Monday, August 5, 2013

Promoting exclusive breastfeeding and safe maternal health practices

By Ruth Ansah Ayisi

Huayngua Village, Saravane province – When her labour pains began, Ouddala walked into the forest and gave birth alone inside a hut which she had built. Her son was born paralysed. She waited until he cried to breastfeed.

“My son died last year at the age of five,” says 22-year-old Ouddala, softly. “I had to feed him even when he was big because he could not move his body.”

Ouddala sits heavily pregnant on the wooden floor far from her visitors. She explains that she is not allowed to sit in front of the bedroom door of her mother-in-law, the most influential member of the family of 11. Instead, Ouddala is confined to the kitchen side of the three-bedroomed house built on stilts. Ouddala is responsible for all the domestic chores, including fetching water and firewood for cooking.

“I will be able to rest for three days after giving birth,” says Ouddala, smiling with no hint of resentment.

However, Ouddala, who left school to get married, is looking after herself better during this pregnancy thanks to the visit of the health volunteer, 55-year-old Duangta, from the same village.

Duangta moves to sit closer to Ouddala, spreading out laminated flip charts showing antenatal and postnatal care. She grins and nods as Ouddala shyly recounts what she has learned, “As soon as the baby is born I must breastfeed my baby and continue to give my baby only breast milk for six months. Then I must give food at six months while I continue to breastfeed.”

Ouddala’s shyness dissipates as they laugh and chat together; they share similar experiences. Duangta went to the forest to deliver her 11 children. She lost one child at birth and three others from diarrhoea.

World Breastfeeding Week
This week, Laos is celebrating “World Breastfeeding Week”, an annual event, every first week of August, which this year is built around the theme of “Breastfeeding Support for Mothers.”

The theme stresses that more mothers, like Ouddala, breastfeed when they receive support, counselling and education in health centres and their communities.

As well as counselling from the volunteer about exclusive breastfeeding, Ouddala is also finding other incentives to take care of her health.  The ‘Community Nutrition Project’ under the Ministry of Health has set up a fund to pay expectant women to attend antenatal clinics and also to deliver their babies in health facilities. Like other pregnant women in her village, Ouddala received 50,000 Kip (about US$7) to cover food and transport costs for antenatal visits to the health centre each month, and will receive 250,000 Kip (almost US$36) for giving birth there. She did not attend any antenatal clinics during her first pregnancy.

Dr. Khamseng Philavong, Deputy Director of the Nutrition Centre, stresses the life-cycle approach to nutrition and highlights the importance of breastfeeding. “Breastfeeding helps a child to survive and thrive,” says Dr Khamseng. “It protects babies against infectious diseases, provides essential nutrients during the first critical two years of a child’s life, and helps prevent stunting, which is a major challenge for our country.”

In Lao PDR, about 44 per cent of children under five years of age are stunted, meaning they are too short for their age; and the rate is as high as 60 per cent in some areas.

“Undernutrition has a detrimental impact on a child’s developmental potential,” warns Uma Palaniappan, Nutrition Specialist for UNICEF Lao PDR. “After the child’s second birthday, the damage is irreversible.”

Palaniappan explains that undernutrition impacts a child’s growth from when it is just a foetus as a result of the mother not receiving enough food and nutrients.
While government education initiatives have boosted exclusive breastfeeding rates significantly in recent years, still only 40 per cent of Lao children are exclusively breastfed to the correct age.  Moreover, only 5 per cent of children are considered to be receiving a “minimum acceptable diet”.

In some cases an underlying illness can dampen a child’s appetite and impacts on the absorption of nutrients critical for growth. Poor hygiene practices are also an important factor. Some 38 per cent of the Lao population still practices open defecation.

A sustained effort
The Lao Women’s Union provided Duangta with a series of trainings on the benefits of exclusive breastfeeding to six months of age followed by continued breastfeeding and correct complementary feeding practices for young children. Duangta spreads this advice among pregnant and new mothers in her community. The trainings are part of a government -led initiative, supported by UNICEF with funding from the European Union, USAID, and the Minerals and Metals Group (MMG).

The work of the Lao Women’s Union – many of whom also act as the village health volunteers – to promote good breastfeeding and child nutrition practices as well as good maternal health and hygiene is targeted this year in Saravane, Attapeu and Sekong  provinces, which have some of the highest malnutrition rates of the country. Their work is making a difference, according to Bounthavy Duanglasy, the president of the Lao Women’s Union in Saravane.

“The volunteers have particularly helped the community understand the importance of exclusive breastfeeding,” she explains.

Work at community level through peer-to-peer counselling sessions has ensured sustained support for mothers, strengthened by health workers, families and community leaders. However, she adds that challenges remain.

“For example, we don’t have enough materials in the different languages of the many ethnic groups, and the volunteers have to walk long distances.”

Khamphai Kaikoo, the village chief, who has lived in Huayngua for 20 years, appreciates the volunteers’ efforts. “There have been so many improvements. Before, women used to deliver their children in the forest because it was considered bad luck if they delivered in their homes. Some of the women and children would die. This practice stopped about four years ago.”

Nearby, 22 year-old Phone has put into practice what Duangta has taught her. “I learnt that I could eat vegetables and fish while I was pregnant,” says Phone, while her four-month-old baby bounces up and down on her lap. “Before my family said I could not eat vegetables while being pregnant and no fish except for carp. I also learnt how to express my milk on the days when it rains heavily and I can’t take my baby to the rice fields.”

Yet most of the households in Huayngua have no toilets or latrines. “I advise them to dig a hole and get rid of the babies’ faeces and wash their hands,” says Duangta. Ouddala has no latrine and although she knows the critical times to wash her hands, she concedes she has no soap. “I cannot afford it,” she says.

Besides the obstacles, Duangta is determined to keep working to promote the health of pregnant women and their babies. “I wanted to give something back to my village,” she says simply as she strides off to the next home.

Through support from the European Union, USAID and MMG, the Lao Ministry of Health, with technical support from UNICEF, has placed maternal and child nutrition issues high on its development agenda.