Great column in today's NYTimes about relearning breastfeeding in Niger.
-- Marguerite Herman, Wyoming

The Breastfeeding Movement in Rural Niger
By NOREEN CONNOLLY 
<http://kristof.blogs.nytimes.com/author/noreen-connolly/>

/Saumya Dave, a student, and Noreen Connolly, a teacher 
<http://www.sbp.org/>, are the 2011 "Win-A-Trip" winners and are 
currently traveling with Nick through parts of North and West Africa. 
Noreen's second post is from Niger. /

You know the saying, "You can't teach an old dog new tricks"? I never 
thought much of it or about it. But today when we visited two different 
health care centers in southern Niger to talk to health care workers and 
breastfeeding mothers, I remembered why I thought it was nonsense.

A large group of women had come to the center with their babies because 
they had been told that guests of Helen Keller International 
<http://www.hki.org/> wanted to see firsthand the benefits of exclusive 
breast feeding of infants up to age six months. Along with the moms and 
babies came other family members, mostly children and a small group of 
Traditional Birth Attendants (TBA's), untrained and illiterate village 
women who deliver babies. Nick had said they could be a real threat to 
mothers' and children's health-even their lives -- because they deliver 
babies under really unsanitary conditions, aren't unequipped to handle 
any complications and don't encourage breastfeeding from moments after 
birth, depriving the newborns of all the health benefits of colostrum. 
But here was a group of TBA's sitting proudly on the floor of the 
integrated health center of the village of Doubatma surrounded by young 
mothers holding their chubby, healthy looking babies. The TBA's told us 
how much prettier, bigger and stronger babies are when they are 
breastfed from their first moments of life to six months.

Maybe because I am older --perhaps older than the TBA's -- I had a soft 
spot for these women even though I was well aware of the terrible damage 
they had done and still could do. They are entrepreneurial and 
apparently important members of the village social structure. Elders. 
And, more importantly, they probably would not be pushed aside by the 
health centers' offers of safer and superior care during childbirth. One 
health center official told us that when the TBA's deliver babies in the 
village they are paid in CFA (the currency of this part of Africa) and 
probably get many other in-kind payments like chickens or millet. Four 
TBA's, Alama, Tassa, Balkiwa and Taroua, could have been put out of 
business by the health centers and everyone would have been better off. 
Except them.

Shawn Baker <http://kristof.blogs.nytimes.com/author/shawn-baker/>, Vice 
President and Regional Director for Africa for Helen Keller 
International, who organized our visits to the health centers, hospitals 
and other health, nutrition and educational initiatives , told me there 
was no way that the TBA's could be marginalized if the maternal and 
infant health programs were to succeed. So HKI figured out how to bring 
them along. They do local training and community information sessions. 
And the health centers pay the TBA's 1,000 CFA (just over $2) for 
accompanying the mothers to the center for childbirth. The TBA's take a 
financial hit but they don't continue to impede progress and maybe their 
standing in the village remains. Virtuous bribery.

Through the interpreter I asked one TBA, Tassa, why she didn't 
exclusively breastfeed her own infants. "They didn't do that," she said. 
"They didn't know." If she and other TBA's really buy into the health 
centers' teachings on exclusive breastfeeding and safe childbirth, other 
women's children can be saved. New tricks? Maybe so.


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