Africa: Breastmilk for Premature Babies Encourages Economic Revival

8 August 2020
guest column

This week is World Breastfeeding Week, a flagship campaign of the International Confederation of Midwives.

Ensuring that mothers can breastfeed – to nurture and nourish their newborns – requires scaling up commitments to reach the last mile for neonatal intensive care and nutrition.

'Support breastfeeding for a healthier planet,' is the theme of this year's World Breastfeeding Week. Wellbeing Foundation Africa, through its 'Alive and Thrive' and Mamacare+Nutrition programs, continue to pioneer improved breastfeeding practices in Nigeria as the unrivaled way of providing nutrition to infants. The programs, which promote maternity care and nutrition, are led by communities and midwives.

We know exclusive breastfeeding is best: it improves physical, emotional and mental health for mother and baby immediately and into adulthood.  It also reduces malnutrition, which accounts for 60 percent of the 10.9 million deaths annually among children under five.

But in many countries, including my home country of Nigeria, many babies are not exclusively breastfed. Worse, it is the most vulnerable babies who need the immunotherapy benefits of mothers' own milk the most, who are denied the benefits.

Fifteen million babies are born too early annually – often to 'child brides' too young to safely bear children.

Fifteen million babies are born too soon every year, and the number is rising. Nigeria itself has the third highest number of premature babies globally.

Preterm babies' lack of access to breastmilk is due to practical reasons: the babies, who usually have a less developed immune system and fewer antibodies than a full-term baby, need to be placed in the Neonatal Intensive Care Unit (NICU). This separates infants from their mothers and presents a challenge for mothers in initiating and maintaining milk supply.

At the same time, in the context of the economic impact on Nigeria of SARS-CoV-2, the virus that causes Covid-19, there have been a plethora of calls to redefine how we rebuild our economy. One way in which we can make practical moves to improve economic development is to invest in solving the issue of breastfeeding in Nigeria, as a focal target within our Every Newborn Action Plan.

Hear me out: Nigeria continues to struggle with economic growth, and the impact of the pandemic has led some to predict that Nigeria's economy is facing collapse.  But every U.S.$1 invested in breastfeeding in countries like Nigeria can generate as much as $35 in economic returns.

Only 33 percent of Nigerian children are breastfed within the first hour of birth, and only 17 percent are exclusively breastfed for the first six months of life. Mothers face a number of challenges in exclusively breastfeeding their children, including cultural beliefs, stress, and balancing work and childcare. Underscoring the impact of this low rate of breastfeeding is the fact that Nigeria ranks seventh highest in the world for infant mortality – and malnutrition is the leading cause of death.

That the problems are so evident in Nigeria lends itself to the potential for dramatic improvement, should we invest in breastfeeding. Imagine that the impact of a $1 (₦315.25) investment could return $35 (₦11,033.75) in economic growth, when scaled to the size of Nigeria's market and need for improved support for breastfeeding.

It is predicted to add US$21 billion (₦6.62 trillion) for the economy over children's productive years, by increasing cognitive capacity and preventing premature mortality in the early years. With the majority of our population skewing young, it is healthy, strong children who are our greatest asset.

With this in mind, during World Breastfeeding Week, my Wellbeing Foundation Africa is scaling up the process of investing in the health and wellbeing of our most vulnerable babies through a new partnership with a corporate social responsibility initiative of Medela, a company active in breastfeeding research, products, technology and innovation, and a member of the UN Global Compact.

As a core commitment to the United Nations Every Woman Every Child Effort, the new partnership aims to improve breastfeeding support and resources in Nigerian NICUs by delivering tailored education and training on the value of human milk for ill or low-birthweight babies, on how to build sufficient milk supply, and on making the transition to breastfeeding.

Breastfeeding can generate a 35 times return on investment.

In most instances, babies born prematurely and critically ill infants, particularly those admitted into intensive care units, are too fragile to breastfeed. As part of its commitment to support and encourage mothers with high-risk infants, WBFA has spent the last year working with midwives and women to provide Lactation Support for Premature and Sick Infants in NICU – focusing on the promoting the administration of buccal colostrum. Colostrum, a mother's first secretion from the mammary glands after giving birth, is saturated with antibodies which protect against disease. Buccal colostrum – administering colostrum directly into a newborn's mouth – provides the benefits of colostrum to sick and preterm infants who cannot yet perform oral breastfeeding. It can be used even in critically ill and ventilated infants.

Toyin Saraki

Ultimately, careful application of colostrum via syringe or gloved finger, and feeding of breastmilk, can decrease morbidities, shorten hospital stays, and aid in the growth, health and development of preterm infants' digestive systems, while strengthening their immunity.

Caring for the most vulnerable infants in the most precarious of times is not solely an issue of compassion for babies and their families. Improving breastfeeding touches many areas of nations' economic and social development.

Each year, optimal breastfeeding practices have the potential to prevent 103,742 child deaths and prevent 1,511 maternal deaths from cancers and type II diabetes, which allows more people to live healthier lives and have more quality time with their loved ones. It will also save over US$22 million (₦6.93 billion) in health-system treatment costs related to inadequate breastfeeding, and reduce families' out of pocket expenditures to treat diarrhea and pneumonia.

Getting breastmilk to the most fragile infants reduces massive costs in human sorrow, increased health-care expenditures and reduction in national economic productivity.

These health outcomes and economic savings constitute an important contribution, as communities and countries deal with the strain from the pandemic. And, investing in breastfeeding will generate an additional US$21 billion (₦6.62 trillion) for the economy over children's productive years, by increasing cognitive capacity and preventing premature mortality in the early years.

WBFA continues to build partnerships, as we work to redefine how we can scale up nutrition to rebuild Nigeria's economy. We are taking care of our most vulnerable infants with our most natural solutions.

Reaching the last-mile lighthouse of care for our country's tiniest citizens, by extending preterm babies' connection to breastmilk, is one aspect of a making the largest impact – long-term economic recovery and revival.

Even amidst the pandemic, I have encouraged Nigerian mothers to continue breastfeeding their infants to protect against infectious diseases.  The World Health Organisation (WHO), after reviewing all available evidence, concludes that mothers with suspected or confirmed Covid-19 infections "should be encouraged to initiate or continue to breastfeed. Mothers should be counselled that the benefits of breastfeeding substantially outweigh the potential risks for transmission. WBFA agrees with WHO that all breastfeeding mothers should take as many precautions as possible to protect their babies – hand washing with soap and water before holding or feeding an infant, regularly cleaning surfaces and wearing masks.

As a supporting member of the Global UN Compact and the United Nations Economic and Social Council ECOSOC, the WBFA supports and adheres to the WHO Breastmilk Code and remains committed to improving breastfeeding rates in Nigeria and globally.

Toyin Saraki, founder-president of WBFA, was admitted to the Nigerian bar as a Barrister and Solicitor of the Supreme Court, has a master's degree in international economic law, and isa longtime advocate for saving the lives of mothers and children – Africa's most vulnerable people. Her passion for newborn care and for the prevention of infant and maternal deaths in childbirth arose from personal experience of the pain of losing newborns. She was the inaugural Global Goodwill Ambassador of the International Confederation of Midwives and has served on several boards, including the Global Foundation for the Elimination of Domestic Violence and the Africa Justice Foundation and as special advisor to the independent advisory group of WHO's regional office for Africa.

To launch its partnership with Medela, the Wellbeing Foundation Africa hosted a World Breastfeeding Week Webinar on breastfeeding in high-risk countries.

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