Kampala — As fewer Ugandan mothers follow WHO guidance for six months of exclusive breastfeeding, newborns are at risk of infections, stunted growth and malnutrition.
When Christine Kyagera gave birth during the coronavirus lockdown, she wanted to breastfeed her newborn. She had learned about the benefits of breastfeeding at the antenatal care clinic, but her circumstances would not allow. Soon after giving birth, the government lifted the pandemic restrictions, and Kyagera, who was 19 when she got pregnant, returned for her final year of high school. She left her son with her mother, who put him on baby formula.
During school holidays, Kyagera would try to breastfeed, but the baby was already used to the formula. As a result, she says, his growth was slow compared with most children. He didn't walk until he was 1½ years old.
Kyagera's son is one of many children in Uganda who are not breastfed as per World Health Organization recommendations, which encourage mothers to initiate breastfeeding within the first hour after birth, breastfeed their children exclusively for six months, then feed them other complementary food while also breastfeeding for up to 24 months.
Breast milk is known to provide proper nourishment for babies. Failure to breastfeed as recommended, according to the WHO, puts newborns at risk of infections, slow growth and death due to malnutrition.
While Uganda's 2016 Demographic and Health Survey indicated that only 6 in 10 women breastfed within an hour after birth, these numbers have declined, says Stella Nambooze Ddamulira, a doctor at Nakasero Hospital in Kampala, the capital. She says that the preliminary results of an unpublished study by the hospital revealed that the percentage of women in Uganda who breastfeed exclusively within the first six months has fallen to about 40% to 50% in the last year, compared with 70% and above in the last five to 10 years.
Mothers are weaning off their babies at 2 to 3 months, the study shows.
Cultural beliefs and practices, and the demands of employment, are some of the reasons many mothers don't follow the recommendations. The pandemic especially drove up the number of children who are not sufficiently breastfed, as teenage pregnancies increased by 22%, Nambooze says.
Many of these girls had to go back to school and could not breastfeed, resulting in babies with delayed development, she adds.
"You find that a baby is 6 months," she says, "but they look younger, have lower immunity than those breastfed as per recommended guidelines."
Nambooze says that although the hospital hasn't properly documented the statistics, doctors are seeing more malnourished children than before.
Jesca Nsungwa Sabiiti, commissioner for the department of reproductive and child health at the Ministry of Health, agrees that teenage girls who get pregnant face unique challenges when it comes to breastfeeding.
"If the support system is not there, stress can affect breast milk production unless they get a lot of support," she says. She adds that her department is working with the education ministry to ensure support for teenage mothers but didn't provide details on the kind of support.
While a spike in teenage pregnancies has increased the number of children in Uganda who aren't breastfed as per WHO recommendations, cultural beliefs have always been a factor, Nambooze says. Sometimes, women discourage other women from breastfeeding.
Tereza Nakwedde got pregnant with her first baby at age 20. Three months after giving birth, she conceived again. Friends and in-laws discouraged her from breastfeeding while she was pregnant. They said it was risky because her breast milk was already spoiled by her unborn baby, who was jealous. Nakwedde didn't take them seriously. She wanted to breastfeed her 3-month-old. But when he got diarrhea, they warned her again. Now she was worried. The evidence was right there.
"It was then that I had to stop breastfeeding," Nakwedde says.
The demands of full-time employment also make exclusive breastfeeding difficult for many women, Nambooze says. While the Ugandan government requires workplaces to give women three months of maternity leave, few do, which makes exclusive breastfeeding for six months difficult, according to a recent study by Makerere University.
Lillian Jjuko, 25, is a first-time mother who works in a mobile money shop in Ntinda, a Kampala suburb. She gave birth to her daughter four months after she got the job.
"It was my first job, and I was glad the owner accepted to employ me when I was pregnant," she says.
Her employer gave her only two months of maternity leave, which made it difficult to follow the breastfeeding guidelines.
"I used to pump the milk from the breasts at first but had no safe place to keep it," she says. "I felt it wasn't safe for my baby either and had to introduce other feeds earlier than recommended."
Although her baby is doing well, Jjuko worries about his growth, which she says is stunted.
Even the three months of maternity leave stipulated by the government isn't enough, says Safula Kyabagye, the administration and human resource officer for Akina Mama wa Afrika, a nongovernmental organization. Kyabagye says her organization is trying to confront this problem by providing three months of paid maternity leave to its staff but also encouraging women to take annual leave during the same period, giving them four months. During the transition process after maternity leave, the mother is allowed to work half days for 30 days so she can keep breastfeeding. The organization also provides a nursery at the workplace.
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All workplaces that employ women should at least have a nursery, says Fortunate Tusasirwe, a mother. Tusasirwe says that when she gave birth, her workplace allowed her to bring her child to work for six months. It was the only way she could follow the six-month breastfeeding guideline.
Although the number of children breastfed exclusively for six months is declining, Sabiiti says that health facilities in Uganda share the guidelines with women during antenatal care. Nambooze agrees. She says officials have conducted sensitizations and retraining programs to equip nurses and midwives to advise women.
"Love and bonding takes place during breastfeeding. We tell them that those who don't breastfeed are missing out on bonding and baby love. Breastfeeding restores the mother's health. For some it's a method of family planning. It helps compress the uterus after delivery," she says.
For other mothers, breastfeeding is not negotiable, even when they face challenges. Polly Namiyingo, a 27-year-old mother of three, says breastfeeding all her children has enabled them to remain healthy.
"Even when I am going to my business, I carry my 5-month-old with me. My children don't fall sick because I breastfeed them," she says.
Apophia Agiresaasi is a Global Press Journal reporter based in Kampala, Uganda.
TRANSLATION NOTE
Apophia Agiresaasi, GPJ, translated some interviews from Luganda.
