Breastfed is Best Fed: Overcoming Challenges to Breastfeeding in Uganda

The World Health Organization, UNICEF, and the Uganda Ministry of Health all recommend that women start breastfeeding within an hour of birth, that a mother breastfeed exclusively for the first six months, and – with adequate complementary foods – continue breastfeeding up to two years and beyond.

Breastfeeding has tremendous benefits, including providing all the nutrients needed for healthy development, transferring antibodies that protect infants from common and sometimes deadly childhood illnesses such as diarrhea and pneumonia, and its availability and affordability.

However, mothers often face challenges breastfeeding their children. In honor of World Breastfeeding Week 2020 from August 1-7, we highlight the stories of three women who overcame challenges to give their babies the ideal food for healthy development.


Breastfed is Best, Even for HIV-Positive Mothers

Three months after giving birth to her third child, Oliver, health workers took a blood sample from Jessica Ayoo, an HIV-positive mother for a viral load test. The test revealed a high viral load.

"I was depressed. I worried that I would lose the baby like what happened with my second child, a stillbirth" Ayoo said. She feared that this baby would get infected through breastfeeding and die as well since her viral load was high.

In addition to the depression, Ayoo, a peasant farmer, thought the poor viral load suppression resulted from too much physical labor. She also lacked enough food supplies to help her take her medicine well.

When she attended antenatal care (ANC) services after giving birth to Oliver, health workers counselled her to take her drugs on time to help suppress the virus and avoid infecting her baby.

"At the ANC, I was counseled to give my baby breastmilk exclusively for the first six months and that I must take my treatment. The nurse advised that mixing breastmilk and other foods before this time would increase the risk of my baby getting HIV," recalls Ayoo.

The USAID Regional Health Integration to Enhance Services in Northern Uganda (RHITES-N. Acholi Activity), led by URC, supports HIV care and treatment services and viral load monitoring and support for non-suppressing clients. Apart from the support given through mentorship and coaching of health workers, the Activity helps health facilities improve education on infant and young child feeding practices in the context of HIV, screen for malnutrition, and support good nutrition practices in the community.

Ayoo struggled to adhere to taking her medicine regularly. Her viral load persistently remained high. Sometimes Ayoo used her partner’s phone to remind her when to take her drugs. She visited the clinic monthly and was counselled by the midwives to continue treatment and exclusive breastfeeding. The health workers assigned her a peer mother for treatment support and her adherence to treatment improved.

In March 2020, a test revealed the virus no longer was detectable in her blood. Oliver received first and second polymerase chain reaction tests, which were negative. Ayoo is overjoyed that Oliver, now age one, is healthy, active, and HIV negative.

The World Health Organization recommends that HIV-positive mothers or their infants take antiretroviral drugs throughout the period of breastfeeding and until the infant is 12 months old. This allows the child to benefit from breastfeeding with very little risk of becoming infected with HIV. Oliver is proof of that.


Breastfeeding May Be Natural, But Not Always Simple

Breastfeeding can be challenging, especially for first-time mothers. Juliet Auma of Nwoya District is the mother of a four-month-old daughter, Faith. When she was 10 weeks pregnant, Auma attended the ANC clinic at Anaka Hospital where she learned about the benefits of exclusive breastfeeding.

When Faith was born, “she fed normally in the first week, but the feeding pattern changed in the second week. This worried me. I sought attention at the hospital,” she recalls. Faith was examined and found to have lingual frenulum (tongue-tie), a condition that interferes with normal breastfeeding.

Juliet Auma breastfeeding her daughter
Juliet Auma breastfeeding her daughter

As Auma waited for Faith’s minor corrective surgery, she continued to breastfeed her frequently. Breastfeeding helped her bond with her baby through tender smiles, blinking, and giggles.

“A community health worker advised me to set up a kitchen garden. In my garden, I grow vegetables which I eat regularly to boost the breast milk,” says Auma.


Small Changes, Big Differences

Margaret Adong who delivered at Kitgum General Hospital, was apprehensive about breastfeeding in public and decided to give her child, Aloyo Cindrella, infant formula. That led to diarrhea, and subsequent admission to the hospital. Sr. Olga Anek, a health worker at the hospital observed that Aloya was being fed infant formula.

“On several occasions I counselled her on the importance of breast milk for the baby. That’s when she started breastfeeding. Two days later the mother came to me. She had stopped giving the baby formula and the baby was discharged,” says Anek.

Olga Anek, Nursing Officer from Kitgum Hospital, conducts a home visit/counseling session with Margaret Adong, a mother facing challenges with breastfeeding
Olga Anek, Nursing Officer from Kitgum Hospital, conducts a home visit/counseling session with Margaret Adong, a mother facing challenges with breastfeeding

Another mother, Beatrice Akello, had not breastfed her child. A village health team (VHT) member approached Anek about the baby, who was malnourished. When Anek went with the VHT to visit the mother, she noticed that the mother was not positioning and attaching the baby properly on the breast. The baby was hungry.

“I showed her how to position the baby. She breastfed exclusively until six months of age and weaned the child at two years,” says Anek.


Learning a Range of Interventions to Keep Mothers and Babies Healthy

Anek is among the health workers who benefited from training supported by the RHITES-N. Acholi Activity on proper history taking and examination of antenatal mothers to identify complications that can interfere with breastfeeding. They learn about the provision of prophylaxis drugs like iron, Fansidar anti-malarial, Mebendazole for parasites, folic acid for pregnant women, and timely management of sick mothers.

RHITES-N. Acholi has supported the training of 80 health workers from 75 health facilities on the Baby-Friendly Hospital Initiative – a WHO and UNICEF program to ensure that all maternities, whether free standing or in a hospital, become centers of breastfeeding support. Health workers have given talks to mothers at ANC and postnatal visits and at young children’s clinic visits on good nutrition, personal hygiene, malaria prevention, exclusive breastfeeding, positioning babies at the breast, appropriate complementary feeding, and birth preparedness. Mothers learn that breast milk really is best.


August 04, 2020
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