Breast-feeding: Working to make it work

By Ellen Piwoz 05 August 2015

A mother is taught about the importance of breast-feeding in Malawi. Breast-feeding is critical in early childhood development. Photo by: Wezzie Grace Kenan / Feed the Children / USAID / CC BY-NC-ND

Back in May, when asked for the one global health challenge he would solve immediately if given a magic wand, Bill Gates said “child malnutrition.” A few weeks later, Melinda Gates referred to breast-feeding as a “miracle investment.” As a lifelong nutrition scientist, advocate and working mother, I couldn’t be happier that this critical issue is being prioritized.

Yes, breast-feeding could help save more than 800,000 lives per year, and yes, it gives children a strong start in life. However, sadly, it doesn’t happen by magic. Any mother will tell you it isn’t easy. It takes a lot of effort from women — and a lot of support from their families and communities.

The theme of World Breast-feeding Week 2015 is “Let’s make it work!” — focusing on supporting working women that breast-feed. The reality is that all women work, whether in the home or in an office, factory or field. The question then is: What do we need to do to make breast-feeding work for women and their children, no matter where they live or what they do?

An important first step is ensuring that women have the accurate information needed to make feeding choices for their children. Just last week, a National Institutes of Health study found that 20 percent of new moms in the United States did not receive any breast-feeding guidance from their doctors. The World Health Organization recommends initiating breast-feeding within one hour of birth and breast-feeding exclusively — no water, nor anything else — for the first six months.

But these aren’t things that people just know — women should be able to rely on their health care providers for this critical information. And beyond making informed decisions, breast-feeding women need to be supported at home, at work and in their communities.

There are many potential approaches to building this supportive environment. One that has had success is Alive & Thrive — an effort not just to improve infant and young child feeding practices, such as breast-feeding and complementary feeding, but to do so on a broad scale.

In Bangladesh, Alive & Thrive worked to strengthen support systems for new moms by engaging fathers, mothers-in-law and other family members. Through a series of short videos, the effort helped get the word out about the role fathers could play in supporting their wives, as well as a supportive message about not feeding the child anything but breastmilk for six months, regardless of tradition. Millions of people were exposed to these videos, which were just one element of Alive & Thrive’s work that contributed to significant improvements in exclusive breast-feeding in program areas.

Women working outside of the home need other kinds of support. I recall when I had my own children and sought to balance breast-feeding and work (graduate studies at the time). It was tough and I was fortunate to have a baby-friendly hospital and support to get me started. But outside the hospital, finding the time and a place to breast-feed was a very different story.

Things have certainly changed since then. More and more workplaces in the U.S and abroad have lactation rooms or mother’s rooms to support breast-feeding moms — and allow them the time to utilize these spaces. In Vietnam, breast-feeding support programs have been established at more than 70 workplaces — including 60 companies and 10 government agencies. Even the country’s National Assembly has its own lactation room. All of this builds on the 2012 achievement in which Vietnam adopted six months of paid maternity in an effort to support mothers and encourage exclusive breast-feeding.

This is all impressive progress, but as media stories continue to illustrate, work is still needed to ensure that attitudes, programs and policies support breast-feeding women. As the global community looks toward the sustainable development goals, with new targets and innovations — let’s not miss some of the low-tech options like breast-feeding that can make a significant and lasting impact on health and development.

Earlier this year, our team at the Bill & Melinda Gates Foundation released a new strategy that will guide our nutrition investments in the coming years. Breast-feeding is a key part of this, as are other interventions proven to strengthen nutrition for women and children. At the same time, we’ll look for new opportunities to address the instances of malnutrition that cannot be reached with current solutions.

We can make this work. Not by magic, but by working together; by improving nutrition for women and girls before pregnancy; by focusing on nutrition and care in the 1,000 days of a woman’s pregnancy until her child’s second birthday; and by ensuring that women are supported in breast-feeding wherever they live and whatever they do.

To read additional content on global health, go to Focus On: Global Health in partnership with Johnson & Johnson.

About the author

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Ellen Piwoz

Ellen Piwoz is a senior program officer in nutrition at the Bill & Melinda Gates Foundation. Her work focuses on data, analytics and evidence to improve nutrition for women and girls globally. She manages a diverse portfolio of grants, including research on healthy birth, growth and development; testing models to achieve change at scale for breast-feeding and complementary feeding; generating evidence for advocacy; and supporting the Scaling Up Nutrition Movement.


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