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Exclusive Breastfeeding: No preludes needed, this is Africa

If at least 50% of children are to be exclusively breastfed in their first 1 000 days of life, then both parents, and not just mothers, need to be empowered. This is the message for World Breastfeeding Week 2019, which kicked off on August 1. Fortunately, two passionate breastfeeding champions have thrown their weight behind this goal - South Africa’s first lady Dr Tshepo Motsepe and the country’s health minister, Dr Zweli Mkhize.

Health Minister Dr Zweli Mkhize and South Africa's first lady Dr Tshepo Motsepe with Stasha Jordan, the executive director of the South African Breastmilk Reserve at the launch of Breastfeeding Week at Kalafong Hospital in Atteridgeville, Pretoria.

The two doctors draw on their personal experiences to drive the awareness campaign promoting the benefits of breastfeeding for both mother and child during World Breastfeeding Week, which will run until August 7.

This year's campaign was officially launched at the Kalafong Hospital in Pretoria on August 1. The mood was light as both doctors, with great humour and candor, prodded and cajoled each other to make sure their message hit home: Breast milk gives children the best chance of a healthy start in life.

Mkhize says that the 2019 theme, 'Empower Parents - Enable Breastfeeding', is especially important now, as society puts increasing pressure on mothers, making them feel ashamed.

If this was a different part of the world the message might need a prelude, but not here. “This is Africa. Breastfeeding is a matter of pride," Mkhize declares, "Mothers must be allowed to breastfeed whenever and wherever it is necessary." Public shame, he says, should not be a factor. "I know that some people are uncomfortable with this, but we shouldn’t be the ones who make mothers ashamed of doing what is natural.”

Mkhize says that when negative public sentiments hinders mothers from breastfeeding in public or in the workplace, children are not only inconvenienced - they are actively disadvantaged. His own mother breastfed most of his siblings until they were about three years.

“She used to then tell me that I wasn’t weaned the normal way,” he says with a smile. “Because I could talk then I went and negotiated for a breast sip. One of my aunts was watching and heard this." The aunt jokingly expressed her shock that a child old enough to ask for his mother's milk was still being breastfed. “Hawu!," he laughs, repeating his aunt's words. "Indoda endala kangaka!” His slick negotiating had betrayed him. The young Zweli was no longer a babbling infant. “Go and eat bread!” she chided him. Mkhize says he was the butt of this joke for a while. “And then of course my mother would tell me that I wasn’t weaned, it was just negotiated nicely.”

Mkhize’s anecdotes are relatable, even to first lady Dr Tshepo Motsepe. She recalls that she had planned to breastfeed all three of her children past the age of two years, but only succeeded with her first born and her last born. The middle child, she says, had other plans and her breastfeeding agenda was rudely interrupted. “The second one, I stopped at one year because he started biting me,” Motsepe reminisces with a laugh.

Motsepe is the patron of the South African Civil Society for Women’s, Adolescents’ and Children’s Rights (SACSoWACH). This is a coalition of 29 civil society organisations working to positively influence policies and programs on reproductive, maternal, neonatal, child and adolescent health. Kalafong Hospital has a special place in the history of SACSoWACH. This is where the coalition was formally launched in 2015.

Both Mkhize and Motsepe agree agree that breastmilk is vital to a child’s development and that babies should be able to get the nourishment and all other associated benefits that breastfeeding offers.

Motsepe says social taboos must not stand in the way of infant health. “We should be able to breastfeed our children anywhere, anytime. Adults can eat anywhere,” she points out.

Mkhize emphasises that ideally, breastfeeding should begin within the first hour after birth. This, he says, is true for all babies, “regardless of the mother’s HIV status”.

Motsepe and Mkhize say there are two particularly 'sore points' that must be addressed if breastfeeding is to be enabled. The first relates to workplaces.

Here Motsepe is adamant about one thing: employers must know that SACSoWACH will not be satisfied with working mothers being ushered into dingy storerooms or unhygienic, cramped spaces to feed their children. Working mothers must be able to breastfeed or express breast milk in safe, comfortable and hygienic spaces.

Resuming work for mothers is also particularly challenging. Mkhize says women often leave their homes early in the morning, only to return home quite late. “That does disrupt the breastfeeding routine.” Many women are also not aware that according to South Africa's Basic Conditions of Employment Act, breastfeeding mothers are entitled to two 30 minute breaks during the course of their work day in order to breastfeed or express milk.

The second burning issue that Mkhize and Motsepe say must be addressed is the inappropriate promotion of infant formula by manufacturers. The public must be protected against this. Motsepe says negative perceptions from manufacturers that say a child can eat other foodstuffs from the third month onwards must be combatted. “It should be exclusive breastfeeding for the first six months of life,” she insists.

Motsepe says formula manufacturers take advantage of non-compliance from companies when it comes to maternity policies, procedures and regulations. Motsepe says mothers only get four months of maternity leave, which for many women means only four months of breastfeeding.

She believes both parents need to be supported if South Africa is to reach important global targets on child development. One such target is the 2015 United Nations World Health Organisation (WHO) goal of a global increase of mothers exclusively breastfeeding in the first six months to 50%. The global average is currently 41%, with South Africa lagging behind at 32%.

Mkhize says competition among infant formula manufacturers must be watched closely. The WHO has recommended that countries should impose significant limits on the marketing of breastmilk substitutes if this 50% average is to be achieved. Another recommendation is for countries to strengthen the monitoring and enforcement of manufacturers' compliance to the Code of Marketing Breastmilk Substitutes as adopted by the World Health Assembly.

South Africa's own regulations, as adapted from the code, were adopted in in 2012 and published as the Regulations Relating to Foodstuffs for Infants and Young Children. “The regulations are very clear,” Mkhize says. “No person shall undertake or participate in any promotional practice in respect of infant formula. I therefore want to call all suppliers and distributors of infant formula to adhere to the code.”

By empowering parents and enabling breastfeeding, infant healthcare, development and well-being can be promoted. Afterall, in Africa, this is a matter of necessity and a matter of pride.

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