Dear all:
The UN Standing Committee on Nutrition is holding their meetings on nutrition this week in
Geneva. ILCA, La League League, and WABA representatives are all attending this event. In
preparation for this event, some of the child survival interventions were examined for
opportunities to work with other nongovernmental organizations that often forget about
breastfeeding. If any of you watched the TV program about Global Health, the focus was on
interventions that offered a one dose approach - e.g. interventions and treatments. These are
very effective interventions in developing areas of the world, but simply not enough.
Breastfeeding is sometimes forgotten because some NGOs just think breastfeeding is just
something women do, some think the array of interventions they have selected is a higher priority,
and some just don't realize that the rates are not as good as you would think. Even I was shocked
when I looked at the exclusive breastfeeding rates compared to the other interventions.
You've seen the statistics I posted before, but since "water and sanitation" popped up on the other
listserve that I'm on, I took the opportunity to post the following:
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I most appreciated the summary of the article that stated that:
"One-third of the African population have no drinking water and almost half of the African
people have health problems due to the lack of clean drinking water. UNICEF-Canada issued a
report underscoring that curable diseases are still take a horrifying toll, with pneumonia being a
leading cause of death, followed by diarrheal disease, which kills 1.6 million under-fives,
after they contract the disease from dirty water."
I have been looking at statistics from UNICEF myself, and this is one of the areas that has an
impact on child survival that has very low coverage compared to other interventions. Surprisingly,
the low coverage of water and sanitation was even lower for another intervention. The rates of
exclusive breastfeeding among infants younger than 6 months was even worse and actually
corresponded to the same areas that had the poorest coverage for water and sanitation. So these
infants and young children are getting a double whammy. In the area of least coverage, Western
and Central Africa: 42% did not use improved water sources, 65% did not use adequate sanitation
facilities, and 80% of the infants under 6 months were not breastfed.
Breastfeeding is really the first, most readily available and most potable source of water. James
Grant, former Executive Director of UNICEF, described breastfeeding as providing a fairer start in
life & compensation for the injustices of the world. Shockingly, a new article in Pediatrics shows
that even in the United States, with good water and sanitation, the death rate from not
breastfeeding is 26.6% higher. (For those who go to the original article, the flipping the OR to the
risk of not breastfeeding requires that you remember it is a ratio and not a simple subtraction
problem. I'll be happy to show you the math.) When I was working on my doctorate, my
dissertation advisor had written an article on Mother's Milk and Sewage. Lack of breastfeeding
had the highest risk among those who did not have access to latrines, followed by those who did
not have access to water (clean or not), followed by those who did not have access to potable
water. This clearly speaks to the extreme risk of death when the areas with the least access to
water and sanitation are not the areas where exclusive breastfeeding rates are the lowest.
Here is some information that was prepared for the upcoming SCN meetings in Geneva by the
International Lactation Consultant Association (ILCA), La Leche League International (LLL) and the
World Alliance for Breastfeeding Action (WABA) on why we should consider looking for ways to
integrate breastfeeding within water and sanitation programs:
Why integrate breastfeeding within a water & sanitation program?
*Infants who never breastfeed:
*Lose their most potable source of water.
*Are much more likely to die.
Even in the USA, nonbreastfed infants are 26.6% more likely to die in the first year of life. (Chen &
Rogan. Pediatrics. 2004;113(5):e435-e439.)
*Infants who do not exclusively breastfeed to 6 months receive less of the most potable &
available source of water.
*Children who do not breastfeed for at least 2 years are more likely to have pathogen-
contaminated feces.
*Not breastfeeding, partially breastfeeding, or early weaning may increase the amount of water
used, time spent collecting & sterilizing water, & fecal contamination.
*Exclusive breastfeeding rates are lower than the coverage rates for improved water sources, & in
most areas, for adequate sanitation facilities.
Statistics from UNICEF's 2006 State of the World's Children report
Use of improved drinking water sources:
Worldwide: 83% Least developed countries: 58% Western & Central Africa: 58%
Use of adequate sanitation facilities:
Worldwide: 58% Least developed countries: 35% Western & Central Africa: 35%
Infants who are exclusively breastfed (< 6 mo old):
Worldwide: 58% Least developed countries: 34% Western & Central Africa: 20%
How can breastfeeding be integrated within a water & sanitation program?
Look for opportunities within routine program activities to promote:
*Exclusive breastfeeding for 6 months.
*Continued breastfeeding for at least 2 years.
For instance:
*Mention breastfeeding in TV & radio spots about water & sanitation.
*List breastfeeding as the most potable source of water for infants & young children in
promotional & educational materials.
*List breastfeeding as a way to decrease fecal contamination in educational materials on hygienic
practices.
*Remind families, health facilities, & ministries that breastfeeding is excellent protection when
emergencies such as the Tsunami & Hurricane Katrina disrupt water & sanitation systems.
*Ensure your promotional & educational materials suggest that water & sanitation is
complementary with, but not a substitute for, breastfeeding.
I urge you to join with ILCA, LLL & WABA to look for ways to work together to reach more mothers
and their infants and young children and improve their survival.
Sincerely,
Susan E. Burger, MHS, PhD, IBCLC
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