Panelists at Unicef roundtable discussion. Pic: UNICEF
South African organisations still fail to prioritise and support working mothers who need to breastfeed. This, according to experts, despite existing laws, regulations and policies to enable an environment conducive to the practice.
According to Ann Behr from the National Department of Health's Child, Youth and School Health Directorate, there are very few organisations with written policies on workplace breastfeeding. Behr was speaking at a UNICEF roundtable discussion, held on May 21 in Johannesburg, where health experts, senior officials from the directorate and other stakeholders gathered to discuss how breastfeeding can be better facilitated and supported in workplaces.
The Basic Conditions of Employment Act entitles breastfeeding mothers to two 30-minute feeding breaks during office hours, but few people are aware of this provision, and workplaces do not always inform their employees of their rights.
Behr says a recent policy review survey of 100 respondents from 32 organisations found that only 11 of the organisations had workplace breastfeeding policies in place. Of those 11, only five had a hard copy of this policy available as a reference for employees.
Toolkit to boost breastfeeding
The Department of Health has developed a breastfeeding toolkit that they hope will assist and guide organisations in their policies on the matter. In turn, more mothers will be empowered and supported to breastfeed their babies and more children will be exposed to the wide array of benefits that breast milk offers, both in terms of health and development. Experts agree that breastfeeding is the best way to build a child’s immune system and ensure that a baby gets a nutritious diet.
Many organisations are either ignorant or negligent to the obligations outlined in the Code of Good Practice on the Protection of Employees during Pregnancy and after the Birth of a Child, despite the code’s introduction to South Africa’s labour law in 1998.
Two decades later and experts agree that more is needed to ensure organisational awareness and education. Lynette Daniels is from Stellenbosch University's Faculty of Health Sciences. She says one of the main problems for working mothers is finding space and time to breastfeed or to express milk. This, she adds, is especially true in organisations where top management is male-dominated.
For this reason, she says, breastfeeding awareness campaigns should not focus exclusively on mothers or on women.
“That came up in my study as a challenge voiced by employees in male-dominated workplace environments,” she explains. “Obviously we need to do a lot of education to involve males in education regarding breastfeeding. Men can also be advocates.”
A breastfeeding roundtable was held in Johannesburg to discuss what could be done to promote breastfeeding in the workplace. Pic: UNICEF
Daniels, who is working towards her PhD, is busy with a study on workplace support for exclusive breastfeeding in designated spaces. The study, set in the town of Worcester in South Africa’s Western Cape, focuses on developing a practice model to assist organisations comply with the Code of Good Practice.
“I wanted to explore. I wanted to find more information and understand the workplace with regards to support for breastfeeding,” Daniels says, adding that her study will be completed towards the end of the year.
She says there are not enough studies conducted that focus on workplace support for breastfeeding in a South African context. Of the few studies available, it was the Lancet Series on Breastfeeding released in 2016 that inspired her current research.
“It identified the workplace as one of the settings of an enabling environment for breastfeeding,” Daniels explained. “What my research also finds is that breastfeeding is not a priority in the workplace.”
Her research shows that in many cases management does not create an enabling environment for working mothers to breastfeed, despite being informed and understanding the benefits of breastmilk for children and childhood development.
Clearer breastfeeding policies needed
The South African health system is still trying to recover from earlier periods of ‘disastrous uncertainty’ with regards to the promotion of breastfeeding. One of the major challenges was how to approach infant feeding in the face of the country’s HIV epidemic. For this reason, two infant feeding options were promoted by government and health workers - mothers were advised to either breastfeed exclusively or to formula-feed exclusively.
Lesley Bamford is a specialist in the Child, Youth and School Health Directorate, and remembers this approach and the challenges it brought. “I remember many years ago when government provided free infant formula to HIV-positive mothers. They said it's a human rights issue,” said Bamford, referring to the Department of Health’s ill-fated Prevention of Mother to Child Transmission (PMTCT) policy implemented in the 2000s in an attempt to curb the increasing cases of mother-to-child transmission of HIV.
According to her, this approach also brought other human rights issues to the fore that had not been anticipated. “If you provide free formula, then what about how you prepare the formula? Then you must also supply safe water. Whereas breast milk comes complete - it's safe and its sterile.”
“There was so much confusion - mothers got the formula free of charge so they would take the formula but also continue breastfeeding, and use the formula for other things.”
This was just one of the many pitfalls of the the PMTCT policy, and lot of confusion ensued.
“I think PMTCT HIV-treatment has improved over the years, and there is more research on transmission. It has been found that if the mother is on treatment and adheres to her treatment, the transmission rate is negligible. We need to encourage mothers to adhere to their treatment.”
Bamford says this mix-feeding defied the purpose and the PMTCT-era saw an increase of children dying of diarrhea, pneumonia and malnutrition. Thanks to improved research, most experts -including the World Health Organisation - now recommend exclusive breastfeeding. This includes HIV-positive mothers, provided they adhere to treatment, to ensure that all children have access to the benefits of breastmilk.
In an attempt to ensure children under five receive the nurturing they need to develop, the National Department of Health launched Side-by-Side, an advocacy campaign on both social and traditional media platforms. Part of this campaign was the production of a 48-episode radio drama by the same name, which is broadcast on various stations in all 11 official languages of South Africa.
The campaign message is simple: The first 1000 days in a child's life are crucial. That is just over two and a half years to ensure that the foundations for a healthy life have been laid properly.
Buhle Mabaso, who manages the campaign, says they wanted to try avoid doing another boring educational programme, which is why they chose a radio drama to deliver the campaign message. “We wanted to mirror the lives of everyday South Africans,” she said.
Pic: @SidebySide (Facebook)
By engaging audiences in stories they can relate to, the campaign hopes to bring behavioural changes as ordinary people connect to characters that are relatable and grow along with these characters as they become more informed and aware of the issues central to the project.
“People are most likely to change behaviours if they can see somebody they identify with doing the same thing. This is what led to the creation of a radio drama with characters that you can find in any South African township or rural area,” Mabaso explained.
This campaign is one of many being run by health departments globally as they attempt to increase infant health and curb the number of childhood deaths.
While it seems these campaigns have had some success, with the mortality rate for children under the age of five dropping significantly since 1990, experts agree that the number of children dying today is still too high.
According to UNICEF, 1 in 26 children died before the age of five in 2017, compared to 1 in 11 children of the same age in 1990. While an improvement, this still means that around 5.4 million children under age of five died in 2017, with more than half of these deaths occurring in Sub-Saharan Africa.
Digital tools to raise awareness
Mabaso says South Africa’s growing digital jungle must be used to bring education about breastfeeding and childcare closer to the audience that needs this information the most. South Africa presently has around 31 million internet users, with many of these using smartphones to access the web. Mabaso says taking Side-by-Side's digital campaigns on social media allows them to tap into a massive audience - one that had previously been excluded in campaigns.
“Because our messages are short and quick to the point using social media makes sense to us. We can share videos, pictures, whatever else we want to promote and people can easily share them with each other,” Mabaso says.
One way they do this is to complement the Mom-Connect and Nurse Connect programmes. Mom-Connect is a free USSD subscription messaging service for pregnant women. Once subscribed, by dialing *134*550# and answering a few questions related to their pregnancy, they are encouraged to register the pregnancy at an antenatal clinic.
Expectant mothers can use this service to tap into resources and useful information about accessing care during labour, proper nutrition, newborn care, breastfeeding and immunisation. The information, in the form of weekly messages until the child reaches the age of one, are tailored to the stage of pregnancy or the age of the baby. Nurse Connect operates on a similar principle, with nurses and midwives receiving weekly messages on family planning, infant and child care and maternal health.
By 2017 about 364 860 women were subscribed to Mom Connect, with more than 1,5 million registered through clinics.
Mabaso says Side-by-Side is not a stand-alone campaign. “Mom-Connect forms part of the platforms through which we get these messages across. The reason we decided to add the extra elements of Facebook and Twitter is because Mom-Connect doesn't allow for active engagement.”
To facilitate this engagement the campaign now has a dedicated team of doctors that answer any questions that new or expectant mothers may have on social media.
More than breastfeeding
The Side-by-Side campaign looks at issues of nutrition, health care and the protection children need from diseases, as well as specialised care that may be required, all in an engaging and educational manner. The project also emphasises the value of play on childhood development, as well as the positive effects on mental development when children are talked to and shown affection. In addition to the South African air waves, the campaign also targets areas where mothers and members of the extended family are likely to gather, which means that aunts and uncles and cousins and grandparents are all exposed to their message. For this reason Mabaso says they target stokvels, churches and communal areas like taxi ranks. Afterall, she says, it takes a village to raise a child.