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Early Initiation, Exclusive Breastfeeding International Nurses & Midwives week Scientific Session Abimbola Williams
Date Posted: 15/May/2019


•       Globally, an estimated 1.45 million child deaths could be prevented each year with improved breastfeeding practices

•        More is now known of the factors and challenges of mothers in the initiation and practice of  continuous  exclusive breastfeeding in the hospital, at home and when they return to work. 

•       Over the past decades, evidence for the health advantages of breastfeeding and recommendations for practice have continued to increase.

•       WHO can now say with full confidence that breastfeeding reduces child mortality and has health benefits that extend into adulthood.

•       On a population basis, exclusive breastfeeding for the first six months of life is the recommended way of feeding infants, followed by continued breastfeeding with appropriate complementary foods for up to two years or beyond


•       About half of all child deaths are from poor nutrition

•       Most deaths occur in the first months of life when infant feeding is vital for survival


•       Nigeria has the second highest stunting burden in the world, with over 11 million stunted children and a prevalence of 42 in 2003, 41 percent in 2008, 37 percent in 2013.

•       Undernutrition has been implicated to be at the heart of Nigeria’s slow progress in reducing child mortality

•       (NDHS) 2015, shows only 17% of children under-six months benefitted from EBF, with insignificant improvement to 23.5% according to MICS 5 2017 and only about a third of all newborns benefited from EI.

•        There are many opportunities currently available to improve EI & EBF & reduce infant & <5 mortality

Causes of Child Mortality in Nigeria

·         Malnutrition 52%

  • Vaccine Preventable Diseases
  • Malaria
  • Acute Respiratory Infections
  • Diarrhoea

Improving breastfeeding practices would have a profound effect on morbidity as well as mortality

·         Improving breastfeeding would prevent: More than 54% of all diarrhea episodes And 32% of all respiratory infections (in LMICs)

·         Protection against hospital admissions even greater:  72% of all admissions for diarrhea 57% for respiratory infections

Figure 3-Child mortality: effective interventions  
Source: Lancet Child Survival Series 2003

Figure 3 Child mortality effective interventions

•       WHO; Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implications for the health of mothers.  Additionally, it recommends Breastfeeding on demand – that is as often as the child wants, day and night, no use of bottles, teats or pacifiers

•       Provides superior nutrition for optimum growth & development.

•       Provides adequate water for hydration.

•       Protects against infection and allergies.

•       Promotes bonding between mother & baby.

•       Breastfeeding plays a significant role in improving nutrition, education, and maternal and child health and survival

•       In emergency settings where there is a high risk of diarrhoea, pneumonia and malnutrition, breastfeeding can be critical for child survival.

Early Initiation of Breastfeeding
What is it?

Putting newborns to breast within one hour of birth is referred to as “early initiation of breastfeeding”. and ensures that the infant receives the colostrum, or “first milk”.

WHO recommendations; Early and uninterrupted skin-to-skin contact between mothers and infants should be facilitated and encouraged as soon as possible after birth.

•       All mothers should be supported to initiate breastfeeding, within the first hour after delivery.

•       Mothers should receive support to enable them  establish breastfeeding and manage common breastfeeding difficulties.

  Early Initiation of Breast feeding (EI)

•       Babies are kept warm in the skin-to-skin contact with mother, Lowering the risk of death from hypothermia

•       Mother and baby feel calmer, helping babies breathe better & keeping the heartbeat more stable.

•       Baby's risk of infection is reduced because safe germs (bacteria) from the mother begin to colonize the skin and intestines, and prevent harmful germs.

•       Infants get the first milk, colostrum, rich in protective factors 

•       Provides early stimulation, love, security and food.

•       It also initiates the process of bonding between baby and mother.

•       Early initiation of breastfeeding increases EBF success

Exclusive Breastfeeding
What is it?

It is the feeding of babies and young infants with only milk from a woman's breast with no additional food, water or other fluids.

•       WHO Recommendations; Infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods, while continuing to breastfeed for up to two years or beyond.

Benefits of Exclusive Breastfeeding
-To the Baby

•       Provides the ideal nutrition for infants. It has a nearly perfect mix of vitamins, protein, and fat -- everything the baby needs to grow, in a form easily digested by the baby.

•       Breast milk contains antibodies that help babies fight off viruses and bacteria.

•       Breastfeeding lowers baby's risk of having asthma or allergies.

•       Babies who are breastfed exclusively for the first 6 months, without any formula or water, have fewer ear infections, respiratory illnesses, and bouts of diarrhea.

•       They also have fewer hospitalizations and trips to the doctor   

•       Breastmilk promotes sensory and cognitive development  in the child & has been linked to higher IQ scores in later childhood in some studies.

•       Breastfed infants are more likely to gain the right amount of weight as they grow rather than become overweight children.

•       It's been known to lower the risk of diabetes, obesity, 

Benefits of Exclusive Breastfeeding
-To the Mother

•       Breastfeeding contributes to the health and well-being of mothers;

•       Breastfeeding burns extra calories, so it helps mother lose pregnancy weight faster.

•       It releases the hormone oxytocin, which helps the uterus return to its pre-pregnancy size and reduce post partum bleeding.

•       It helps to space children, reduces the risk of ovarian cancer and breast cancer,

•       Increases family resources & is a secure way of feeding 

•       It may also lower the risk of osteoporosis, too.

Benefits of Exclusive Breastfeeding
To the Economy, environment & government

•       Is Environment-friendly

–      Breastfeeding does not waste scarce resources or create pollution. Breast milk is a naturally-renewable resource that requires no packaging, shipping, or disposal

•       Financial Savings to Government and Families

–      Breastfeeding reduces the cost of healthcare and the need for costly health services that must be paid for by insurers, government agencies, or families.

–      Breast-fed babies are less likely to need excessive medical attention as they grow.

–      The cost of artificial feeding has increased astronomically over the last 10 years.

•       Improved Vaccine Effectiveness

–      Breastfed infants showed a better serum and secretory responses to per-oral and parenteral vaccines than the formula-fed, whether with a conventional or low protein content

•       More Ecological

–      There is less use of natural resources (glass, plastic, metal, paper) and also less waste for landfills.

New Evidence on Breastfeeding

•       Saves 823,000 lives every year

•       Reduces Diarrhoea & Pneumonia cases

•       Improves intelligence scores in children

•       Reduces maternal caner deaths – 20,000

•       Reduces adult chronic diseases (e.g. overweight, Diabetes)

EI & Excl. Breastfeeding
Role of Nurses & Midwives

•       Be BF advocates, providing information about early initiation and exclusive breastfeeding for 6 months, & support the mother to breastfeed

–      The Midwife should inform the mother of the benefits of breast feeding to herself and her baby & prepare the mother psychologically during antenatal care.

•       The midwife in the labour and delivery room should help initiate breastfeeding within the first hour of birth 

•       Reassure the mother who has a Caesarean birth, or a premature or sick infant, that she too can breastfeed & provide the needed support to do so.

•       The midwife should support breast feeding by refraining from giving prelacteal fluids

•       Assist lactating mothers resolve common breastfeeding problems/difficulties

•       Compliance with the Breast milk substitute code

•       Ensure  that health facility is baby friendly with the 6 / 10 steps to breastfeeding  conspicuously placed in the clinics

Thank you for listening

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