant mortality.
To see what the Minister really said , Read Dr Motsoaledi speech which was delivered at the National Department of Health Breastfeeding Consultative Meeting in Gauteng from 22-23 August 2011.
HEALTH EXPERTS SAY:
Rosemary Gauld, a registered nurse / Midwife and works for the International Board Certified Lactation Consultant (IBCLC), International Certified Childbirth Educator (ICCE), La Leche League Leader, says:
I was fortunate to have attended the recent National Department of Health Breastfeeding Consultative Meeting in Gauteng, 22 - 23 August 2011. The much reported outcome that formula feeding should now be banned, is not an accurate reflection of the outcomes of this meeting.
I have a concern that because of this sensationalised reporting, the momentous steps proposed in getting breastfeeding back on track, might be lost or overlooked. Since 1985, when the first reports of HIV-transmission through breast milk were made known, HIV-infected mothers were recommended not to breastfeed. The emphasis was placed on HIV-transmission rates rather than on health outcomes.
The intervening years have led to some frightening statistics of increased infant morbidity and mortality when the focus of Infant and Young Child Feeding shifted from the promotion, protection and support of breastfeeding to supporting formula feeding. A staggering figure of R204 million being spent annually by the Government on the free supplies of formula to HIV-infected women on the PMTCT (Prevention of Mother to Child Transmission) scheme, was revealed at the meeting.
The statistics delivered at the meeting of our pitifully low exclusive breastfeeding rates (1.5 percent at 4 - 5 months) in comparison to other countries, was alarming. The emphasis will now be placed on the strategy of reversing these figures. The role that the aggressive marketing by the baby milk companies has played in helping to contribute to this appalling data, was recognised. The International Code of Marketing of Breast-milk Substitutes and its subsequent resolutions, will be superseded by the South African Regulations relating to Foodstuffs for Infants, Young Children and Children once these are promulgated.
These Regulations were developed 2000 and submitted in 2003. The Minister of Health stated at the meeting that these Regulations would become a priority and that they should be adopted into the Law within the next 12 months. It was also recognised that the baby milk companies had a vested interest in blocking the adoption of these Regulations.
The Minister of Health did not call for a ban of all formula but actually said: “….that we should discontinue the practice of providing milk formula through hospitals and clinics except when recommended by an authorised health practitioner.”
The Ten Steps form the basis of the Baby Friendly Hospital Initiative (BFHI) and it was recommended that this strategy be integrated into a package of newborn care in all health care facilities in both the private and the public sector.
In many areas where there is a high incidence of HIV-infection, the AFASS (Acceptable, Feasible, Affordable, Sustainable and Safe) conditions are not met and yet mothers are still counselled not to breastfeed. The supplies of free breast milk substitutes to mothers on the PMTCT scheme, influence their choice not to breastfeed. The acronym AFASS has now been replaced with 7 criteria that mothers need to meet in order to safely formula feed. In the MDG (Millennium Development Goals), Countdown to 2015, South Africa is one of the 12 out of 68 countries not on track to reduce infant mortality.
A positive outcome of the meeting is that it has now been identified that there is an urgent need to reduce child mortality through breastfeeding and especially exclusive breastfeeding for 6 months. It is now proposed that South Africa follow the International Guidelines of having one breastfeeding policy for all mothers. In alignment with the cessation of the unwarranted supplying of formula, the minister also said: “We will thus also be discontinuing the distribution of free breast milk substitutes through health facilities, as this cannot be reconciled with an exclusive breastfeeding strategy”.
This does not ban the use of formula and still allows all mothers the freedom of choice as to how they feed their babies. However, with the updated research available, this choice will now be a far more informed one and the new policies that will be adopted, will far better support the choice of exclusive breastfeeding for 6 months.
It is hoped that the money freed up by the withdrawal of the supplies of free artificial baby milk, could be used for training and implementing the new strategies needed for the protection, promotion and support of breastfeeding in South Africa. The past bias of the health care workers towards HIV-infected mothers, leading them to choose not to breastfeed, will now hopefully be rectified. The emphasis is now placed on the risks of artificial feeding rather than on the benefits of breastfeeding. These risks were well covered at the Meeting.
The Innocenti Declaration, developed in 1990 and revisited in 2005, is one of the most powerful documents in support of breastfeeding, to be distributed. All the new proposals put forth at the Consultative Meeting are supported by this document.
|As James Akre, formerly WHO, said at the GOLD10 Conference “We need to recall that infant formula was originally developed for emergency use; it was never intended for routine consumption. We need to identify infant formula for what it is: an inert paediatric fast food based on the milk of an alien species, and the least-bad alternative to human milk.
Leana Habeck, works at the I International Board Certified Lactation Consultant (IBCLC) SA office as a health care professional who specializes in the clinical management of breastfeeding, says:
A National Breastfeeding Consultative Meeting took place on 22 & 23 August 2011 at the St Georges Hotel, Irene, Gauteng, South Africa. 650 delegates (stake holders, academics, researchers, traditional healers, various NGO’s, health professional, etc.) from all over South Africa attended this long awaited meeting.
The Minister of Health (Dr Aaron Motsoaledi) said in his opening address, South Africa is one of only 12 countries in the world where infant mortality has been on the increase and "as government we have committed ourselves to changing this unacceptable situation. Reducing child mortality is one of the most important priorities in our country and central to this is breastfeeding as a child survival strategy".
In the press conference on the 23rd the Minister emphasised that implementation of exclusive breastfeeding strategies that can start now through antenatal breastfeeding counselling, support for breastfeeding immediately after birth and getting the media to assist with positive messages about Breastfeeding and Exclusive Breastfeeding in particular.
The Minister clarified that commercial infant formula may only be given if there is a medical indication not to breastfeed and if an authorised health practitioner recommends / prescribes its use to a mother. He said South Africa will be discontinuing the distribution of free breast milk substitutes through health facilities to HIV+ mothers, as this cannot be reconciled with an exclusive breastfeeding and in addition he will make regulations to enforce the International Code of Marketing of Breastmilk Substitutes.
(Notes that the aim of the International Code of Marketing of Breast-milk Substitutes is to contribute to the provision of safe and adequate nutrition for ALL infants, by the protection and promotion of breast-feeding, and by ensuring the proper use of breast-milk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution, http://www.who.int/nutrition/publications/code_english.pdf).
At the meeting Dr N. Rollins (WHO) pointed out that the cost to provide formula as a preventative strategy against HIV transmission costs 4x more than providing ARV’s to breastfed mothers/babies. He quoted the Guidelines on HIV and infant feeding 2010 saying the "effectiveness of ARVs to reduce HIV transmission through breastfeeding is transformational. In conjunction with the known benefits of breastfeeding to reduce mortality from other causes, it justifies an approach that strongly recommends a single option as the standard of care."
As you can see from the remarks above the focus here is on promoting, protecting and supporting exclusive breastfeeding, not on banning formula. I have spoken to a lot of mothers over the past few days and most of them have a distorted idea that formula is not going to be available anymore. Again the media need to assist with positive messages about Breastfeeding and Exclusive Breastfeeding.
Deputy Minister of Health, Dr Ramokgopa, at the end of the meeting, said, among other things that South Africa should declare itself as a country that actively support, protect and promote breastfeeding. She said the National Code of Marketing of Breastmilk substitutes is to be finalised and adopted into legislation within 12 months, that Human Breastmilk Banks are to be promoted and supported and that ALL private hospitals be BFHI accredited by 2015. (The Baby-friendly Hospital Initiative (BFHI) was launched by WHO and UNICEF in 1991, following the Innocenti Declaration of 1990. The initiative is a global effort to implement practices that protect, promote and support breastfeeding.
Hopefully from this health facilities will create a post for a qualified Lactation Consultant** (IBCLC) to be on site to assist breastfeeding families.
Dr Motsoaledi said in his closing remarks it was clear when statistics were published that South Africa is one of the worst when it comes to exclusive breastfeeding rates. He said with the Tshwane declaration of support for breastfeeding we will be one of the best when it comes to breastfeeding practices.
He said just as we were one of the worst when it came to Apartheid and turned South Africa around to a country with one of the best constitution, and people come from all over the world to see how it is done, so they will come to South Africa to see how it is done when it comes to breastfeeding practices.
To quote Ameena Goga who helped with the summary of the meeting and with the Declaration: "it was truly a great meeting and one that we have been waiting for, for a long time. The clear direction that stemmed from the meeting will hopefully do much to promote breastfeeding and Exclusive Breastfeeding in particular".
Ellen Kamman, a La Leche League leader in Randburg, says:
A lot has been said in the media in the past few days about the decision taken by the Minister of Health, Aaron Motsoaledi, to make breastfeeding the method of choice for infant feeding in South Africa. Some newspapers reported that the minister would "force mothers to breastfeed", while others said that "formula will be banned". And of course, these media statements have given rise to some very emotional responses from the public.
Some feel it is just another way for the government to save money. Some worry that babies may be infected with HIV through their mother’s breastmilk. Others feel that mothers should be given the choice whether or not to breastfeed. There is a need to clarify some of the issues that were discussed, as the media reports alone seem to create confusion about what the Minister’s proposal really entails.
Without going into the statistics (which have been extensively covered at the 2-day National Breastfeeding Consultative meeting, it is clear that infant mortality in South Africa is on the rise, and HIV has a huge influence on how mothers choose to feed their babies.
Furthermore, aggressive marketing of artificial infant formula has been identified as having a negative effect on our breastfeeding rates overall. Many mothers do not have correct information to base their infant feeding decision on, and many terminate breastfeeding sooner than they might have really wanted to, due to lack of support and information.
This is not just my personal opinion because I happen to support breastfeeding. Just have a look at the WHO guidelines on infant feeding for all the research done on this topic. Unfortunately, in the South African context, the policy that was thought to prevent babies from potentially being infected with HIV, turned out to actually lead to more babies dying of other causes.
But even for those whose decision is not affected by their HIV status, the government is sending mixed messages by providing free artificial milk. People start seeing artificial baby milk as a good substitute for breastmilk, a modern way of feeding babies – surely the government wouldn’t want to give something to babies if it was harmful? The spin-off effects are devastating to a culture that used to be a breastfeeding culture. Combine this with aggressive marketing of artificial infant formula at all levels, and as a result, babies are dying. Some of you may now raise your eyebrows and say "What? She’s exaggerating". I wish that were true.
We hear so much about the "benefits of breastfeeding", but breastfeeding is the normal way to feed a baby. It is human milk meant for a human baby. We don’t say "the benefits of breathing fresh air" when we talk about the difference between smoking and non-smoking, do we? We are supposed to breathe fresh air, and if we choose to do otherwise, we talk about the "negative effects of smoking". In the same light, we should look at the negative effects of artificial infant feeding. I accept that this approach makes many people feel very uncomfortable, but unfortunately there ARE negative effects to giving our children an artificial infant food. And mothers have the right to know this.
At the breastfeeding summit, all the facts pertaining to breastfeeding, HIV, artificial infant feeding and overall health were carefully weighed by a large contingent of experts (about 650, I believe). There were many doctors, nurses, breastfeeding counsellors, traditional leaders, lactation consultants and academics, who investigated the research, discussed the issues, and together they came up with a plan of action.
How often are mothers, newly delivered, given a bottle of formula to top-up their newborns as they "don’t have any milk", instead of encouraged to keep feeding colostrum until the mature milk comes in? How often do doctors advise giving up breastfeeding when a medication a mother needs is contraindicated instead of searching for a medication that can be safely taken while breastfeeding?
When out and about, mothers are expected to nurse their babies in private, often in public toilets if a feeding room has not been provided in the shopping centre – what message does that send? And then there is a constant stream of advertising suggesting that your baby will be healthier or more intelligent if you feed them this or other artificial baby food.
Mothers returning to work have to deal with long hours away from their babies, disasterous for successful breastfeeding. And every shop and department store has shelves of bottles, dummies, teats, and bottle feeding paraphernalia on their baby shelves. Even successful breastfeeding mothers are worn down by the constant question "when are you going to stop breastfeeding?"
The list is endless. In such an environment it is VERY hard to breastfeed successfully. And yet, many women still manage. But even more don’t. This is not their fault, this is a problem in our society that is not a supportive environment for breastfeeding.
So what can we do about that? How did mothers make breastfeeding work when there was no such thing as artificial formula around? Firstly, they had no choice, really. Secondly, the art of breastfeeding was passed down from mother to daughter, from sister to sister, and from neighbour to neighbour. If you lived in an environment where everybody breastfeeds, you would know what to do, and where to get support.
You would know how to overcome problems of low supply, cracked nipples, and a baby who wants to drink seemingly non-stop. You would learn about normal infant behaviour. You would learn to look at the baby, and recognize whether he or she is thriving, or whether there may be a problem.
One of the many recommendations made at the conference was the need for community support for breastfeeding. You can’t simply say "ok, now everybody needs to breastfeed" and expect the mothers to get it right. It’s like throwing a child into the deep end of the pool and expecting them to swim without the support of armbands. So the conclusion was that mothers should be (strongly) encouraged to breastfeed, and at the same time, offered all the support needed to make it work. This support has to come from health care workers, hospitals, the workplace, but most of all from a supportive community.
To me, the notion of community support for breastfeeding is nothing new. When I breastfed my first baby, I encountered a number of problems and decided to seek help from La Leche League. The ladies from this organisation were very supportive, and after a number of years (and a couple more children), I decided to start helping mothers myself and became accredited as a La Leche League leader.
I have been supporting breastfeeding mothers for a number of years now at our local breastfeeding support group (one of many La Leche League groups throughout the world). From experience, I know what a difference we can make by just listening, exploring options, supporting, and providing information. Mothers have the built-in ability to breastfeed, and given the right support, they will be empowered and strengthened in that ability.
Our organisation, La Leche League, was established by a group of mothers in the USA in the 1950s who recognized the need for breastfeeding support and realised that the most effective support came from other breastfeeding mothers. They started sharing their experiences – from one mother to another, in the same way it had been done since the beginning of humanity. From one small group of seven mothers, the organisation has grown into an international organisation which supports mothers in breastfeeding.
The organisation published a book, called "The Womanly Art of Breastfeeding", which is now in it’s 8th edition, and distributed worldwide in many languages. It tells the story of breastfeeding, as it has been told for many years It reads as if you are talking to another mother, sharing her experiences and finding solutions to problems.
The difference is that now, the story of breastfeeding is backed up by many years of research. In South Africa, the organisation runs support groups throughout the country. In addition, we run a successful peer counsellor programme in collaboration with the Western Cape Department of Health. The peer counsellors are women from the communities who are provided with training, and who are working in maternity hospitals and communities in the Western Cape – helping mothers with breastfeeding issues.
My wish is for this kind of mother-to-mother support to be available to EVERY mother in South Africa, as they all deserve to have access to it. My wish is for La Leche League to be able to train many more peer counsellors to be able to assist mothers everywhere. My wish is for every mother to receive the information she needs to be able to breastfeed for as long as she and her baby want to.
But my biggest wish is to look back in a few years time, and realise that our organisation is no longer needed in South Africa, because breastfeeding is once again so ingrained in our culture that everybody will know how to support a breastfeeding mother, whatever her challenges may be.
A lot of hard work will be needed for that wish to come true. But I am sure that if the Minister of Health follows through with the all the recommendations made at the National Breastfeeding Consultative Meeting, South Africa will become a breastfeeding nation. And it’s not just up to the Government to do it’s part. We can all do our part to support breastfeeding mothers. Our babies deserve it.
Erica Neser, an international Board Certified Lactaction Consultant, in Stellenbosch, says:
The importance of breastfeeding is often marginalised in our society. There are many obstacles mothers face in their attempts to breastfeed exclusively.
Similarly, those wishing to support their efforts are often undermined by the medical profession, the media and formula and bottle manufacturers who profit from mothers NOT breastfeeding. It is therefore very heartening to see breastfeeding in the spotlight this past week, and to read the Minister’s statement.
As Lactation Consultants (IBCLCs) working daily with mothers and babies, would like to see the principles agreed upon at this meeting to be put into practice at every level, the proverbial “put your money where your mouth is.” It is now necessary to maintain the momentum created by this meeting, and have sustained effort and commitment to improving breastfeeding rates in our country.
- Adequate (re)training of nursing staff to assist mothers in initiating breastfeeding. The training should reflect evidence-based practices and steps should be taken to ensure that correct and accurate information is given to mothers. Parents who are well-informed and empowered enough to insist on breastfeeding-friendly procedures, are often perceived by nursing staff as “difficult/demanding” patients, and these parents feel as if they are swimming against the current when they insist on practices that are scientifically proven to promote breastfeeding (such as routine rooming-in, extended skin-to-skin contact, demand feeding etc.)
- Encouraging policy changes in hospitals in order to incorporate more breastfeeding-friendly procedures. Hospitals should receive some form of incentive to implement the Baby Friendly Hospital Initiative 10 Steps to Successful Breastfeeding, or at least a minimum number of these steps. This could also include employing a full time Lactation Consultant (IBCLC) in hospitals to provide specialised lactation support.
- Ensuring that health practitioners – including doctors, paediatricians, midwives, nurses – become more supportive of exclusive breastfeeding. In practice, we see far too many health practitioners who subtly or even overtly discourage breastfeeding initiation or continuation. These include: mothers who have had breast surgery, inverted nipples, taking medication which is compatible with breastfeeding, previous breastfeeding problems, multiple births, premature babies, babies with special needs, and mothers who wish to breastfeed a toddler during her next pregnancy. All of these should be supported and encouraged and given sound evidence-based advice. Many doctors and other healthcare practitioners are very supportive of breastfeeding, and need to be acknowledged, but there are still too many who are not. Health practitioners should be encouraged to refer mothers to Lactation Consultants to assist with breastfeeding management.
- Medical Aids should be encouraged to reward mothers for breastfeeding, providing incentives to continue breastfeeding.
- International Code of Marketing of Breastmilk Substitutes needs to be implemented in practice. A strong message needs to be sent to companies who continue to flout the code and steps should be taken to prevent this from happening.
As IBCLCs we look forward to seeing many positive steps to promoting breastfeeding in SA and we applaud the willingness of the Minister to initiate much needed change.
