Before coming to West Africa I had experience in sexual health promotion and HIV prevention. I didn't think of HIV transmission in terms of mothers and their children. Frankly, I didn't think of breastfeeding much at all. Now, my concept of breastfeeding has taken a naturally clinical turn, since I am working in public health. I think of breast feeding in terms of nutrition, HIV and malaria.
In Burkina nearly a third of infants are under-nourrished. Some of the issue is a lack of food, but part of the problem is food selection during the weaning process. Babies are often given a plain millet porridge when they need additional ingredients to maintain healthy weight and physical development. Nutritional local ingredients are available. Even wild plants such as the legendary baobab (think the monkey's tree in "The Lion King") can be used to ensure optimal nutrition during weaning.
For cultural reasons women often do not allow their babies to take the colostrums (first milk) because it seems to be discolored. This is rather unfortunate for babies that may already be born with a lower birth rate because of their mother's lacking diet and/or malaria during pregnancy. Also, some believe that a baby should be given water or tinctures that not only prevent a baby's appetite for milk, but also risk infecting the child with intestinal parasites.
In terms of HIV, mother to child transmission is one of if not the most important area of transmission. Women's testing is subsidized by international donors and the Burkinabé government. ARVs (anti retro virals) are provided to pregnant women who test positive and they are given instruction on how to breastfeed and wean early to maximize the natural benefits while minimizing the risk of transmission.
At the Stomp Out Malaria Boot Camp I learned that in terms of malaria, babies who are breastfeeding are less susceptible to infection because of the resistance acquired through breastmilk. The most at risk are the children who have been weaned, but haven't been exposed to malaria enough to develop their own resistance. Pregnant women and young mothers are encouraged to sleep under mosquito nets to prevent infection and are encouraged to take young children with a fever directly to a health agent. Malaria during pregnancy can lead to low birth rates and death of the mother or fetus.
Here breastfeeding is much more than just a natural process. There are layers of cultural expectation, implications of poverty and of course foundational health practices playing a part in a mother's life. Public health interventions involve a wide range of topics including optimal positioning of the baby, how to know when a baby needs to feed and weaning methods. Without access to formulas (or treated water to mix them with) and with an overall imbalance of nutrients in diets, breastfeeding is paramount to a baby's success in early years. Women here don't have the luxury to set breast feeding aside with modern cultural trends like American mothers.
About the Author:
Casey D. Hall is a Health Development Peace Corps Volunteer in Burkina Faso and will be pursuing his MPH beginning the fall of 2012. Observation of breastfeeding has consumed much of the past two years of Casey's life. As a queer activist and ally to women's movements, he is passionate about gender studies, race studies, reproductive health, queer theory and international studies. He blogs about his experiences at Caseydhall.blogspot.com