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Deeply Talks: Challenges in Promoting Exclusive Breastfeeding

Partnerships are key in encouraging exclusive breastfeeding among vulnerable communities, Kathleen Pellechia, nutrition knowledge management specialist at Alive & Thrive, tells us.

Written by Amruta Byatnal Published on Read time Approx. 4 minutes
Mothers nurse their children during the “Seventh Mexican Breastfeeding Festival,” to mark the World Breastfeeding Week, in Mexico City.PEDRO PARDO/AFP/Getty Images

To conclude this year’s World Breastfeeding Week, our latest Deeply Talks tried to identify the challenges to promoting exclusive breastfeeding at both international and national levels.

We spoke to Kathleen Pellechia, nutrition knowledge management specialist at Alive & Thrive, on the developments in the field and strategies going forward. Pellechia emphasized the role of developing partnerships, building the capacity of local players and keeping the momentum going beyond World Breastfeeding Week.

“As the global public health community, I think we just have to keep talking to each other,” she said. “I think the biggest lesson we have is how do we build our data and how can we share our data with others.”

You can listen to the episode here or read an edited and condensed transcript below, featuring highlights from the discussion with Kathleen Pellechia.

Malnutrition Deeply: When we look at the Global Breastfeeding Scorecard we see that some important gains are being made globally but also that there’s a long way to go when it comes to reaching exclusive breastfeeding goals. Can you talk about some of the major challenges that you see at the moment and also some of the strategies that might be working or gains that are worth highlighting?

Kathleen Pellechia: When we think about exclusive breastfeeding, we’re really thinking about a couple of points. First is early initiation of breastfeeding, having that breastfeeding start within the first hour of the infant’s birth; and I think we’re starting to see, and have been seeing, strides in that area, and it’s making that connection between the hospital, the health clinic, even at home births, making that connection between whether it’s a vaginal birth or a cesarean-section birth, having trained health professionals or birthing aids who are familiar with the practices that can get that infant, that baby, to mom, to start that early initiation of breastfeeding. So that’s the first piece because that sets things in motion.

From there, when we talk about exclusive breastfeeding, it’s only offering those infants breast milk for the first six months. No water, no other liquids, just breast milk, with the exception of liquid vitamins. So one of the issues there, we’ve seen a lot of campaigns around what we call “No Water” campaigns, there are some myths, there are some social norms around giving water to infants. And so providing education to mothers and fathers and grandmothers and grandfathers or any care providers for mom and the family on what can be the value of that breast milk for that infant, for the first six months. So a policy advocacy around limiting breast milk substitutes, particularly we’re seeing over this past summer a lot of action in that area and some new legislation.

And finally, I think the last piece is we know many moms go back to work very early on, whether they’re working at home or certainly if they’re working for a business – and does that mom that’s returning to work have access to a safe, clean place to pump her breast milk or even to feed her infant? In Nigeria, one of the countries in which Alive & Thrive works, we’ve heard this week about a lot of policy dialogue going on around breastfeeding and even looking at maternity entitlements and extending maternity leave and giving those moms that time that they need with that new baby. So a lot of exciting developments are happening.

Malnutrition Deeply: One of the points you made was about getting nurses or the health workers who are assisting pregnant women up to speed so they’re aware of the importance of exclusive breastfeeding. Can you talk a little bit about any programs you’ve seen or efforts that work in that direction or that are worth replicating?

Pellechia: Both in our Alive & Thrive programs and in many programs that are partnerships between government, hospitals, hospital associations and professional associations, we see examples. In India, we have an effort going on to partner with professional associations, medical colleges and medical associations, to make sure that there’s training in place for that maternal infant and young child nutrition, so that we can continue to train the workforce that’s out there, those front-line workers in health and nutrition. And around breastfeeding, again early initiation, exclusive breastfeeding and certainly other issues, we’re focusing on breastfeeding this week, but we talk about complementary feeding when you’re starting to give those infants those foods after the first six months.

So partnership is key, again partnering with all those groups that can continue the training. You can only do so many Train the Trainer sessions at the beginning, you need to have the mechanisms in place for the ongoing refresher training and capacity building.

Malnutrition Deeply: How does an organization like Alive & Thrive work with local organizations, both in terms of identifying partners and then building those relationships over time?

Pellechia: It always starts with a landscape analysis: who’s already doing the work and, if someone’s doing it, how can we then help or provide technical assistance, so we have offices in the countries that we work in? Again I’ve given some examples, we have Bangladesh, India, Vietnam, as well as expanding into Southeast Asia; we have Burkina Faso and expanding into francophone West Africa. There’s just some examples, but we need to know who’s already working in those (countries). Whether it’s targeting adolescents, whether it’s working with the agricultural sector, like I said in India, if it’s working with medical associations. What are those groups that are already there on the ground and then how can we amplify the work that they’re doing?

So we start out doing an analysis, we’ll work with research institutions and universities, both in-country and also here in the U.S., to do that research, to get on the ground and find out what’s happening and then we can build off it. Because as you know, you always need that data to be able to justify – not to justify, but to just to continue to leverage resources.

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