“My first kid died because I breastfed him after my husband had had an affair,” Tina Kollie, mother of a seven-month-old in the Liberian capital, Monrovia, told IRIN. She has not breastfed any children since. “[If I breastfeed], whenever my husband has an affair my child gets sick.”
Rebecca Carter in the Buzzi Quarter neighbourhood said she stopped breastfeeding after a few months because she could not have sexual intercourse while breastfeeding – the semen will mix with breast milk, she said, making it toxic for the child.
“I didn’t want my husband to go with other women so I could not breastfeed,” she told IRIN. “I had to be available for him.”
UNICEF estimates that just 35 percent of Liberian mothers practice exclusive breastfeeding; a survey by NGO Action contre la Faim (ACF) in Monrovia estimated 44 percent in 2008.
ACF staff regularly hear widespread beliefs about breastfeeding perils: It is dangerous to breastfeed while pregnant as it could weaken the unborn infant; women should not breastfeed if a previous child has died while breastfeeding; and breastfeeding over time is dangerous as breast milk can mix with blood.
Instead Kollie, Carter and dozens of other women IRIN spoke to, feed their babies mainly rice and water.
The World Health Organization and UNICEF recommend feeding newborns only breast milk for the first six months to reduce vulnerability life-threatening diseases or malnutrition. Aid agencies in Liberia are trying to re-frame breastfeeding and infant nutrition as a health issue.
“Working with communities on breastfeeding is a long, drawn-out job, because malnutrition is often not seen as a sickness, but is associated with witchcraft-like beliefs,” ACF Liberia head, Massimo Stella, told IRIN.
Photo: Anna Jefferys/IRIN
|Red hot peppers helped breastfeeding messages sink in in Gbargna-ta village|
UNICEF nutrition specialist Kinday Samba agreed, saying aid agencies have to support the Health Ministry over the long term to bolster exclusive breastfeeding. “We won’t see huge changes immediately.”
Men, grandmothers key
The UN Children’s Fund (UNICEF), Catholic Relief Services (CRS), ACF and others are encouraging women to exclusively breastfeed their babies up to at least six months.
Dispelling breastfeeding myths is not the key to changing women’s behavior, ACF’s Stella said; all staff can do is inform communities of the benefits of breastfeeding and trigger discussion, he said.
Women who have already changed their feeding practices can show that it is not dangerous, encouraging others to attempt change, ACF’s care practices manager, Audrey Gibeaux, told IRIN.
ACF must also target men and grandmothers in the discussion, she said.
“I always try to encourage men to come, as they have so much decision-making power in Liberian households…and grandmothers must be present as the knowledge they pass down is considered very valuable.”
Liberia has one of the highest teenage pregnancy rates in West Africa and grandmothers often care for babies.
Breastfeeding messages must be spread through every channel to be effective, UNICEF's Samba said, citing radio, posters, community groups and clinic visits as examples.
UNICEF is developing messages to be disseminated on all of these fronts, she said.
|I didn’t want my husband to go with other women so I could not breastfeed|
Stella agreed: “We found the prevention activities are more effective if they take place simultaneously at country level, community level and school level.”
Monitoring the impact of these efforts is not easy, Stella said. “Immediate evidence of the links among increased knowledge, behavior change and improved health cannot all be measured in medical or statistical terms.”
A UNICEF-supported infant feeding practices survey is due out in late 2009, while ACF will carry out a study of its activities’ impact in February 2010.
More red peppers, more breastfeeding
One village where knowledge has translated to behavior change among some families is Gbarnga-ta, 15km outside of Gbarnga in Bong County, where according to NGO Caritas a third of under-five children are undernourished.
Caritas, supported by CRS, has been working with residents to improve agricultural productivity and infant feeding practices.
Before, women and men thought having sex while still breastfeeding was dangerous, resident Helena Sharif told IRIN.
It was partly the success of the agricultural activities that made villagers more receptive to the NGO’s breastfeeding messages, giving them traction, say villagers.
Photo: Anna Jefferys/IRIN
|Upped red pepper sales made Gbarnga-ta residents more receptive to breastfeeding messages|
Residents are now producing surplus aubergines and red hot peppers which they sell to nearby villages, giving them money to pay school fees, said Sharif.
Helena’s husband Tony Sharif is relieved. “We don’t worry so much about [having sex while breastfeeding] now. We do it. Things are much better than they were,” he said, prompting laughter and nods from fellow villagers.
While intensive efforts may work, some aid experts are skeptical that behavior change can be effective on a mass scale.
“It’s very difficult to change people’s behavior,” said European Commission humanitarian aid department (ECHO) representative in Liberia Koen Henckaerts.
“I’m skeptical that you can [do so] in the short term or on a mass scale. It takes a long time, and it is related to wider, entrenched issues such as poverty.”