“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”
- World Health Organisation (WHO)
While many international bodies including the WHO highly recommend breastfeeding for the new-born, Sri Lanka was recently recognised as the only country in the world to achieve the ‘green nation’ status in breastfeeding. The World Breastfeeding Trend Initiative (WBTi), a New Delhi based research institution which focuses on breastfeeding practices in 97 countries, published their latest world ranking last week, giving a much-deserved accolade to the island nation.
According to their findings, Sri Lanka has achieved 10 out 10 in most of WBTi parameters including National Policy, Program and Coordination/ Baby-Friendly Hospital Initiative/ Health and Nutrition Care Systems/ Mother Support and Community Outreach/ Infant Feeding and HIV/ Infant Feeding during Emergencies/ Monitoring and Evaluation. Implementation of the International Code and Information Support are also in commendable positions while Sri Lanka needs to focus a little bit more over Maternity Protection, the report recommends. Sri Lanka has received 91 points out of 100 in the overall score.
Midwives
Midwives who closely engage with mothers from the early days of the pregnancy till several years after the delivery can be considered as the main driving force towards this achievement. The President of the Government Midwifery Service Association, Devika Kodithuwakku had much to share about it.
“We are so delighted about our country being named as the first country in the world to receive the green nation status in breastfeeding,” she said.
Preparing the mother for breastfeeding the child is one of the important duties they have during their relationship with the mothers.
“The first task is to build confidence in the mother that she can produce breast milk adequately. I know that mothers with smaller breasts constantly worry about their ability to feed the child.
But breastfeeding is determined by the areola and not by the size of the breast or nipple. Such education sessions could boost their confidence which ultimately helps when they feed the child” Kodithuwakku explained.
In addition to education and building confidence, midwives teach mothers about techniques in breastfeeding and certain foods which enhance breast milk production.
“We do this as a humanitarian service rather than as employment. It is our greatest pleasure to see what our country has accomplished with that commitment” Kodithuwakku said. Surprisingly, Australia is sitting at the bottom of the ranking with Cape Verde and Libya being nations with ‘red status’. Kodithuwakku believes that the separation of Nursing and Midwifery as two services has been key for Sri Lanka to achieve green status whereas most other countries have combined both fields.
“In the 19th century, Sri Lanka had faced a high infant mortality rate. The Lankan midwifery service was formed as a solution to that. We as midwives are dedicated and mentally prepared for mother and child care.” she said.
UNICEF
The United Nations Children’s Fund (UNICEF) Sri Lanka office also welcomes and congratulates Sri Lanka about the achievement. Communication Specialist at UNICEF-Colombo, Jeremy Sprigge told the Sunday Observer that it is the culmination of decades of commitment and work by the Government and authorities, health workers, partners and mothers to ensure that children in Sri Lanka get the best possible start in life which breastfeeding offers which gained this recognition for Sri Lanka.
Despite breastfeeding being popular and widespread among Sri Lankan mothers, yet every breastfeeding woman and baby requires an enabling supportive environment, Sprigge said. “This supportive environment includes policies guaranteeing parental leave and the right to breastfeed in the workplace, restrictions on the marketing of breastmilk substitutes (in line with the International Code of Marketing of Breast-milk Substitutes), information and support to breastfeed immediately after birth, and beyond, positive social norms that support and encourage breastfeeding and support from trained counsellors and peers, including other mothers and family members plays a key role. The support of men, husbands and partners is also essential” he elaborated.
UNICEF also points out certain obstacles which Sri Lanka has to overcome in the future to keep up the momentum. Discrepancies in maternity leave in the private and public sector, non-availability of creche facilities in workplaces and breastfeeding corners to support breastfeeding working mothers, lack of paid breastfeeding breaks for working mothers at the workplace are some of such hindrances, listed by Sprigge.
However, Founding Professor and Department Chair of the Department of Community Medicine at the Rajarata University of Sri Lanka and Visiting Research Scientist at Yale School of Medicine in the USA, Professor Suneth Agampodi, believes that even though Sri Lanka is the best in comparison, to other countries the country has a long way to go when looking at it objectively.
“The recent WBTi world ranking and Sri Lanka receiving the first-ever Green Nation status in breastfeeding is truly commendable and we know the policy, political and health professional commitment and the cultural support for breastfeeding as key factors to achieve this status. However, the question is, can we be satisfied with this achievement?” he questioned.
Director-General of Health Services Dr Anil Jasinghe told the media last week, that Sri Lanka has achieved 82 per cent of exclusive breastfeeding among 0-6 months infants whereas the world average is a mere 41 per cent. But Prof. Agampodi who has 13 years long research expertise on the subject has a different view.
“We need to have an insight into the published data to improve this status. The reported 82% exclusive breastfeeding does not mean that 82 per cent of Sri Lankan mothers are feeding their babies only with breast milk up to six months” he commented.
As per his explanation the Department of Health Services (DHS) report, shows the proportion of babies who were given only breast milk within the last 24 hours. Also, the survey includes babies of all ages, not only those who have completed six months. Therefore, the actual six months exclusive breastfeeding rates are much lower than 82 per cent he argues.
“The on-going studies on breastfeeding clearly show that working mothers and mothers in urban, suburban areas are not getting enough support for breastfeeding. The propaganda and influence of infant formula milk companies seemed to be a major challenge for exclusive breastfeeding” he opined.
Prof. Agampodi also stressed that the Ministry of Health should make sure that milk powder companies and health professionals adhere to the Sri Lanka Code for the Promotion of Breast Feeding and Marketing Breast Milk Substitutes and Related Products which was first published in 1983.
“Strengthening of lactation management centres in hospitals including the private sector and continuing breastfeeding support through PHMs in the field will help Sri Lanka to further improve the maternal and child health status through breastfeeding” he added.