Nigerian Journal of Paediatrics

Need for baby friendly community initiative to improve the low exclusive breastfeeding rates in Nigeria

Niger J Paediatr 2016; 43 (3): 229 – 230

OPINION

Ekanem EE

Need for baby friendly commu-

Fajola AO

nity initiative to improve the low

exclusive breastfeeding rates in

Nigeria

DOI:http://dx.doi.org/10.4314/njp.v43i3.13

Accepted: 26th April 2016

the later. The BFCI was developed by the United

Nations and UNICEF to expand on the BFHI, and aims

Ekanem EE (

)

at sustaining breastfeeding after mothers leave the hospi-

Department of Paediatrics,

tal.⁶ The initiative emphasises as community involve-

University of Calabar, Calabar, Nigeria

ment, formation and training of mother support groups

Email:emmanuelekanem@unical.edu.ng

at the village level, close link to the health facility and

Fajola AO

training messages derived from the community through

interviews with community members. This initiative

Regional Community Health,

Sub Saharan-Africa; Shell Petroleum

has proven effective in many developing and developed

Development Company of Nigeria

countries including Kenya with an EBF rate of 97%,

Gambia, Cambodia, New Zealand and Italy

The initiative has the advantages of linkages between

The benefits of Exclusive Breastfeeding (EBF) are no

health facilities and communities, including men as im-

longer debatable. The Baby Friendly Hospital Initiative

portant players, mobilizing resources from the whole

(BFHI) was launched in 1991 to encourage EBF for the

community while providing governments with an entry

first six months of life and continued breastfeeding for

point for other community health and development pro-

grams, and continuity/sustainability, among others. In

at least one year of life. The initiative has been

launched in at least 152 countries worldwide and in sev-

Nigeria the traditionally strong community institutions

eral parts of Nigeria. However studies from different

1,2

such as traditional rulers, women groups and women

parts of the country have continued to show very low

leaders and NGOs could be mobilized as fulcrum for

rates of EBF despite this initiative. Agu and Agu re-

3-5

such initiative. This would fit well into the community

model of solving health problems in our environment

ported only 63% rate of initiation of EBF at birth among

254 women in south-eastern Nigeria despite 87.0% of

and the Adopt-a-Health-Centre Initiative of the Paediat-

the woman being aware of EBF. The rate had declined

ric Association of Nigeria. Communities could be incen-

to 30.5% by 4-6months.In a rather more robust study in

tivized by issuance of certificates and other benefits for

rural western Nigeria among 410 mothers, 95.1% had

meeting laid down criteria.

heard about EBF, 65% knew that EBF should be initi-

ated from birth and 21.5% knew of the benefits of EBF

Some aspects of this community involvement have

yet only 10.2% were practicing EBF at the time of the

already been demonstrated to positively influence EBF

study. Agho et al examining data from several parts of

in Sokoto, Nigeria where the use of community volun-

the country, have reported Nigeria to have the poorest

teers to counsel women on the benefits and need for

rate of EBF in the world despite good levels of aware-

EBF significantly increased the percentage of mothers

ness.

with intention to exclusive breastfeeding and their

knowledge of the benefits of EBF. In South South Ni-

It would appear therefore that the reasons for poor EBF

geria where Shell Nigeria has adopted some community

rates in Nigeria go beyond lack of awareness. In addi-

facilities and introduced community health insurance

tion, it is obvious that the BFHI is not able to maintain

schemes in collaboration with the communities and gov-

influence on mothers after discharge from hospital, thus

ernment, high rates of acceptance and compliance with

the rapid declines in EBF rates soon after birth. To

3-5

public health initiatives have been observed due to the

improve the EBF rates in the country we need a model

large numbers visiting such facilities and receiving

awareness education, and community participation.

that would address the identified impediments to EBF at

the community level which include firmly held opinions

on infant feeding and poor motivation.

3-5

Very impor-

tantly, lack of ownership by the community is an obvi-

ous limitation to continuation of EBF after hospital dis-

Conclusion

charge.

In view of this we propose that the Baby Friendly Com-

Knowledge of EBF is widespread in Nigeria yet practice

munity Initiative, (BFCI) would be an effective comple-

rates are abysmally low. It is obvious that the BFHI is

ment to the BFHI in Nigeria, and provide continuity to

not able to sustain EBF rates in the community. Deeply

230

tion of 2005 on Infant and Young Child Feeding . We

held opinions about infant feeding in the communities

play a major role in the declining rates. The BFCI is a

please invite opinions on the subject.

viable addition to the BFHI in Nigeria to improve EBF

rates and meet our obligations to the Innocenti Declara-

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