The promotion of breastfeeding in developing nations struggling with hunger directly addresses the problem of infant undernutrition. Thirty-five percent of all childhood deaths are attributed to undernourishment, which is the largest single contributor to childhood mortality worldwide (Horton, et al. 2010). Childhood undernutrition refers to the inadequate nutrition of children under the age of five. After the first 24 months of an infant's life, the effects of childhood undernutrition are largely irreversible, such as stunting, which refers to low height for one's age, wasting, which is low weight for one's height, and the impairment of cognitive ability. It is therefore critical that infants obtain proper nutrition within the first 1000 days of their life (IFPRI, 2010).
Breast milk can provide infants with all the nutrients they need; however, many mothers are unaware of this fact, while others are unable to breastfeed due to undernutrition and micronutrient deficiencies, particularly in vitamin A, iron, and folic acid (IFPRI, 2010). Breastfeeding also can serve as an uncontroversial means of birth control: fertility reduction due to breastfeeding is similar to the effect of other methods of contraception (Pérez-Escamilla, 2007). Fertility reduction decrease population growth, which is interlinked with food insecurity as presented in the Cost of Inaction.
Breastfeeding will be promoted in areas affected by hunger, especially in areas with high rates of child undernutrition. Promotion will occur throughout the community, in pre-existing hospital clinics, as well as any new facilities that are developed by the innovation villages. The government will be responsible for the oversight of all programs, while each hospital's or heath care facility's program would be under the care of the hospital managers. The managers would be held accountable for the training of their staff by government institutions.
At hospitals, after the birth of a child, the following protocol, adapted from the World Health Organization's (WHO) and the United Nations Childhood Fund's (UNICEF) "Baby Friendly Hospital Initiative" would be implemented (UNICEF, 2010).
- A nationwide breastfeeding policy will be implemented at each hospital. Under the oversight of the manager of the health care facility or the hospital, the heath care staff will be properly trained on the policy and its implementation methods.
- The health care staff will inform all pregnant women about the benefits of breastfeeding, providing them with pamphlets and any additional resources available. All pregnant women will be given this information throughout their gestation and reminded of the importance after the birth of their child.
- Health care staff will aid mothers in initiating breastfeeding within one-half hour to hour of birth to ensure establishment and sustainment of breastfeeding through infancy (UNICEF and WHO, 2009).
- Show mothers how to breastfeed and how to maintain lactation. Provide them pamphlets and additional information concerning these subjects. Health care staff will also teach them how to use the hospital's electric breastfeeding pump, if applicable at that particular hospital, along with proper storage containers. As one of the key problems women faced with breastfeeding is their inability to breastfeed while at work (“Infant Feeding in Emergencies,” 2010). An available electric pump would allow them to store breast milk that could be given to their infants while they are away. The cost of electric breastfeeding pumps range from 50 to 900 US dollars, and therefore, may not be able to be available in every hospital and health care clinic (Comit Stores, 2009).
- Health care staff will promote exclusive breastfeeding for the first six months, informing the women that breast milk has all the key nutrients an infant needs. Exclusive breastfeeding refers to only breast milk feeding with no other foods or fluids, with the exception fo drops or syrups as micronutrient supplements and/or medicines. After six months, infants should receive complementary foods with continued breastfeeding for up to two years and beyond. Woman should be informed that breastfeeding is also a more efficient way of distributing calories. Infants between zero to six months need, on average, 627 calories/day,which can all be acquired through breast milk, while a breastfeeding mother only needs 500 extra calories per day (Atlas of World Hunger, 2010). This is approximately a 20% increase in caloric efficiency. Mothers, therefore, only need to be worried about acquiring food for themselves, instead of needing to be concerned with purchasing formula, which can put further strain on economic resources for impoverished families struggling with hunger.
- They should also encourage breastfeeding on demand and discourage the use of pacifiers, as pacifiers can provide mothers who have anxieties concerning breastfeeding with a means of weaning their children off of breast milk. Instead, health care staff should consult women about their anxieties when educating them about the benefits of breastfeeding (UNICEF and WHO, 2009) ("Exclusive Breastfeeding," 2010).
- Health care facilities should foster the establishment of breastfeeding support groups and provide mothers with information upon their discharge from the hospital or clinic.
- As many pregnant women suffer from micronutrient deficiencies, mothers should be given supplements in vitamin A, iron, and folic acid. Also, they should be informed about the importance of procuring an extra 500 kcal per day (UNICEF, 2010).
The above image is an example of an instruction card for the promotion of
"Best Practices in Agriculture, Nutrition, and Health" with a special focus on
breast feeding (IFPRI, 2010).
Initiatives in the community are also important, especially in areas where women do not tend to go to the hospital to give child birth. The promotion in the community would follow a similar set of guidelines as the hospital protocol, as it would:
- Educate about the importance of breastfeeding/ Encourage exclusive breastfeeding/ Provide information on breastfeeding and lactation
- Inform women about nearby available electric pumps and how they work
- Provide women with micronutrients, especially vitamin A, iron, and folic acid.
The World Bank estimates that the cost of breastfeeding promotion initiatives would be approximately $2.893 billion worldwide, while it would cost about $85.2 million worldwide to provide pregnant women who have low levels of micronutrients with iron and folic acid supplements (Horton, et. al, 2010). Vitamin A supplements cost approximately 2-4 cents per dosage per person (Sommer, 2001).
One problem with breastfeeding is the passing of AIDS from mother to her child through breast milk. About 42% of the children affected with AIDS each year, acquire the disease through breastfeeding. UNICEF has been working to provide voluntary confidential counseling testing, antiretroviral drugs, and counseling regarding infant feeding options and how to minimize risk of transmission (“Mother-to-Child Transmission of HIV/AID,” 2010). This type of information should be available at the local health facilities, as well as included in the promotion programs of the community.
Breastfeeding promotion could have an immediate impact on child undernutrition rates, and therefore can be considered a short term solution. Mothers who are taught about the benefits of breastfeeding and how to properly breastfeed can immediately begin providing their children with the adequate nutrition they need. Promotion of breastfeeding with continue in the communities strongly afflicted by hunger and undernutrition rates until it becomes an integral part of the community. The actual time this will take will vary from place to place, and therefore does not have an exact period of implementation, but will continue throughout the 100 year period until it is unnecessary.
Bassett, T. & Winter-Nelson, A. (2010). Atlas of world hunger. Chicago: The University of Chicago Press.
Horton, S., et al. (2010). Scaling Up Nutrition: What Will It Cost? Washington, D.C: The World Bank.
IFPRI. (2010). Fighting the Crisis of Early Childhood Undernutrition. Global Hunger Index, 21-29.
UNICEF. (2010). Mother-to-child transmission of HIV/AIDS. Programmes to Prevent HIV/AIDS. Retrieved November 15, 2010, from http://www.unicef.org/programme/hiv/focus/mtct/mtct_int.htm
UNICEF. (2010). The baby-friendly hospital initiative. Retrieved November 7, 2010, from http://www.unicef.org/programme/breastfeeding/baby.htm#10
UNICEF and WHO. (2009). Baby-friendly hospital initiative. New York: Nutrition Section-Programme Division UNICEF.
World Health Organization. (2001). Infant feeding in emergencies. Retrieved November 14, 2010, from http://www.who.int/nutrition/publications/emergencies/ife_module1/en/index.html
World Health Organization. Exclusive breastfeeding. Retrieved November 14, 2010, from http://www.who.int/nutrition/topics/exclusive_breastfeeding/en/index.html
Comit Stores. (2009). Electric Breast Pumps. Retrieved November 29, 2010, from http://www.breastpumps.com/electric-breast-pumps.htm