Although over-worked, LHWs now being eyed to promote breastfeeding practices

Islamabad
With an emphasis on improving the knowledge of Lady Health Workers (LHWs) for promotion of breastfeeding within communities as part of the need to improve child health and decrease infant mortality in Pakistan, a breast-feeding advocacy seminar was convened on Tuesday at the MCH Training Centre at Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), PIMS.
The seminar was a collaborative effort of the Maternal Neonatal and Child Health Research Network (MNCHRN), Children’s Hospital PIMS, Unicef, Ministry of National Health Services, and the federal chapter of Pakistan Paediatric Association. This year’s theme for World Breastfeeding Week was ‘Breastfeeding and Work: Let’s make it work.’
LHWs, being the primary healthcare providers with direct contact with the community, can doubtlessly play an important role in promoting breastfeeding, provided they themselves are empowered with basic knowledge on the subject. At present, this particular workforce is unable to deliver due to excessive workload and lack of proper training.
To this effect, Dr. Hana Mahmood from MNCHRN shared details of a project being conducted under the supervision of Dr. Tabish Hazir, head of the paediatric department and honorary principal investigator of MNCHRN. Under this project, mobile phone technology is being employed to counsel mothers on nutrition.
“Upon input from technical experts from South Asia including Pakistan, a specialized, highly user-friendly audio-visual application was created by the name of ‘Sehatmandkal,’ which was incorporated into mobile phones of LHWs who were also trained in its usage,” Dr. Hana shared. The LHWs, during their monthly visit, carried this application along and entered data on nutrition by asking a few questions from mothers. On getting the answers, an automatic response-based audio would pop up which the LHW give the mother to listen to. At the same time, women are sent weekly voice and text messages on nutrition to improve their knowledge and induce behaviour change.
Speaking as chief guest, the deputy country representative of Unicef, Karen Allen, referred to the global issues and challenges that arise with respect to breastfeeding at work, giving examples of countries like Ghana and Vietnam who have improved their mortality by improving breastfeeding rates.
Dr. Tabish Hazir explained why exclusive breastfeeding is so important, and what potential impact it can have on infant mortality in Pakistan. He defined exclusive breastfeeding as “only breastfeeding and no additional food, water or other fluids for first 6 months of life.” Sharing harrowing statistics which continue to be repeated at every seminar on the subject, Dr. Tabish highlighted that Pakistan still stands poor in South Asia, with lowest exclusive breastfeeding rates of 38% and highest bottle feeding rates of 41%. “Exclusive breastfeeding rates in Pakistan are undesirably low and need to be improved,” he asserted.
What policy options Pakistan needs to exercise were also outlined by Dr. Tabish. He said legislation ordinance on breastfeeding and marketing code should be strictly implemented; healthcare providers at all levels should be targeted for improved breastfeeding counselling skills; undergraduate curriculum should be revised with greater emphasis on good IYCF practices including exclusive breastfeeding; and effort should be made to make health facilities more baby-friendly.
Dr. Tabish shared that despite high cultural acceptance for breastfeeding in Pakistan, the practice declines rapidly with age. “There is a need to evolve behaviour change strategies to discourage this trend. An integrated approach to IYCF communication from pregnancy to early infancy is required. Women from all education and SES levels need IYCF counselling,” he stated. In order to improve timely initiation, exclusive breastfeeding strategies should target working women and health facility deliveries including Caesarean sections. And to decrease bottle feeding practices, strategies should target urban women and higher socio-economic strata, he concluded.
Professor Syeda Batool Mazhar, head of the Department of Gynaecology and Obstetrics, PIMS, focused on the need to encourage breastfeeding at work. She presented a brief overview of how an enabling environment can be created for working women with proper maternity leave. She said working women should breastfeed because it prevents infant death, provides perfect nutrition, and protects the newborn from childhood illnesses such as respiratory and GIT infections as well as non-communicable diseases such as asthma and diabetes. Breastfeeding also supports brain development, improves cognitive performance, and protects maternal health, she emphasized. It is basically for the government, the health sector, and employers to create better support systems and policies to enable working mothers to breastfeed.
Dr. Batool shared that there are approximately 830 million women workers in the world, and that only 39 per cent of children less than six months of age in the developing world are exclusively breastfed. According to PDHS 2012-13, there has been an increase of 0.6 per cent in the exclusive breastfeeding rate, while the rate of bottle-fed babies has risen by 8.9 per cent since 2006. In Pakistan, from 1983 to 2008, the prevalence of breastfeeding at 6 months has decreased from 96% to 31%.
“A woman’s ability to breastfeed is markedly reduced when she returns to work. Given the substantial presence of mothers in the work force, there is a strong need to establish lactation support in the workplace. Legislation guaranteeing breastfeeding breaks could substantially improve working mothers’ ability to continue to breastfeed,” Dr. Batool pointed out. Unlike in the US, UK and India, there is no clear provision on breast-feeding breaks in Pakistan.
Dr. Batool shared that 45 countries (25%) have no policy regarding breastfeeding breaks, seven countries (4%) have policies guaranteeing unpaid breaks, while paid breastfeeding breaks are in place in 130 countries (71%).
Talking about barriers to breastfeeding, Dr. Batool referred to lack of privacy, non-availability of breastfeeding breaks, employers’ perception that the presence of infants in the workplace reduces mothers’ productivity, inadequate maternity leave in private sector/organisations, and lack of child care close to the workplace.
The head of the nutrition department at Unicef, Dr. Melani Galvin, emphasised the need for breastfeeding advocacy and communication for a 21st century world. “The need to protect breastfeeding is becoming more urgent as formula companies’ influence grows. Stakeholders must now reach a technical and policy consensus on scaling up breastfeeding programmes at country level,” Dr. Melani asserted. A staggering 84 per cent of mothers have reported in a recent survey that they were advised to use formula milk or other milk or food for infant under six months of age, making the task for the advocates of breastfeeding in the country more difficult to accomplish, Dr. Melani added.
In the end, Ministry of Health Director (Nutrition) Dr. Baseer Achakzai delivered the concluding remarks. The welcome address was delivered by Dr. Humaira Mehmood, research administrator at the MNCHRN.
Post-lunch, a three-hour continued medical education (CME) session on the subject was organised in collaboration with Pakistan Paediatric Association. The session focused on problems encountered during breastfeeding and ways to handle them.