Why Kenya is likely to miss its breastfeeding targets

Giving infants breast milk alone for the first six months of their life is one of the widely recommended actions for safeguarding a baby’s health.

But, according to the recently released Kenya Demographic Health Survey (KDHS), only 77 per cent of Kenyan children aged 0-1 month are exclusively breastfed. This is contrary to the 100 per cent recommendation by the World Health Organisation (WHO). Also, exclusive breastfeeding dropped from 61 per cent in 2014 to 60 per cent in 2022.

Laura Kiige, a nutrition support officer at UNICE, says the report is a clear indication that Kenya needs to re-look at its breastfeeding strategies, so as to encourage more breastfeeding of infants. She says, the breastfeeding trends are worrying compared to the targets Kenya has set for herself.

“If we do not meet our target of breastfeeding, it means that we are disadvantaged because these children will not to grow as expected. Thus we are giving them room to suffer from malnutrition. The trajectory is not very promising, which is unfortunate. We need to pull our efforts together, so that we can reach our targets by 2030,” she says.

More support needed

And as the world marks World Breastfeeding Week, there is rising concern over the country’s ability to achieve 70 per cent breastfeeding prevalence by 2030.

WHO has set a global target rate for the initiation of breastfeeding (within the first hour after birth) at 70 per cent as well as exclusive breastfeeding.

The health organisation further targets for 80 per cent continued breastfeeding at one year, and 60 per cent at two years.
But numerous barriers such as the pervasive use of breast milk substitutes, the disparity in maternity health, lack of skilled breastfeeding counselling, and insouciant attitude towards supporting working breastfeeding mothers has made realisation of this goal foggy.

Kiige reveals one component that is critical in achieving EBF is the ante-natal care counselling. KDHS 2022 survey shows that about 87 per cent of children whose mothers were counselled on breastfeeding during Antenatal Care visits (ANC ) were exclusively breastfed for the first two days after birth.

This is contrary to 27 per cent of children whose mothers did not receive any ANC counselling, affirming the critical role of professional counselling.

Kiige further says another emerging obstacle to fully realisation of EBF has been urbanisation, where the majority of the new mothers are based in the town centres. She notes that this has denied mothers the support accorded by older women such as mothers-in-law, who previously guided mothers on childcare.

“Once the mothers have left the hospital and gone home, the continued skill support for breastfeeding ends there. They do not have someone who can guide and help them in the whole breastfeeding process,” Kiige notes.

Breastfeeding exclusively, which means giving an infant under six months breast milk only, has numerous benefits such as protection against diseases such as diarrhoea and respiratory infections consequently reducing infant mortality.

“What this means is that Kenya is most likely not going to achieve the SDG target of 2030 as far as neonatal mortality is concerned because EBF is one of the measures addressing neonatal mortality,” explains Stephen Mwangi, senior programmes officer at Nutrition International.

Mwangi says these obstacles are majorly caused by lack of support for the lactating mothers despite laws and policies that give guidance on the rights of breastfeeding mothers.

Although Kenya has progressive laws and policies that protect the breastfeeding rights of women such as the Employment Act 2007, which states that female employees are entitled to three months of maternity leave whilst a male employee gets two weeks, such law remains on paper, as there are still women who face challenges getting even the maternity leave.

Implementing the laws

Further, the Health Act 2017 provides for the establishment of lactation stations in the workplace while section 72 provides for break intervals for nursing employees.

“In the formal environment this is adhered to, but in the informal sector, as soon as they note you are pregnant, a number of women, especially the casual labourers lose their jobs. This translates to loss of income for the family and will eventually impact their health,” Kiige explains.

And to coincide with this year’s theme of the breastfeeding week “Making a Difference for working parents”, the UNICEF official says employers should support breastfeeding as it improves retention skills and experience, reduces recruitment costs, boosts loyalty, and increases the satisfaction and resilience of employees.

She notes that employer’s support to their nursing employees elevates their work output, improves satisfaction, and self-esteem and is an added recruitment incentive for women.

“When we help mothers at the workplace before they even give birth and allow them to go for antenatal care as frequently as recommended by a health care officer, then they will be prepared for breastfeeding. We are likely to get better healthy children in this country,” she says.

Professor Grace Irimu, Chairperson, Department of Paediatrics and Child Health at University of Nairobi says mothers who breastfeed alongside expressing milk within the first month are guaranteed to have enough milk to feed and store after three months. This will be helpful when the mother resumes work after her three month maternity leave.

“Milk can stay for up to eight hours at room temperature in areas that are not too hot and where it is too hot, it can stay up to four hours. It can also be left in the fridge for up to 72 hours and it can last for between six to 12 months when frozen,” she says.

Mary Kimani from Action Against Hunger says establishing public spaces for lactating mothers who work in informal sectors such as markets or public parks is also a major step towards meeting breastfeeding targets. Kimani says such facilities will confer mothers with privacy and comfort to nurse the infants while still working to earn for their families.

“Policy makers and custodians of such premises can create a space to empower mothers to breastfeed. It is happening in Tharaka Nithi and Kisumu counties, which have designated spaces for mothers to nurse,” she says.

And while calls for implementation of the existing policies supporting lactating mothers are being made, experts maintain that mothers and hospitals still play the bigger role of ensuring exclusive breastfeeding of children.

This can partially be achieved through training of mothers by skilled health workers during the ANC.

Antenatal care visit provides an opportunity for the health care provider to measure the mother’s blood pressure, take urine sample and blood sample for testing, listening to the baby’s heartbeat, advise on maternal diet and breastfeeding as well as enquire about any pregnancy abnormalities.

Existing gaps

Peterson Wachira, National Chairman, Kenya Union of Clinical Officer (KUCO) says one obstacle to using ANC as a path to reaching out to women, is the shortage of health care workers. He says it is likely for breastfeeding mothers to not benefit from education on aspects such as achieving appropriate circling rhythm, nipple attachment approach, and learning cues for feeding if there are no enough workers at the health facilities.

“Health care officers are like firefighters, they are attending to numerous cases at one time. It therefore, becomes difficult for them to give ample time to explain practical ways of successful breastfeeding,” he notes.

Also, mothers continue to favor breastfeeding alternatives, such as baby formula despite the existance of the Breast Milk Substitutes Regulation and Control Act 2012, which regulates its usage and marketing.
“The modern woman wants to keep her figure and may, therefore opt to give a child formula, which does not contain the nutrients that are found in breast milk,” Wachira adds.

He also says the practice of giving babies pacifiers might appear harmless but it inhibits successful breastfeeding. Introducing teats and bottles brings about nipple confusion for the baby, preventing proper attachment to the nipple.

Efforts to introduce 16 per cent of VAT by the National Treasury on milk substitutes in the Finance Bill 2023 were thwarted after it was rejected by the Finance and National Planning Committee.