The African continent has the ignominious distinction of housing the seven countries in which the highest number of children die before their fifth birthday, according to the United Nations Inter-agency Group for Child Mortality Estimation. These countries — Angola, the Central African Republic, Chad, Mali, Nigeria, Sierra Leone and Somalia — all have an under-five mortality rate above 100 deaths per 1 000 live births.
Children in sub-Saharan Africa are more than 14 times more likely to die before the age of five than their peers in developed countries, according to the World Health Organisation (WHO). One of the main reasons is rampant child and maternal malnutrition in the region, which weakens children’s immune systems and makes them more vulnerable to diseases such as pneumonia, diarrhoea and malaria.
The WHO says almost half of all child deaths are linked to malnutrition. Although the drivers of malnutrition are complex and the solutions varied, at least one response is simple: breastfeeding.
Exclusive breastfeeding — giving a baby nothing else but breast milk, not even water — in the first six months of life is one of the best ways to reduce child death rates and improve children’s development outcomes.
Antibodies in breast milk help prevent acute respiratory infections and diarrhoeal disease, which are leading causes of children dying. Studies have also shown that they also protect against obesity and noncommunicable diseases such as asthma and diabetes. In addition, exclusive breastfeeding is closely linked to improved cognitive development in children, translating into higher productivity levels when they reach working age.
Despite these benefits, the world is not on track to meet the WHO target to ensure that at least 50% of children are exclusively breastfed for their first six months by 2025.
As the 2016 Global Nutrition Report shows, exclusive breastfeeding rates during children’s first six months remain abysmally low (39%) around the world. Nowhere is this more evident than in South Africa, which has an exclusive breastfeeding rate pegged at a low 8.3% at six months of age. This is in stark contrast to Zambia, where about 73% of babies are exclusively breastfed for their first six months, but this proportion drops to about 41% in Mozambique and Tanzania.
In South Africa, researchers have found that many mothers living with HIV may choose not to breastfeed exclusively for fear of passing the virus on to their babies. A 2015 article published in the South African Journal of Clinical Nutrition revealed that mothers frequently cited their HIV-positive status as a reason for deciding not to breastfeed.
Yet studies have shown that use of antiretroviral treatment during exclusive breastfeeding for both mother and baby can significantly reduce the risk of transmitting HIV to babies — meaning that a child can be breastfed with very little risk of becoming infected with HIV. Thanks to the use of this medication, data from South Africa’s National Health Laboratory Service shows, the country’s mother-to-child HIV infection rate has decreased from about 30% in 2004 to about 1.5% in 2015.
Breastfeeding can help Africa turn the tide in improving its child survival rates. But this practice has to become a movement if we are to realise its true potential. This means that women and their families, as well as communities and healthcare systems, must come together to encourage breastfeeding, especially during the first six months of a child’s life.
African governments must invest much more in training health workers and community counsellors to share evidence-based nutrition and health education with mothers to empower them to take charge of their children’s futures. Given the structure of African societies, governments will likely find merit in peer-to-peer education and community-based programmes on exclusive breastfeeding.
Governments can also do more to communicate the message that breast is best for newborn children and implement policies — such as paid maternity leave — to give women the time they need to breastfeed exclusively.
Africa’s destiny will be shaped by the decisions we take today, and there’s no doubt that a decision to prioritise exclusive breastfeeding will lay the foundation for a prosperous and healthy African way of life.
Rachel Toku-Appiah is the nutrition programme manager at the Graça Machel Trust. The Trust works to ensure Southern African countries implement policies to improve the nutritional status of pregnant women and infants.