Dorze Tribe Mother breastfeeding her Baby - stock phot near Arba Minch, Gamo Gofa Zone, Ethiopia. It is a common sight to see mothers breastfeeding their babies in public.Credit: Kirsten Walla/iStock Editorial/Getty Images Plus
While giving infants only breast-milk for the first six months of life (exclusive breastfeeding or EBF) has been increasing in many African countries, there is great disparity between different regions within these countries.
Researchers looked at the changes in the prevalence of EBF in several sub-Saharan countries between 2000 and 2018 at the district-level and compared them to national numbers.
For example, Sierra Leone is expected to meet the EBF target of 70% by 2030 but only on the national level. Only Lesotho, Burundi and Rwanda are predicted to meet this target at all their province- and district-levels.
Chad, Nigeria, Niger and Somalia had some of the lowest levels of EBF prevalence between 2000 and 2018. Chad and Somalia also had among the highest rates of annualized decline in EBF during the study period. Nigeria has one of the highest absolute geographic inequalities in EBF prevalence, with a six fold or greater difference in EBF between districts in 2018.
“Our analysis looked at prevalence of EBF across the continent, by nation, and did not look at non (or never) breastfeeding as a whole. We see that there have been increases in EBF over time in many countries,” says Natalia Bhattacharjee, a researcher at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington School of Medicine.
Some countries have fared better than others overall. In Gambia, for example, national level EBF prevalence has been on the rise, and variations have been decreasing during the study period. In contrast, Chad has had a decline in EBF across all district-levels.
“The patterns over time vary across countries so we do not think it is useful to generalize about trends for the continent as a whole,” says Bhattarcharjee. “Although breastfeeding is a cost-effective intervention, it requires investment of time and resources from mothers and wider networks, including families, health systems, and policy makers.
“A key message is that we are not moving together on EBF. The large differences between countries and within countries, with many even recording declines in EBF rates, point to the need for appropriate interventions at both national and subnational levels,” says Sara Nieuwoudt from the School of Public Health at the University of the Witwatersrand, South Africa.
Helen Mulol, from the Research Centre for Maternal, Foetal, New-born & Child Health Care Strategies at the University of Pretoria, South Africa, also points out that the research suggests that countries with the lowest EBF rates also had the highest prevalence of under-five mortality, stunting, and childhood diarrhea.
“Education on EBF and introduction of policies supporting it, such as skilled lactation support and breastfeeding counselling in health facilities and paid maternity leave, could help alleviate these burdens,” she says
