By Milka Njeri, Research Assistant, APHRC
Role of men in breastfeeding and child nutrition
The Year 2015 is fast approaching yet achievement of the millennium development goals by many developing countries still seems like an elusive idea. Despite the effort invested in the fight against poverty, diseases and illiteracy, only modest progress has been made over the past decade. Poor child nutrition has been acknowledged as one of the hurdles on the road to achieving these goals(1). Poor child nutrition, especially in the first 1000 days increases susceptibility to both infectious and non-communicable diseases, impairs the children’s physical and intellectual development, educational outcome and economic productivity; all of which perpetuate poverty in the long run.(2-6)
Optimal breastfeeding including early initiation, feeding colostrum, exclusive breastfeeding for six months and continued breastfeeding for at least two years has been evidenced to reduce child mortality and morbidity rate; improve mental and intellectual development; and improve productivity and the overall country’s economy. (7-11) In cognizance of this, numerous interventions have been proposed and implemented in the country to promote optimal breastfeeding practices with varying degree of success.
Male involvement however is an area that has been sidelined in designing these programs. Breastfeeding has for long time been perceived as a sole maternal domain, with men playing a passive role. Recent studies in both developed and developing countries have however documented the vital role that men play in breastfeeding and child feeding practices. They not only influence maternal breastfeeding intentions but also enhance successful initiation, sustained breastfeeding and the duration of breastfeeding.(12-15)
Constant physical and emotional support; and encouragement accorded to a breastfeeding mother by her partner have been strongly associated with maternal confidence in breastfeeding, enhanced milk production and positive breastfeeding practices including higher probability of exclusive breastfeeding; and longer breastfeeding duration. Lack or inadequate paternal support has been associated with maternal stress, anxiety and fatigue which yield poor breastfeeding practices and consequent poor child nutrition status (16)
In a focus group discussion on maternal and child nutrition in one of the Nairobi slums, men admit that breastfeeding and child feeding practices are only well understood by mothers. When asked about child nutrition, the response was usually;
‘I think the ones who can answer that question well are mothers, because they carry the pregnancy and know whether what they eat is good or bad for them. The work of the man is to buy food so I think that’s a question for the mothers to answer’ …… ‘It is for women’ ………… (FGD with village elders – viwandani slums)
Similarly, poor male involvement in breastfeeding and infant feeding issues is a theme that emerged in community dialogue with women in during the world breastfeeding week. Women were concerned that their partners pay little attention to their breastfeeding and infant feeding practices:
‘They leave at the crack of dawn and go to hustle, they come back late at night; they are tired and just eat and go to sleep. They have no business with how you breastfeed the baby’ (community dialogue with women on breastfeeding – Mathare slums)
Men are however not entirely to blame for their little or no involvement in breastfeeding. Being the head of the family puts heavy responsibities on them which leads to spending more time working and less family time. They work so hard to put food on the table, leaving vital matters such as breastfeeding to mothers alone. Too much focus has also been put on women in implementation of child nutrition programs leaving out their partners, some who though willing, are often clueless on how and when to support mothers in breastfeeding.
Existing evidence underpins the need to not only integrate men in child nutrition programs but also empower them to provide the necessary breastfeeding and child feeding support to their spouses. In this way, optimal child nutrition will be achieved, marking a significant step towards achieving the Millennium Development Goals (MDGs) 1, 2 4, 5 and 6.
1. Government of Kenya UNDP. Draft progress in attainment of MDGs and way forward in achieving the MDGs by 2015 in kenya. Nairobi, Kenya: 2010.
2. Dewey KG, Begum K. Long-term consequences of stunting in early life. Maternal & child nutrition. 2011;7 Suppl 3:5-18. Epub 2011/10/05.
3. Caulfield LE, de Onis M, Blossner M, Black RE. Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles. The American journal of clinical nutrition. 2004;80(1):193-8. Epub 2004/06/24.
4. Robert E Black LHA, Zulfi qar A Bhutta, Laura E Caulfi eld, Mercedes de Onis, Majid Ezzati, Colin Mathers, Juan Rivera. Maternal and child undernutrition global and regional exposures and health consequences. Lancet. 2008.
5. Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, et al. Maternal and child undernutrition: consequences for adult health and human capital. The Lancet. 2008;371(9609):340-57.
6. Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJ, Comparative Risk Assessment Collaborating G. Selected major risk factors and global and regional burden of disease. Lancet. 2002;360(9343):1347-60. Epub 2002/11/09.
7. Mullany LC, Katz J, Li YM, Khatry SK, LeClerq SC, Darmstadt GL, et al. Breast-feeding patterns, time to initiation, and mortality risk among newborns in southern Nepal. The Journal of nutrition. 2008;138(3):599-603. Epub 2008/02/22.
8. Graff M, Yount KM, Ramakrishnan U, Martorell R, Stein AD. Childhood nutrition and later fertility: pathways through education and pre-pregnant nutritional status. Demography. 2010;47(1):125-44. Epub 2010/04/02.
9. Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS. How many child deaths can we prevent this year? The Lancet. 2003;362(9377):65-71.
10. Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis. WHO Collaborative Study Team on the Role of Breastfeeding on the Prevention of Infant Mortality. Lancet. 2000;355(9202):451-5. Epub 2000/06/07.
11. Victora CG, de Onis M, Hallal PC, Blossner M, Shrimpton R. Worldwide timing of growth faltering: revisiting implications for interventions. Pediatrics. 2010;125(3):e473-80. Epub 2010/02/17.
12. Tan KL. Factors associated with exclusive breastfeeding among infants under six months of age in peninsular malaysia. International breastfeeding journal. 2011;6(1):2. Epub 2011/02/03.
13. Hector D, King L, Webb K, Heywood P. Factors affecting breastfeeding practices: applying a conceptual framework. New South Wales public health bulletin. 2005;16(3-4):52-5. Epub 2005/08/18.
14. Inoue M, Binns CW, Otsuka K, Jimba M, Matsubara M. Infant feeding practices and breastfeeding duration in Japan: A review. International breastfeeding journal. 2012;7(1):15. Epub 2012/10/27.
15. Tohotoa J, Maycock B, Hauck YL, Howat P, Burns S, Binns CW. Dads make a difference: an exploratory study of paternal support for breastfeeding in Perth, Western Australia. International breastfeeding journal. 2009;4:15. Epub 2009/12/01.
16. Agunbiade OM, Ogunleye OV. Constraints to exclusive breastfeeding practice among breastfeeding mothers in Southwest Nigeria: implications for scaling up. International breastfeeding journal. 2012;7:5. Epub 2012/04/25.