Soothing her malnourished baby at a clinic in a Freetown slum, a Sierra Leonean mother says she has never heard of exclusive breastfeeding, but observes `banfa’ - a traditional practice where women abstain from sex as long as they are breastfeeding because they believe that sex during that period endangers the child’s health.
Breaching `banfa’ results in babies being weaned from breast milk, which health experts recommend as an infant’s sole food for the first six months, and continued alongside other foods up to the baby’s second birthday or older.
“I have never heard of exclusive breastfeeding. I know of `banfa’ and I have been observing it,” said Kadiatu Dubero, whose 13-month-old baby is severely malnourished. The baby weighed 5.8kg and his mid-upper arm circumference was 11cm. A child with a mid-upper arm circumference of less than 11.5 cm is considered severely malnourished.
Dubero said she has been feeding her baby on breast milk, porridge and water. Joseph Senesie, a nutrition specialist with the UN Children’s Fund (UNICEF) in Sierra Leone, told IRIN that many mothers in the small West African state do not know appropriate infant nutrition mainly because of illiteracy and poverty.
At the clinic in Kroo Bay, a slum on the shores of the Atlantic ocean in Freetown, several mothers brought their children for check-ups.
Malnutrition is a common child health problem in Sierra Leone and traditions such as `banfa’ can be risky for infant health.
“Women have faith in [`banfa’] to the extent that they stop providing breast milk to the child when sex is resumed,” said Senesie. “Children are expected to continue breast milk for two years and beyond. Most of them [women] will resume sex before the child is two years. Can women and their partners wait until the child is two years old before resuming a sexual relationship? I very much doubt this.”
“I would not have sex with my husband when I’m breastfeeding because the baby will be sick,” Fatimata Bangura, 19-year-old mother of a two-month-old baby, told IRIN. “It is good not to have sex with my husband while I’m breastfeeding.”
In Sierra Leone, a country rebuilding from a decade of civil war that ended in 2002, 32 percent of children are exclusively breastfed until six months; 22 percent of children under five years old are underweight, 8.5 percent too thin for their height and 44 percent are chronically malnourished, according to UNICEF data; and 35 percent of child deaths are due to malnutrition.
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Prone to infections
In the first six months after birth, some mothers begin feeding their children liquid foods alongside breast milk, but because of poor sanitation and water quality in Sierra Leone, the children are prone to infections, Senesie said, adding that even when the children are weaned, many mothers do not know the right mix of nutritious foods.
Malnourished children are particularly vulnerable to diseases due to a weak immune system. At a public hospital just outside Freetown central business district, an Outpatient Therapeutic Programme run by the government and UNICEF, around 50-60 children are taken ill every month due to malnutrition and other medical complications.
Tuberculosis, HIV and malnutrition are the main illnesses the children are treated for at the Ola During hospital outside the city centre, said Salimatu Kargbo, a community nurse. Chronic diseases and negligence by families also contribute to weak health among children, she added.
Child malnutrition peaks during the rainy season between June and September because mothers, who often run small businesses to support their families, are unable to venture out to sell their wares. This year the rainy season also accelerated the spread of cholera in Sierra Leone, infecting thousands of people and killing hundreds others, especially in Freetown’s slums, making it the country’s worst outbreak in 15 years.
Kargbo said more than 75 percent of the sick and malnourished children brought to the hospital recovered.
“Relapse cases are very rare. We explain to them [mothers] how to take care of their children to avoid malnutrition.”
Despite saying she strictly observed `banfa’, Dubero struggled to explain why her claimed chastity did not protect her child from malnutrition, but insisted nonetheless: “I still believe in it.”