Why Achieving Exclusive Breastfeeding is Still Elusive


Breast milk is the best food for a newborn baby. No commercial-made baby formula, or any other food, or drink can match breast milk. The World Health Organization (WHO) recommends that babies should be breastfed exclusively for the first six months and thereafter continue breastfeeding supplementing with complementary feeds until the baby is two years and beyond for optimal growth and development.

The theme for this year’s World Breastfeeding Week Empower Parents, Enabling Breastfeeding calls for empowerment of parents to achieve exclusive breastfeeding right from conception. However, the prevalence of exclusive breastfeeding in Africa including Kenya is less than the recommended standard. Major obstacles cited to hinder exclusive breastfeeding include medical challenges, short maternity leave, lack of institutional policies to support breastfeeding staff, lack of food, lack of knowledge, lack of physical and emotional support among other issues.

Medical challenges

A number of medical challenges have greatly contributed to failure to achieve exclusive breastfeeding especially for mothers living with HIV/AIDS, or women on medical treatment that is contraindicated for breastfeeding like cancer.

Mothers living with HIV should breastfeed for at least 12 months and may continue breastfeeding for up to 24 months or longer (similar to the general population) while being fully supported for antiretroviral therapy adherence (see the WHO consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection for interventions to optimize adherence).

In settings where health services provide and support lifelong antiretroviral therapy, including adherence counselling, and promote and support breastfeeding among women living with HIV, the duration of breastfeeding should not be restricted.

Breastfeeding is safe for cancer mothers unless being treated with chemotherapy, or hormonal therapy. Nursing mothers undergoing, or scheduled to start chemotherapy treatments should stop breastfeeding until after treatment which is usually between three to four months. Radiation treatment can reduce breast milk production, cause mother to produce very little if any milk at all. For such mothers, formula milk is recommended as an alternative to breastfeeding in order to avoid transmitting harmful medication from the mother to the child.

Lack of physical and emotional support

To promote exclusive breastfeeding, interventions should be delivered in a combination of settings by involving health systems, home and family and the community environment concurrently.

Breast milk formation starts as early as 28 weeks of pregnancy. In order to ensure steady and continued formation of breast milk, hospital antenatal clinics are urged to initiate and provide the parents with necessary knowledge all throughout the pregnancy period, delivery and post-natal for them to support each other both physically and emotionally in order to get constant supply of breastmilk.

Lack of essential foods and nutrients

Pregnancy and breastfeeding place extra demands on the mother’s body. To meet these demands, they need to think about what is best to eat and drink. Good nutrition in pregnancy helps the mothers to stay healthy and energetic and to prepare for taking care of the new baby. Through breast milk, the baby eats everything the mother eats and therefore, the best way of giving the baby a healthy diet is for the mother to eat a healthy diet.

Mothers should eat a balanced diet rich in folic acid, vitamin D, iron and calcium. Such can include liver, kidneys, green vegetables, plenty of fruits and fluids. Breastfeeding mothers should avoid alcohol, smoking, caffeine and self-medication as these can cause harm to the baby either in the uterus, or through breast milk.

Short maternity leave

The standard maternity leave usually a period of three months is not enough to promote exclusive breastfeeding. In some instances, mothers are made to work from home while still on maternity leave, or even forced to resume work before the three months lapse with threats of work termination. In addition, there is also the challenge of workplace support after maternity leave for breastfeeding rooms where mothers can express milk and storage facilities. Organizations should also consider introducing day-care centres at the work place for breastfeeding mothers to promote exclusive breastfeeding.

In rural areas, working mothers experience similar, but more challenges than their urban counterparts coupled with lack of breastfeeding accessories like breast pumps for expressing breast milk, milk storage facilities, travelling for long distances in search of water leaving their babies unbreastfed for long hours. In such cases, babies are introduced to cow milk and complementary feeds early before the recommended period of six months for exclusive breastfeeding.

Empowering parents right from conception through to delivery and breastfeeding to achieve exclusive breastfeeding is crucial to curb infant malnutrition by providing essential nutrients for a healthy baby, reduce obesity, reduce vulnerability to allergies and diseases as well as achieve both optimal growth and higher baby IQ.

By Dr Sikolia Wanyonyi, Obstetrician Gynaecologist, Dr Rose Kamenwa, Paediatrician and Mary Mathenge, Lactation Manager at Aga Khan University Hospital, Nairobi.