Jul 29, 2012 08:24 PDT
The Jakarta Globe
July 29, 2012
Mother’s Milk, Not Bananas, Key to Infant Health in Aceh
by Jenny Marc
Zahira beamed. It wasn’t just the proud-parent smile that spreads
across a mother’s face when strangers fawn over her child. And it
wasn’t because her baby lay so quietly in her bassinette amid the
commotion. Zahira grinned with a sense of accomplishment as she stood
in her living room rhythmically rocking Zafira.
When asked how she fed her baby, Zahira replied that she exclusively
breastfed for the first six months, and then introduced other foods
and liquids later on.
“Then I rephrased the question,” said Nurdanlia Lairing, a behavior
change specialist in Unicef’s Aceh field office. “I asked her how old
Zafira was the first time she was given a banana, and Zahira said one
Nurdanlia constantly meets mothers like Zahira in Aceh — mothers who
understand the importance of nursing their babies, but don’t grasp the
concept of exclusive breastfeeding, or the dangers of complementary
feeding too early. And now she’s working to fight these
misconceptions, because the health of Aceh’s next generation depends
Aceh has some of the highest stunting rates for children under five in
the entire country, which is why health organizations like Unicef
aggressively promote exclusive breastfeeding. Nothing but breast milk
during a baby’s first six months is one of the most effective ways to
prevent stunting, but studies show that exclusive breastfeeding rates
have dropped over the past decade.
“Breastfeeding is a major intervention that contributes to reducing
stunting — it’s probably the most major intervention,” said Edward
Carwardine, Unicef’s chief of communication. “[But right now] there
are a lot of cultural practices that prevent optimal breastfeeding
Indonesia has been struggling with nutrition for decades. Although
there’s been a steady decline in acute malnutrition — wasting, which
results from food deprivation over a short period of time — the
archipelago still sees some of the highest stunting rates in the
More than one in three Indonesian children under five suffer from
stunting, says Unicef, and Aceh is the country’s fourth most impacted
province, with about 45 percent of children suffering from the
Stunting, or stunted growth, is a low weight-to-height ratio that
results from chronic malnutrition.
According to Unicef, stunted children look healthy, but grow to be
about four to six inches shorter than average, which makes them more
susceptible to physical illnesses like diarrheal diseases and
parasitic infections, and also impairs their cognitive development.
Stunting becomes irreversible after a certain age, and part of the
reason that it’s so difficult to fight is because of its cyclical
“Stunting is indicative of much deeper rooted problems. It basically
goes across generations,” said Robin Nandy, Unicef’s chief of child
“If, for example, the mother is malnourished, and gets pregnant, this
can get transmitted to the child, so the child will be stunted as
well,” Nandy added.
Medical experts identify the first 1,000 days — the time from
pregnancy through the child’s second birthday — as the most critical
period in terms of nutrition. Mothers must maintain healthy diets
while carrying their child, and after giving birth they need to
provide the right nutrients and vitamins for their babies — an
endeavor that’s relatively simple and cheap.
A Simple Solution
Breastfeeding provides unparalleled benefits for both mother and
child. According to the World Health Organization, breast milk
contains not only key vitamins, but provides babies with antibodies
that fight common childhood diseases. Studies also show that for
mothers, nursing reduces the risk of certain types of cancer and acts
as a natural form of birth control.
Health officials and organizations across the board promote exclusive
breastfeeding for at least the first six months. Realizing its
importance, the government jumped on the bandwagon as well when it
passed a law promoting exclusive breastfeeding in 2009.
Yet despite this unanimous support, exclusive breastfeeding rates have
been on the decline. About 40 percent of Indonesian mothers
exclusively breastfed in 2002, according to Unicef, compared to 32
percent in 2007. Experts cite a rise in formula use as a leading
culprit, but also explain that cultural practices play a large part,
particularly in Indonesia’s rural areas.
“In Brebes, for example, there is a traditional belief that when a
baby is born, it has to be given a banana,” explains midwife Rahayu
Rahayu has worked in Jakarta for nearly two decades, but travels to
rural provinces like Brebes in Central Java to train midwives. In
these areas, she finds that traditions usually lead family members to
feed babies solid food far too early, sometimes just a few days after
Similar beliefs prevail in Aceh. It’s not that women don’t nurse their
children. In fact, it might be difficult to find a mother who doesn’t.
It’s just that they don’t exclusively breastfeed, and that is where
the problem lies.
After a decade of rigorous educational campaigning, mostly supported
by non-governmental organizations, perceptions of breastfeeding are
In rural areas, midwives and posyandus, or community health centers,
are particularly crucial in communicating these messages, and luckily
Aceh seems to have its fair share of dedicated messengers.
Posters splashed across health center walls show mothers gazing
lovingly at their infants as they nurse. Midwives repeatedly stress
the importance during routine check-ups. And in one posyandu hallway
hangs a map, which marks the homes of pregnant mothers or newborns, so
the midwife can better keep tabs on each baby’s feeding regiment. So
far, the effort appears to be working.
“In the old days, I gave my daughter bananas, starting when she was
three months,” recalled Husnaini, 46, who often watches her
3-month-old granddaughter, Kanza Putri.
Now she says she only feeds Kanza her daughter’s breast milk.
“My mindset changed because of what I learned at the posyandu,” Kanza said.
Many mothers and grandmothers throughout Aceh echo Husnaini’s
attitudes. Either from the posyandu or information online, mothers
today not only know the importance of nursing, but they regularly pass
the knowledge on to older generations.
Despite this progress, officials still face the challenge of defining
what “exclusive” means exactly. Husnaini, for example, explained that
her granddaughter only drank breast milk, but then said that she
sometimes fed the baby water when there wasn’t enough.
Setting the Message Straight
To facilitate this change, Unicef is developing a new communications
campaign. Because most women nurse their babies in some capacity,
officials plan to stress that poor feeding habits can have harmful
consequences, such as stunting.
“We will not be [promoting] the benefits of breastfeeding, because
that has become the norm,” explained Nurdanila. “We will emphasize our
measures on the dangers of giving additional food and bottle feeding.”
The communications strategy began with a four-month study aimed at
pinpointing misconceptions. In addition to beliefs that solid foods at
an early age are beneficial, Nurdanlia and her team found that many
families believe formula milk can increase intelligence and improve
Now, Unicef is strategizing how to best deliver the correct
information. They plan on asking religious leaders for help, as well
as facilitating support groups.
“Instead of using the media, our studies show that the most effective
method is to go through interpersonal communication,” Nurdanlia said.
The strategy should be finished this September and from there
officials will help the community implement the new plan. In addition
to breastfeeding education, Unicef will stress the importance of
health during pregnancy and hand-washing with soap. And although it
will be tough to foster behavior change on such a large scale,
Nurdanlia remains optimistic.
“Once you succeed in one step, the others will follow.”
Before the plan rolls out this fall, Nurdanlia will join officials
around the globe in promoting World Breastfeeding Week, which is
hosted annually by the World Alliance for Breastfeeding Action. The
event kicks off on Wednesday, and activities will include lectures,
workshops and photo contests.
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