Programme Director
MECs for Health
Traditional leaders and healers
Heads of Health and other officials
Members of UN agencies and other development partners
Our guests and partners
Ladies and gentlemen
Good morning!
Our country is going through a rough patch – one that no country would like to see itself in! child mortality is increasing at a very disturbing rate. South Africa is only one of 12 countries in the world in which child mortality is increasing?
There are a number of interventions that we need to take to decrease child mortality. One of the key initiatives must be a review of the evidence on breastfeeding especially in the context of HIV.
I asked the department to invite academics and researchers as well as a wide range of stakeholders and partners to both present the evidence on breastfeeding so that we can generate consensus on policy and practice on breastfeeding, especially in the context of HIV. Without pre-empting the outcomes of this consultative meeting my view is that we need to reposition, promote, protect and support breastfeeding as a key child survival strategy in South Africa.
We have invited community leaders, traditional leaders, and traditional healers to this meeting as they are very influential in society and I wanted them to hear what experts are saying about what we need to do to reduce child mortality and in particular with respect to strengthening breastfeeding
Current situation in South Africa
Although breastfeeding initiation rates are reportedly high in South Africa, exclusive and extended breastfeeding is far from optimal. South Africa, is one of the countries with low prevalence of exclusive breastfeeding at 8% according to the 2003 Demographic and Health Survey. A dramatic drop in exclusive breastfeeding rates was reported in the age group 4 to 6 months, where only 1,5% of infants were exclusively breastfed. This is one of the lowest rates of exclusive breastfeeding in the world. Data from the Human Sciences Research Council national survey suggests that among infants 0 to 6 months, 25,7% were reported to be exclusively breastfed whilst 51,3% were mixed fed,with solids and formula beingintroduced far too early in life.
The benefits of breastfeeding are well recognised for both infant and mother. Breastfeeding has profound impact on child’s survival, health, nutrition and development – and we have known this for decades. These benefits will obviously be lost when formula feeding is given.
Almost all mothers can breastfeed successfully. Only a small number of health conditions of the infant or the mother may justify recommending that she does not breastfeed temporarily or permanently.
There are many reasons that have been identified to contribute to the decline in breastfeeding considering in the past, most mothers’ breastfed their children. We need to bring these into our discussions today and tomorrow and find innovative strategies to address them.
I wish to suggest some barriers to breastfeeding and I am sure that this meeting will raise others as well:
- Aggressive promotion by manufacturers or distributors of formula milk.
- Practices in health facilities that are not supportive of breastfeeding– delayed initiation of breastfeeding in health facilities, separation of well babies from their mothers, issuing of infant formula to mothers who opt for breastfeeding, poor infant feed counseling, lack of support.
- Working mothers often stop breastfeeding once they return to work due to challenges in the working environment. Most working environments are not supportive of breastfeeding. I urge this conference to take a resolution on the promotion of breastfeeding in the workplace!
- As a country we have a high teenage pregnancy rate. Teenage mothers leave their babies at home with grannies and rely on formula feeding.
- I was very impressed with a school in Harlem, New York that I visited when I was the MEC for Education in Limpopo – the principal established a crèche for students who had babies; these children were expected to breastfeed their children during breaks; this taught the girls responsibility for their babies and also proved to be a very effective contraception to the boys!
- Lack of family and community support after discharge.
- Sub-optimal involvement of men in supporting breastfeeding.
- National policies are often not supportive of breastfeeding promotion. Mothers are discharged soon (6 hours) after delivery when breastfeeding has not yet been established.
- Confusion on the risks of HIV transmission and breastfeeding. AFASS (acceptable, feasible, affordable and safe) criteria are not well understood. That infant formula should only be used when specific conditions are met (e.g. safe water and sanitation, continuity of adequate supplies, ability to prepare and give it safely, family support, availability of health care) is not shared and practiced.
- There are very few medical conditions make it necessary for formula feeding! Most if not all mothers can breastfeed! In the past all mothers breastfed their children, in fact this was the tradition. I don’t know what changed – but by actively promoting formula feeding, manufacturers portrayed those that breastfed as not being worthy pretty much as those that sold skin whiteners to us did – unless you had fair skin you were not a worthy human being!
- I propose that infant formula should only be used when prescribed by a doctor!
- Lack of systematic efforts to promote exclusive breastfeeding (EBF) at scale due to limited understanding of the value of exclusive breastfeeding.
In the 1980’s the GOBIFFF strategy was the first of United Nations Children's Fund (UNICEF) strategy to improve child health. Who can still remember it? Breastfeeding is core of the GOBIFFF
G = Growth monitoring
O = Oral rehydration
B = Breastfeeding
I = Immunisation
F = Female education
F = Family planning
F = Food supplementation and security
I want us to return to GOBIFFF as we strengthen maternal and child health services in South Africa.
There is new scientific evidence on safety of exclusive breastfeeding in the context of HIV. This evidence will be shared at the meeting so that we can collectively take decisions based on evidence. Incidentally, South Africa has implemented a range of strategies since 1994 to promote breastfeeding but we have not gone to scale and not provided the support needed to achieve high rates of exclusive breastfeeding.
Some initiatives supporting breastfeeding:
- South Africa launched the Baby Friendly Hospital Initiative (BFHI) in 1994. Currently, 239/545 (44%) health facilities with maternity beds have been designated as baby-friendly. The Baby-Friendly Hospital Initiative addresses a major factor which has contributed to the erosion of breastfeeding - that is health care practices
- Breast milk banking- breastfed mothers donating their breast milk to breast milk banks saves lives. This initiative should be fully supported. National, provincial and local government, traditional leaders, non-governmental organisations, civil society business and organised labour should partner with us to scale up promotion, support and protection of breastfeeding to improve child survival.
Encouraging breastfeeding, providing accurate information about the benefits of breastfeeding and support will increase awareness, acceptance, and will encourage more women to do what is best for their babies - and that is to breastfeed. This initiative, of promoting breastfeeding, should be viewed in a broader context as well – that of strengthening primary health care.
The National Health Council has taken a decision to implement three streams of primary health care re-engineering which will assist us in promoting and sustaining exclusive breastfeeding. These are: - A ward based PHC outreach team – where a team of about 10 people, including community health workers, will perform health promotion and prevention activities in homes and communities; we have more than 72 000 community based workers, most on stipends and employed by non-governmental organisations (NGOs) – but I am not sure of the full value of this cadre is being realised. There are 4 000 electoral wards in the country and we would like to see these teams operating in each of the wards
- A strengthened school health programme. There are 29 000 schools in the country and over time there must be a nurse in each school. We hope to start in this programme in schools in quintile 1 and 2 districts, the poorest schools
- District based clinical specialist teams composed of a principal gynaecologist, a principal paediatrician, a principal family physician, an anaesthetist, an advanced midwife, PHC nurse as well as a paediatric nurse. This team will be responsible to strengthen clinical governance of public health services in each district.
These initiatives must also contribute to support exclusive breastfeeding!
I thank you and wish to successful deliberations. I shall return tomorrow to close the meeting – at which time I hope we would have generated sufficient consensus on the way forward.
I thank you!!!
