Kenya is a breastfeeding success story but still has its challenges

Breastfeeding has both short-term and long-term nutritional benefits for children. Nutrition is central to sustainable development. Good nutrition in the first 1000 days of a child’s life is critical for child growth, well being and survival, and future productivity.

The World Health Organisation recommends exclusive breastfeeding for children until they are six months old and continued breastfeeding with appropriate complementary feedings until children are two, for optimal growth and development.

What Kenya did right

Kenya has seen a remarkable growth in exclusive breastfeeding for children under six months old. In 2003 only 13% of mothers were breastfeeding exclusively. This year, according to the National Demographic and Health Survey, 61% of mothers of children aged less than six months were breastfeeding exclusively.

This achievement is the result of massive drive to promote breastfeeding. Two of the programmes, set up by the Kenyan government, are the Baby Friendly Hospital Initiative and the Baby Friendly Community Initiative. One promotes breastfeeding in hospitals at the time of delivery and the other breastfeeding in the community.

Both have been proposed in the country’s most recent maternal infant and young child nutrition strategies, stretching to 2017. Although the initiatives have not yet been scaled up fully, they have created mass awareness of breastfeeding. Government plans to increase exclusive breastfeeding to 80% by 2017.

Kenya, however remains one of only a handful of countries that have been able to achieve the World Health Assembly (WHA) target of increasing exclusive breastfeeding to 50% by 2025. The assembly is the forum that governs the World Health Organisation. Exclusive breastfeeding levels remain low across Africa. Between 1995 and 2010, exclusive breastfeeding in the developing world has increased from 33% to 39%. According to UNICEF, West Africa has one of the lowest rates in the world, with countries such as Chad recording 2% and Côte d’Ivoire 4%.

Globally about 40% of babies are not on exclusive breastfeeding. Sub-optimal breastfeeding results in over 800 000 deaths each year.

A recent study in six counties within Kenya looked into the challenges among Kenyan women around breastfeeding. It considered women in different settings from urban poor to middle income and rural areas.

The study is in line with this year’s world breastfeeding week theme: supporting women to combine breastfeeding and work. The study shows that work as a barrier to optimal breastfeeding cuts across different social classes.

The findings

The obstacles include:

• work

• lack of food

• poor knowledge

• myths and misconceptions

• teenage (and single) motherhood

• health related challenges including HIV, and

• poor social and professional support.

In trying to combine breastfeeding with work, for urban poor women, their concern is limited livelihoods and the nature of their employment. Women are constantly looking for a job, and are often casual labourers. They are not entitled to maternity leave and limited pay does not allow them to save enough for the period after birth. This means they resume work shortly after giving birth. They also have long hours and their environments are not conducive for carrying babies to work or breastfeeding.

Although middle income women are often in formal employment and entitled to three months maternity leave, they also have their share of challenges. In some instances, maternity leave is not respected. Mothers are sometimes asked to do some work on maternity leave. On other occasions they are recalled with the threat of being fired if they don’t return.

Another challenge for middle income working women is the lack of workplace support such as breastfeeding rooms and facilities to either breastfeed or express breast milk.

Some women narrated stories of having to express in uncomfortable setting such as toilets. Although flexi-time and breastfeeding breaks are recommended internationally through the Maternity Protection Convention, Kenya has not ratified this convention. Globally, only 29 countries have ratified the convention while 158 have not.

Rural women have similar circumstances to urban poor women, and often get casual farm labour to make a living. In these cases, they would work on someone else’s farm for an entire day, leaving their babies at home with no breast milk. Even those who work on their own farms have challenges. Aside from toiling on their own farms, they go for long distances in search of water.

Normalising breastfeeding

Despite the success Kenya has made around exclusive breastfeeding in the last few years, more needs to be done to ensure the rights of mothers and children are realised.

Kenya needs to ratify the Maternity Protection Convention. Although women in the formal sector in Kenya are entitled to maternity leave, breastfeeding breaks and flexi-time are not provided for in the law.

The government also needs to ensure that the law is enforced. And employers need to be sensitised to provide the necessary support, such as breastfeeding rooms and facilities to enable women to express breast milk comfortably. These measures are key in ensuring continued exclusive breastfeeding even after women resume work after their three months of maternity leave.

For the informal sector, there may be need to reconsider labour laws with the possibility of social protection measures, specifically targeting women.

Generally, there is also need for the public to be sensitised about the need to support breastfeeding women to ensure they have all the necessary support to combine work with breastfeeding.

Such support may include allowing mothers to carry babies to the workplace both in the formal and informal sector.

Elizabeth Kimani received funding from the Wellcome Trust for this research and is a member of the interrnational non-profit organisation, the APHRC.