KZN leads on breast-feeding
Recognising the need to improve child health, KwaZulu-Natal became the only province to scrap the provision of free formula milk in favour of promoting exclusive breast-feeding among pregnant women attending government antenatal facilities at the beginning of the year. By so doing, the province set the national agenda.
After the national Health Department’s adoption of a policy last week to promote exclusive breast-feeding amongst South African women, eight other provinces will now phase out the distribution of infant formula milk in government hospitals and clinics. Launching the policy, Health Minister, Dr Aaron Motsoaledi, said the decision recognises that breast milk remains the best feeding option for both child and maternal health, more especially in the first six months of a baby’s life.
‘Breast-fed babies are better protected against infections like diarrhea, respiratory illnesses, allergies and ear infections. They are at much lower risk of malnutrition. Mother-child bonding is also accelerated through breast-feeding. Mothers who breast-feed also benefit. They have a reduced risk of developing breast and ovarian cancer. In addition, they will return to their pre-pregnancy weight more easily and the likelihood of falling pregnant again while breast-feeding is reduced’, he said.
Motsoaledi said exclusive breast-feeding is central to reducing infant mortality. South Africa is one of 12 countries in the world where the number of children who die prematurely is on the rise. The Health Minister said this is partly because fewer infants are now being breast-fed.
‘In 2003, the Demographic and Health Survey showed an exclusive and extended breast-feeding rate of eight percent. And only 1.5 % of babies aged 4 ‘ 6 months were exclusively breast-fed. And a 2008 Human Sciences Research Council study found that only 25.7 % of children under six months were reported to be exclusively breast-fed. By comparison, 51.3% were mix-fed, that is, feeding both breast and formula or other substances such as tea, water and porridge, and the remaining 24 % are on infant formula only’, said Motsoaledi.
The new policy will increase the rates of breast-feeding in the country as government will stop providing free formula milk. Women are required to exclusively breast-feed their babies for the first six months of life, regardless of their HIV status. Formula milk and other food substances can be introduced after this period. Pregnant HIV-positive mothers will be put on antiretroviral medicines immediately. Their babies will also be put on ARVs to prevent HIV transmission during the breast-feeding period. This policy has already seen an increase in the rate of women who exclusively breast-feed their babies in KwaZulu-Natal after the province stopped supplying formula milk, in January.
‘While we were sitting at 55 % of breast-feeding, we now are, as of June this year, sitting at 72 %’, according to Dr Sibingiseni Dhlomo, the MEC for Health in KwaZulu-Natal.
Dhlomo said early results are beginning to show the nourishing capabilities of natural milk.
‘During the period when we had a lot of infant formula feeding or a choice that a mother would make, not only were we admitting children in our hospitals for what we commonly see ‘ respiratory diseases and diarrhea, and, therefore, die after a successful PMTCT ‘ but some of these children were coming into our hospitals with severe malnutrition. Among other things, you’d then realise that mothers were probably diluting the formula so much – and there’s no dilution in the breast milk’¦ You just get the right content, the right amount at the right time. With the infant formula feed you can choose to re-dilute, therefore, not actually giving the child the best of that’, he said.
Fully conclusive results of the impact of the decision will be available by June next year. Meanwhile, the decision is also a cost-cutting measure. The national Health Department will save about R200 million per annum once all provinces follow suit. In a province such as KwaZulu-Natal, the savings are not only for government.
‘KZN Department of Health operates within a resource-constrained environment and in a poverty-stricken province and most of the women that deliver babies live in those resource-constrained settings. Therefore, for them it’s economically viable to exclusively breast-feed because there is no additional cost to prepare the milk, to store the milk. In that sense, they can stretch their resources to do other things that will assist the baby to survive and lead a better health. And also, if we look at the KZN setting in terms of the illness, if a baby is formula-fed, the likelihood of developing illnesses because of lack of safe drinking water, because of lack of transport, access to health facilities timeously, babies are likely not to survive in those settings. So, the resources that are saved can be then utilised to follow up timeosuly for immunisation, for early childhood development and other things that will make the well-being of the baby to be better’, said Dr Sibongile Zungu, head of the KwaZulu-Natal’s Health Department.
As other provinces begin to phase out the choice on child feeding options, they are most likely to emulate what KwaZulu-Natal has done.
‘If, in the first 12 weeks a woman presents at a health facility, that is where we start talking about choices of feeding the baby when the baby is born. What we are encouraging is exclusive breast-feeding regardless of the HIV status of the woman. Should a woman be HIV-positive, we immediately put her on ARVs. That on its own helps the baby that is unborn not to get the transmission of the virus. But should the mother decide not to breast-feed, we don’t stand in the way of the mother. That’s the mother’s choice, and the mother will then see to it that she provides formula for the baby. But it will not be provided by our facilities. And, if for any medical reason, the mother cannot breast-feed, then, the State will prescribe formula feed just for that baby that cannot be breast-fed’, said Zungu.
In such rare cases where medical conditions require that the mother should not breast-feed or that the baby should not feed from its mother, the State will continue to sponsor free infant formula milk for these mothers and babies.