Aneri Pattani, a freshly minted graduate of Northeastern University, is the winner of Nicholas Kristof’s annual win-a-trip contest. She previously wrote about the seven most inspiring people she met in Liberia and education for girls.
While traveling around Liberia, I discovered a super-medicine. In a world full of intractable health problems, it’s a low-cost, practical and easily administered substance that saves children’s lives like almost nothing else.
Any guesses? It’s probably not something that readily comes to mind, so simple that it’s often overlooked in favor of high-tech solutions. I’m talking about breastfeeding.
Breastfeeding is a foundation for good nutrition. It reduces child mortality by providing protection against illnesses like diarrhea and pneumonia, which kill 1.4 million children each year. In fact, by implementing proper breastfeeding practices alone, we could save the lives of 800,000 children a year in the developing world, according to estimates from the medical journal The Lancet.
The benefits go beyond saving lives. Breastfeeding also improves quality of life, global health experts say. It supports healthy brain development, improves cognitive performance and is associated with better educational achievement by age 5. These are benefits that extend into adulthood and contribute to the overall economic productivity of the world.
Now, I’ve never had a baby, let alone had to wake up every few hours to breastfeed one, and I don’t want to tell people what to do with their bodies. Some moms can’t breastfeed or don’t have a work situation that allows them to do so. But child health experts say that as they look at how to save more children’s lives in poor countries, it’s hard to find a more cost-effective intervention than the promotion of breastfeeding.
“Breastfeeding is a critical investment to increase child survival but also to improve the child’s overall development,” said Shawn Baker, director of the nutrition team for the Bill and Melinda Gates Foundation.
Despite the staggering benefits, it’s not always easy to get people on board. Myths and traditional customs often contradict best practices for breastfeeding. That means even though 98 percent of Liberian children are breastfed at some point in their lives (an encouraging number), many are also given water or solid food when they are young.
In fact, babies should get nothing but milk for their first six months.
Yei Vahn, a 39-year-old mother of 12, told me she’d been giving her youngest son, Arthur, water since he was 4-months-old. “I noticed he would cry a lot when it was very hot outside, so I gave him water from the well,” she said. It’s a habit she developed while raising her 11 older children, and one that she passed on to her daughters as well.
The problem is, it is a dangerous practice. Giving a baby water, especially when it’s not boiled, can introduce harmful pathogens into the child’s system, leading to illness or death. That’s the most obvious problem, but not the only one.
“Because the infant’s gut is so small, if the child is drinking half a cup of water, that’s half a cup of breastmilk he won’t be drinking,” Baker said. “Anything you’re doing that displaces breastmilk, you’re depriving the child of that optimal source of nutrients.”
One of Vahn’s daughters, Angeline, has an 8-month-old daughter. She gives the child water from the same pump her mom uses, unknowingly continuing a tradition that puts her daughter’s life at risk.
The challenge for breastfeeding in very poor countries is not so much the use of infant formula, which is more of a problem in nations just a bit better off. In the poorest countries, very few have the money to buy formula.
Rather the problem is that breastfeeding isn’t done quite right. Moms delay breastfeeding after birth. They offer the baby sugar water or tea, cassava or fruit, well before six months — or they stick to exclusive breast milk too long.
I did many of my interviews in a hospital where nurses regularly counsel new mothers on the do’s and don’ts of breastfeeding. But learning the right answers doesn’t necessarily translate into implementing them.
Many of the women I spoke with throughout the trip could tell me all of the best practices for breastfeeding: Start breastfeeding your child within an hour of birth. Don’t give the child any water or solid food during the first six months. Yet data show they were not necessarily doing what they said.
Only 55 percent of Liberian children under 6 months are exclusively breastfed. Twenty-eight percent of infants consume water, and many others drink other types of milk and non-milk liquids.
Some mothers think colostrum — the first breast milk, full of nutrients and sometimes called a baby’s first vaccination — is unsafe because it’s yellow and doesn’t look quite like milk, said Agatha Neufville, nursing director at Ganta Methodist Hospital. Traditional stories of “dirty milk” lead them to discard it, depriving their children of a powerhouse of nutrients and antibodies that could help build their immune systems.
The consequences of such practices can be far-reaching. Malnutrition affects hundreds of thousands of kids in Liberia. Nearly a third of children under the age of 5 are stunted (short for their age).
Breastfeeding is one of the earliest and simplest interventions to prevent this. Many cases of severe malnutrition the hospital sees have to do with improper breastfeeding, Neufville said.
In some cases, breastmilk can be the last line of defense for a malnourished child. It’s free and readily available — two aspects of vital importance for women struggling to feed their children.
At the public county hospital in Buchanan, I met Raye Dabagar, an 18-month-old whose ribs and spine protruded beneath his skin and whose light brown hair was growing in patches due to protein deficiency. He was in the hospital’s severe acute malnutrition ward, with a hemoglobin level of 4.5 — a rate rarely seen in the United States, signaling extreme anemia.
Raye’s father had abandoned the family and his mother had no money for food. Breastfeeding would not solve their problem, as Raye was at an age where he needed solid food too, but it was a tool that helped him survive, his doctor said. Even though Raye’s mother was malnourished, she was able to breastfeed, giving him at least some form of nourishment.
Despite widespread beliefs that malnourished mothers cannot produce enough breastmilk, countless studies refute this. Even when it lacks food, a mother’s body will deplete its own resources to produce enough milk for the child.
“It’s phenomenal if you think about the impact of this technology we have at hand and can implement at scale,” Baker said. “It’s really a miracle cure.”