Dear all:

One of the things that I love about Lactnet is the differences in perspective.  While at times, we 
may get uncomfortable when someone challenges our point of view - I always in the end find that 
it is those posts that make me think a little deeper.  

I credit Valerie McClain with asking some excellent questions that has just really refocused how I 
am looking at the Niger crisis.  She very rightly pointed out that the exclusive breastfeedng rates 
are very low.  This I DO know from my work in Niger.  There is one very small study in ONE village 
that found that women were using the "hot knife test" to see if the colostrum is "good" or "bad".  
Pity the infant whose mother's milk is deemed bad in that environment.  As I said, there are no 
artificial products, but they do give water when they dump the colostrum.  Keep in mind that there 
are many different ethnic groups in Niger and practices do vary village to village.  On this 
particular point, I do know that there was a Nutrition Communications Project that took some of 
this research and did some radio messages and work with community health workers that 
decreased the practice of tossing the colostrum.  It was very nicely detailed work.  I remember 
Maradi as one of the project areas.

The next big problem is giving complementary foods (that is foods in addition to breast milk) too 
early.  I know a number of projects did work in this area.  The complementary foods that they give 
are really awful from a nutritional point of view.  Millet fermented in watered down cow's or goat's 
milk.  This mixture can be deadly even if given when the child is old enough to start solids.  The 
reason is that there is a lack of water.  In the article "Mothers Milk and Sewage" an old but good 
reference - the order of priority for water interventions is providing enough water first.  Only when 
you have enough water can you make a difference by boiling the water.  This poses another 
problem.  Although they have been doing a lot of tree planting since 1984, firewood is a scarce 
commodity.  

My two most striking flights were the first time I flew over the northeastern part of the Democratic 
Republic of Congo (then called Haut-Zaire of Bend in the River fame).  I flew for hours without 
seeing anything but a sea of green trees.  Niger was the opposite - hours of flying over nothing 
but a sea of light red sand with faint wisps of spindly trees that were few and far between.

Again, there were some excellent nutrition programs that made inroads on the complementary 
feeding issue -delaying its introduction and working on getting more nutritious ingredients and 
improving the sanitation.   Again, I remember Maradi as being one of these areas.

UNICEF works in different areas.  While I can point to many countries where UNICEF has done 
wonderful and ground-breaking work in turning the nutrition situation around, Niger was not one 
of their big success stories.  Also, large-scale surveys are few and far between -they are costly to 
mount.  So, my recollection of the more detailed nutrition work is that the exclusive breastfeeding 
rates are not at low as the UNICEF stats suggest.  I tossed all my old survey reports because I 
didn’t think I’d need these anymore.

BUT keep in mind that you are dealing with a situation in a country where the baseline is the 
second highest mortality rate in the world.  This is a situation in which breastfeeding is likely to 
have a much greater protective effect against disease than almost anywhere.  If you look at the 
first NY Times article with the video by Micheal Wines, you can see that there are fat babies in one 
picture.  These are the lucky ones that are still breastfeeding.  

Also, women in Niger really suffer.  During the last famine, I did have many women tell me that 
their milk dried up.  Some of this may very well be due to the use of goat’s milk, but I am now 
inclined to believe that their calorie intakes drop down to levels where they actually could be 
having a reduction in production.  These women are spindly during nonfamine times so the 
baseline is not good to begin with. 

So, in thinking through Valerie’s comments, I had accepted an unacceptable baseline as a “norm’.   
The baseline situation is that not exclusively breastfeeding has been a problem for as long as I can 
remember and in areas with good projects had improved slightly.  Not exclusively breastfeeding is 
and EVEN BIGGER problem now that the famine has worsened to the point that it is receiving 
international attention.

Best regards, Susan Burger, MHS, PhD, IBCLC

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