Maa https://maacharity.org Supporting Mothers Mon, 15 Feb 2021 15:44:19 +0000 en-US hourly 1 https://wordpress.org/?v=5.4.4 https://maacharity.org/wp-content/uploads/2019/02/cropped-Website-Icon-32x32.png Maa https://maacharity.org 32 32 139131515 MAA x Scrubbed Up OSCE Workshop https://maacharity.org/product/osce-workshop https://maacharity.org/product/osce-workshop#respond Mon, 15 Feb 2021 15:37:48 +0000 https://maacharity.org/?p=8675 SATURDAY 6TH MARCH 10AM-1.30PM

We’ll be covering 5 of the most common stations that come up in OSCEs for pre clinical years!

- Examinations
- History taking/Communication
- Data interpretation
- Anatomy
- Explanations

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Immediate stay at home orders to control COVID: the impact on Bangladeshi Mothers. https://maacharity.org/immediate-stay-at-home-orders-to-control-covid-the-impact-on-bangladeshi-mothers https://maacharity.org/immediate-stay-at-home-orders-to-control-covid-the-impact-on-bangladeshi-mothers#comments Wed, 13 Jan 2021 16:00:25 +0000 https://maacharity.org/?p=8413 Bangladesh has suffered in numerous ways at the hands of the notorious and on-going COVID-19 pandemic. From the first week of March, the country sought to ban all mass gatherings, including a notable 100th-anniversary celebration event of the birth of the founder of Bangladesh, Sheikh Mujibur Rahman.

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Immediate stay at home orders to control COVID: the impact on Bangladeshi Mothers.

By Sabeera Dar | MAA Academics Officer | 6th Year Medical Student, UCL

Immediate stay at home orders to control COVID: the impact on Bangladeshi Mothers.

Immediate stay at home orders to control COVID: the impact on Bangladeshi Mothers.

By Sabeera Dar

Bangladesh has suffered in numerous ways at the hands of the notorious and on-going COVID-19 pandemic. From the first week of March, the country sought to ban all mass gatherings, including a notable 100th-anniversary celebration event of the birth of the founder of Bangladesh, Sheikh Mujibur Rahman. In addition, a national lockdown was enacted, hoping to contain community transmission between March 26th to April 4th which went on to be extended to May 30th.

Despite such measures, the ripples streaming through Bangladeshi society have been complex and unprecedented. The pandemic has exposed the insufficiency of a fragmented healthcare system, reaching widely into one of the world’s most densely populated countries. Though this exposure has happened in concert with other more developed countries such as Italy, the UK and the USA who are suffering a similar unrelenting challenge, the complications in Bangladesh appear starker, especially given the pre-existing healthcare divide emanating from urban and rural disparities.

Importantly, critical maternal health services have been stretched thin. This short blog touches upon trends in maternal health during COVID-19 lockdowns, using data gathered from Bangladesh’s Ministry of Health and Family Welfare and Directorate General of Family planning. In addition, I explore connected factors pertaining to maternal mental health using new research from mothers enrolled on the BRISC trial in Bangladesh.

Obtaining timely antenatal care (ANC) is a vital aspect to maternal health. It allows medical professionals to track the progression of a pregnancy and enables any worrying symptoms or stagnation in the growth of a foetus to be picked up early. ANC outlines the assessment of the individual needs of a pregnant woman and covers screening tests and education on self-help during pregnancy.

In Bangladesh, ANC visits in April 2020 were 50% lower than in April 2019 (Ainul et al., 2020). As the country slowly recovers, from July 2020 the ANC figures remained around 25% lower than in July 2019 (Ainul et al., 2020). Dhaka and its surrounding districts such as Rajbari and Chandpur, along with eastern districts in Sylhet division suffered more serious disruptions in ANC services, whilst the greatest disruption of a 71% decline occurred in Sherpur in Northern Bangladesh. Improvements in the first ANC visit have been encouraging, however, disruption to the fourth ANC visit nationwide continued into July (Ainul et al., 2020). Why is the fourth ANC visit so pertinent? As it happens, studies show that implementation of policies geared towards provision of at least four ANC appointments can serve as an effective intervention to link mothers to appropriate skilled birth attendants and health facilities for safe motherhood (Ryan et al., 2019).

Post-natal care (PNC) allows the avoidance of maternal and neonatal death. Examining a mother and child post-partum allows for any excessive blood loss or infection following delivery to be picked up. Any worrying issues in the neonate can be identified, examples including neonatal jaundice, sepsis and congenital malformations that require urgent review. In addition, PNC visits provide a safe space for issues pertaining to post-partum depression and post-partum psychosis to explored. 

Sadly, PNC declined in a similar fashion to ANC visits. PNC visits were 40% lower in April 2020 than in April 2019 (Ainul et al., 2020). Figures for PNC visits are recovering at a steady rate, yet in July they remained lower than the year prior. One third of districts have documented declines in the first PNC visit, as much as 40% even in July (Ainul et al., 2020). This could indicate longer lasting impacts of COVID-19 on initial PNC visits.

Unsurprisingly, institutional delivery, i.e. any delivery that takes place at a medical facility staffed by a skilled delivery assistant, dipped through March and April. There has been slight recovery but figured remained 10% lower in June 2020 than in the previous year (Ainul et al, 2020). In Dhaka at least, there has been rapid recovery following the end of lockdown.

COVID-19 related disruptions stem from the obvious restriction of mobility of patients as well as service providers. During the lockdown, community-based immunisations and family planning programmes were suspended. Essential community health workers services were cancelled due to movement restrictions (Ahmed et al., 2020). City-wide lockdowns involved the closure of public transport, thus impeding the flow of medical supplies. Supplies from China did little to suffice the needs to the population (Chowdhury, 2020). The lack of PPE and safety equipment made it even harder for co-ordination between service providers to continually reassess the situation and be prepared for continual challenges to patient management and referral. These facts help to explain the logistical difficulties in healthcare provision.

The closure of small clinics that would enable low-cost healthcare access to more deprived regions have excluded much of the population from seeking medical attention (Ahmed et al., 2020). Intertwining with this is the fear of infection and stigmatisation. Indeed, the first COVID-19 suicide case was a tragic story of man hanging himself because of the intense prejudice he suffered in his village (Mamun & Griffiths, 2020). The case is a mere glimpse into the psychological stress being endured by such communities (Bhuiyan et al., 2020). It seems the fear of infection is as contagious as the virus itself, as is the rampant spread of misinformation.

The effects on maternal mental health are quickly emerging.  A survey looking at the effects of the immediate stay-at-home lockdown reveal that maternal mental health deteriorated (Hamadani et al., 2020). The median GAD-7 score measured in this survey of 2424 mothers was 3. This is consistent with mild anxiety with the majority saying their anxiety had increased since the onset of lockdown. The same study depicted women experiencing a concerning increase in the prevalence of intimate partner violence, in particular emotional (being insulted, humiliated, intimated and threatened) and physical violence (being pushed, having their hair pulled, kicked, dragged or threatened with a weapon). 

These results reflect a combination of predisposing and precipitating factors. In Bangladesh, 55.0% of women in rural areas and 48·7% in urban areas report having experienced physical or sexual violence from their husbands, with the most common reasons cited by women being unprovoked violence or violence provoked by a financial crisis (Bangladesh Demographic and Health Survey 2007). In contrast, men cited disobedience by their wives as the leading cause. Precipitating factors include the heavy psychosocial stress encompassing losing work, income, occupational identity, and of course loved ones to COVID-19.

So, whilst the macroeconomic cost of stay-at-home orders appear evident in China, Europe, and other middle-income/high-income settings, the same cannot be said for countries like Bangladesh where the situation remains precarious. The declines in critical maternal health care covered here have happened within the context of varying degrees of food insecurity (Islam et al., 2020). In fact, the World Food programme estimates that food insecurity could double worldwide as a direct consequence of the pandemic. In Bangladesh, half the population entered extreme poverty and the lockdown has had deleterious impacts on Bangladeshi women both in terms of mental health and maternal health.

In summary, there is an urgent need for the creation of targeted interventions to rebuild the shaken trust between communities and the health system. The development of standard operating procedures for maternal health continuation for a potential future emergency should include clear instructions regarding family outreach and health worker readiness (Ainul et al., 2020). Alongside dedicated research involving pregnant mothers to acquire accurate outlines of both supply and demand factors in maternal health services during COVID-19, there is a need to emphasise pregnant women’s fears and anxieties about visiting faculties.

The use of telemedicine is a possible route to grappling with the mental health crisis, but is of course, limited to the technological capabilities across the region. A national hotline or radio broadcast addressing mental and maternal health could serve as ways of improving effective communication amongst women in Bangladesh. In the face of COVID-19, fortifying the existing relations within the healthcare system could also aid in mitigating the effects of pandemic.

References:

  1. Ahmed SAKS, Ajisola M, Azeem K, et al. Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results of preCOVID and COVID-19 lockdown stakeholder engagements. BMJ Global Health 2020;5:e003042. doi:10.1136/ bmjgh-2020-003042
  2. AKMI Bhuiyan, N Sakib, AH Pakpour, MD Griffiths, MA Mamun
  3. Chowdhury SI. China to Give Bangladesh Testing Kits, Protective Gears. (2020). Available online at: https://www.newagebd.net/article/102576/china-to-give-bangladesh-testing-kits-protective-gears
  4. COVID-19-related suicides in Bangladesh due to lockdown and economic factors: case study evidence from media reports
  5. Hamadani, J.D., Hasan, M.I., Baldi, A.J., Hossain, S.J., Shiraji, S., Bhuiyan, M.S.A., Mehrin, S.F., Fisher, J., Tofail, F., Tipu, S.M.M.U., Grantham-McGregor, S., Biggs, B.-A., Braat, S., Pasricha, S.-R., 2020. Immediate impact of stay-at-home orders to control COVID-19 transmission on socioeconomic conditions, food insecurity, mental health, and intimate partner violence in Bangladeshi women and their families: an interrupted time series. The Lancet Global Health 8, e1380–e1389. https://doi.org/10.1016/s2214-109x(20)30366-1
  6. Int J Ment Health Addict (2020) published online May 15.
  7. Islam, S.M.D.-U., Bodrud-Doza, Md., Khan, R.M., Haque, Md.A., Mamun, M.A., 2020. Exploring COVID-19 stress and its factors in Bangladesh: A perception-based study. Heliyon 6, e04399. https://doi.org/10.1016/j.heliyon.2020.e04399
  8. Mamun, M.A., Griffiths, M.D., 2020. First COVID-19 suicide case in Bangladesh due to fear of COVID-19 and xenophobia: Possible suicide prevention strategies. Asian Journal of Psychiatry 51, 102073. https://doi.org/10.1016/j.ajp.2020.102073
  9. National Institute of Population Research and Training (NIPORT) MaA, and Macro International: Bangladesh Demographic and Health Survey 2007 National Institute of Population Research and Training, Mitra and Associates, and Macro International, Dhaka, Bangladesh and Calverton, Maryland, USA (2009)
  10. Ryan, B.L., Krishnan, R.J., Terry, A. et al.Do four or more antenatal care visits increase skilled birth attendant use and institutional delivery in Bangladesh? A propensity-score matched analysis. BMC Public Health 19, 583 (2019). https://doi.org/10.1186/s12889-019-6945-4
  11. Sigma Ainul, Md. Saddam Hossain, Md. Irfan Hossain, Md. Kamruzzaman Bhuiyan, Sharif M. I. Hossain, Ubaidur Rob, Ashish Bajracharya. Trends in Maternal Health Services in Bangladesh Before, During and After COVID-19 Lockdowns: Evidence from National Routine Service Data. Research Brief. Dhaka: Population Council. September 2020.
  12. World Food Programme, COVID-19 – Potential Impact on the World’s Poorest People, April 2020: https://www.wfp.org/publications/covid-19-potential-impact-worlds-poorest-people

Immediate stay at home orders to control COVID: the impact on Bangladeshi Mothers.

By Sabeera Dar

Bangladesh has suffered in numerous ways at the hands of the notorious and on-going COVID-19 pandemic. From the first week of March, the country sought to ban all mass gatherings, including a notable 100th-anniversary celebration event of the birth of the founder of Bangladesh, Sheikh Mujibur Rahman. In addition, a national lockdown was enacted, hoping to contain community transmission between March 26th to April 4th which went on to be extended to May 30th.

Despite such measures, the ripples streaming through Bangladeshi society have been complex and unprecedented. The pandemic has exposed the insufficiency of a fragmented healthcare system, reaching widely into one of the world’s most densely populated countries. Though this exposure has happened in concert with other more developed countries such as Italy, the UK and the USA who are suffering a similar unrelenting challenge, the complications in Bangladesh appear starker, especially given the pre-existing healthcare divide emanating from urban and rural disparities.

Importantly, critical maternal health services have been stretched thin. This short blog touches upon trends in maternal health during COVID-19 lockdowns, using data gathered from Bangladesh’s Ministry of Health and Family Welfare and Directorate General of Family planning. In addition, I explore connected factors pertaining to maternal mental health using new research from mothers enrolled on the BRISC trial in Bangladesh.

Obtaining timely antenatal care (ANC) is a vital aspect to maternal health. It allows medical professionals to track the progression of a pregnancy and enables any worrying symptoms or stagnation in the growth of a foetus to be picked up early. ANC outlines the assessment of the individual needs of a pregnant woman and covers screening tests and education on self-help during pregnancy.

In Bangladesh, ANC visits in April 2020 were 50% lower than in April 2019 (Ainul et al., 2020). As the country slowly recovers, from July 2020 the ANC figures remained around 25% lower than in July 2019 (Ainul et al., 2020). Dhaka and its surrounding districts such as Rajbari and Chandpur, along with eastern districts in Sylhet division suffered more serious disruptions in ANC services, whilst the greatest disruption of a 71% decline occurred in Sherpur in Northern Bangladesh. Improvements in the first ANC visit have been encouraging, however, disruption to the fourth ANC visit nationwide continued into July (Ainul et al., 2020). Why is the fourth ANC visit so pertinent? As it happens, studies show that implementation of policies geared towards provision of at least four ANC appointments can serve as an effective intervention to link mothers to appropriate skilled birth attendants and health facilities for safe motherhood (Ryan et al., 2019).

Post-natal care (PNC) allows the avoidance of maternal and neonatal death. Examining a mother and child post-partum allows for any excessive blood loss or infection following delivery to be picked up. Any worrying issues in the neonate can be identified, examples including neonatal jaundice, sepsis and congenital malformations that require urgent review. In addition, PNC visits provide a safe space for issues pertaining to post-partum depression and post-partum psychosis to explored. 

Sadly, PNC declined in a similar fashion to ANC visits. PNC visits were 40% lower in April 2020 than in April 2019 (Ainul et al., 2020). Figures for PNC visits are recovering at a steady rate, yet in July they remained lower than the year prior. One third of districts have documented declines in the first PNC visit, as much as 40% even in July (Ainul et al., 2020). This could indicate longer lasting impacts of COVID-19 on initial PNC visits.

Unsurprisingly, institutional delivery, i.e. any delivery that takes place at a medical facility staffed by a skilled delivery assistant, dipped through March and April. There has been slight recovery but figured remained 10% lower in June 2020 than in the previous year (Ainul et al, 2020). In Dhaka at least, there has been rapid recovery following the end of lockdown.

COVID-19 related disruptions stem from the obvious restriction of mobility of patients as well as service providers. During the lockdown, community-based immunisations and family planning programmes were suspended. Essential community health workers services were cancelled due to movement restrictions (Ahmed et al., 2020). City-wide lockdowns involved the closure of public transport, thus impeding the flow of medical supplies. Supplies from China did little to suffice the needs to the population (Chowdhury, 2020). The lack of PPE and safety equipment made it even harder for co-ordination between service providers to continually reassess the situation and be prepared for continual challenges to patient management and referral. These facts help to explain the logistical difficulties in healthcare provision.

The closure of small clinics that would enable low-cost healthcare access to more deprived regions have excluded much of the population from seeking medical attention (Ahmed et al., 2020). Intertwining with this is the fear of infection and stigmatisation. Indeed, the first COVID-19 suicide case was a tragic story of man hanging himself because of the intense prejudice he suffered in his village (Mamun & Griffiths, 2020). The case is a mere glimpse into the psychological stress being endured by such communities (Bhuiyan et al., 2020). It seems the fear of infection is as contagious as the virus itself, as is the rampant spread of misinformation.

The effects on maternal mental health are quickly emerging.  A survey looking at the effects of the immediate stay-at-home lockdown reveal that maternal mental health deteriorated (Hamadani et al., 2020). The median GAD-7 score measured in this survey of 2424 mothers was 3. This is consistent with mild anxiety with the majority saying their anxiety had increased since the onset of lockdown. The same study depicted women experiencing a concerning increase in the prevalence of intimate partner violence, in particular emotional (being insulted, humiliated, intimated and threatened) and physical violence (being pushed, having their hair pulled, kicked, dragged or threatened with a weapon). 

These results reflect a combination of predisposing and precipitating factors. In Bangladesh, 55.0% of women in rural areas and 48·7% in urban areas report having experienced physical or sexual violence from their husbands, with the most common reasons cited by women being unprovoked violence or violence provoked by a financial crisis (Bangladesh Demographic and Health Survey 2007). In contrast, men cited disobedience by their wives as the leading cause. Precipitating factors include the heavy psychosocial stress encompassing losing work, income, occupational identity, and of course loved ones to COVID-19.

So, whilst the macroeconomic cost of stay-at-home orders appear evident in China, Europe, and other middle-income/high-income settings, the same cannot be said for countries like Bangladesh where the situation remains precarious. The declines in critical maternal health care covered here have happened within the context of varying degrees of food insecurity (Islam et al., 2020). In fact, the World Food programme estimates that food insecurity could double worldwide as a direct consequence of the pandemic. In Bangladesh, half the population entered extreme poverty and the lockdown has had deleterious impacts on Bangladeshi women both in terms of mental health and maternal health.

In summary, there is an urgent need for the creation of targeted interventions to rebuild the shaken trust between communities and the health system. The development of standard operating procedures for maternal health continuation for a potential future emergency should include clear instructions regarding family outreach and health worker readiness (Ainul et al., 2020). Alongside dedicated research involving pregnant mothers to acquire accurate outlines of both supply and demand factors in maternal health services during COVID-19, there is a need to emphasise pregnant women’s fears and anxieties about visiting faculties.

The use of telemedicine is a possible route to grappling with the mental health crisis, but is of course, limited to the technological capabilities across the region. A national hotline or radio broadcast addressing mental and maternal health could serve as ways of improving effective communication amongst women in Bangladesh. In the face of COVID-19, fortifying the existing relations within the healthcare system could also aid in mitigating the effects of pandemic.

References:

  1. Ahmed SAKS, Ajisola M, Azeem K, et al. Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results of preCOVID and COVID-19 lockdown stakeholder engagements. BMJ Global Health 2020;5:e003042. doi:10.1136/ bmjgh-2020-003042
  2. AKMI Bhuiyan, N Sakib, AH Pakpour, MD Griffiths, MA Mamun
  3. Chowdhury SI. China to Give Bangladesh Testing Kits, Protective Gears. (2020). Available online at: https://www.newagebd.net/article/102576/china-to-give-bangladesh-testing-kits-protective-gears
  4. COVID-19-related suicides in Bangladesh due to lockdown and economic factors: case study evidence from media reports
  5. Hamadani, J.D., Hasan, M.I., Baldi, A.J., Hossain, S.J., Shiraji, S., Bhuiyan, M.S.A., Mehrin, S.F., Fisher, J., Tofail, F., Tipu, S.M.M.U., Grantham-McGregor, S., Biggs, B.-A., Braat, S., Pasricha, S.-R., 2020. Immediate impact of stay-at-home orders to control COVID-19 transmission on socioeconomic conditions, food insecurity, mental health, and intimate partner violence in Bangladeshi women and their families: an interrupted time series. The Lancet Global Health 8, e1380–e1389. https://doi.org/10.1016/s2214-109x(20)30366-1
  6. Int J Ment Health Addict (2020) published online May 15.
  7. Islam, S.M.D.-U., Bodrud-Doza, Md., Khan, R.M., Haque, Md.A., Mamun, M.A., 2020. Exploring COVID-19 stress and its factors in Bangladesh: A perception-based study. Heliyon 6, e04399. https://doi.org/10.1016/j.heliyon.2020.e04399
  8. Mamun, M.A., Griffiths, M.D., 2020. First COVID-19 suicide case in Bangladesh due to fear of COVID-19 and xenophobia: Possible suicide prevention strategies. Asian Journal of Psychiatry 51, 102073. https://doi.org/10.1016/j.ajp.2020.102073
  9. National Institute of Population Research and Training (NIPORT) MaA, and Macro International: Bangladesh Demographic and Health Survey 2007 National Institute of Population Research and Training, Mitra and Associates, and Macro International, Dhaka, Bangladesh and Calverton, Maryland, USA (2009)
  10. Ryan, B.L., Krishnan, R.J., Terry, A. et al.Do four or more antenatal care visits increase skilled birth attendant use and institutional delivery in Bangladesh? A propensity-score matched analysis. BMC Public Health 19, 583 (2019). https://doi.org/10.1186/s12889-019-6945-4
  11. Sigma Ainul, Md. Saddam Hossain, Md. Irfan Hossain, Md. Kamruzzaman Bhuiyan, Sharif M. I. Hossain, Ubaidur Rob, Ashish Bajracharya. Trends in Maternal Health Services in Bangladesh Before, During and After COVID-19 Lockdowns: Evidence from National Routine Service Data. Research Brief. Dhaka: Population Council. September 2020.
  12. World Food Programme, COVID-19 – Potential Impact on the World’s Poorest People, April 2020: https://www.wfp.org/publications/covid-19-potential-impact-worlds-poorest-people

Recent Posts

MAA x Scrubbed Up OSCE Workshop

SATURDAY 6TH MARCH 10AM-1.30PM

We’ll be covering 5 of the most common stations that come up in OSCEs for pre clinical years!

– Examinations
– History taking/Communication
– Data interpretation
– Anatomy
– Explanations

Blog

How ‘global’ is breastfeeding?

Breastfeeding is thought to be a universal concept. However, we find that in actuality, breastfeeding rates differ significantly globally. To explore why, we must look at the finer nuances behind why some women breastfeed, and why others do not.

The post Immediate stay at home orders to control COVID: the impact on Bangladeshi Mothers. appeared first on Maa.

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JourneyMaa 2019 Report https://maacharity.org/journeymaa-2019-report-2 https://maacharity.org/journeymaa-2019-report-2#respond Sun, 27 Dec 2020 16:00:00 +0000 https://maacharity.org/?p=8360 The JourneyMaa 2019 report explores how our maternal health education seminars are working towards making an impact to pregnant women in rural Bangladesh by addressing key maternal health topics such as nutrition, breastfeeding and the importance of the recognition of red flags symptoms.

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How ‘global’ is breastfeeding? https://maacharity.org/how-global-is-breastfeeding https://maacharity.org/how-global-is-breastfeeding#comments Thu, 03 Dec 2020 04:09:31 +0000 https://maacharity.org/?p=8164 Breastfeeding is thought to be a universal concept. However, we find that in actuality, breastfeeding rates differ significantly globally. To explore why, we must look at the finer nuances behind why some women breastfeed, and why others do not.

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]]>

How ‘global’ is breastfeeding?

By Tasneem Ahmed | MAA Academics Officer | 4th Year Medical Student, KCL

How ‘global’ is breastfeeding?

How ‘global’ is breastfeeding?

By Tasneem Ahmed

Breastfeeding is thought to be a universal concept. Most mothers, regardless of their nationality or ethnicity, are able to produce breastmilk for their newborn babies with biology superseding all. However, we find that in actuality, breastfeeding rates differ significantly globally. To explore why, we must look at the finer nuancesbehind why some women breastfeed, and why others do not.

Breastfeeding has gained much attention in the medical field over the last two decades, with increased research investigating its numerous health benefits, including paediatric cognitive and immunological development. Studies have found that babies who are breastfed are also less prone to infections, diarrhoea,
obesity and cardiovascular diseases later in life (NHS, 2018). Babies who are weaned off breast milk prematurely are more likely to suffer from illnesses such as gastrointestinal infections, lower respiratory infections, as well as Sudden Infant Death Syndrome (Anstey et al., 2016). The protective health benefits to mothers are also manifold, including decreased risk in chronic conditions such as diabetes, hypertension, osteoporosis and ovarian and breast cancer (NHS, 2018).

‘Exclusive breastfeeding’ refers to mothers solely feeding their babies with breast milk. The introduction of formula milk or any other nutritional substance impacts the benefits that come from exclusively breastfeeding, particularly in the first 6 months of a baby’s life. This is reflected in the global guidelines set by the World Health Organisation (WHO & Unicef, 2009) which encourage exclusive breastfeeding for the first six months of life, thereafter supplementing breastfeeding with other nutritional sources up until two years of age. Despite the many benefits of breastfeeding for baby and mother, the UK has amongst the lowest breastfeeding rates in the world with 1% of mothers exclusively breastfeeding at 6 months (Fox et al., 2015). Comparatively, 25.4% of women in the US exclusively breastfeed at 6 months (CDC, 2019). Considering medical advancements in the west, it’s hard to believe something so crucial is going amiss.

In Bangladesh, breastfeeding is more common with 35.9% of mothers exclusively breastfeeding their child for the first six months (Hossain et al., 2018). One reason as to why this may be, is that breastmilk is free, naturally renewable and more accessible than formula milk. This is significant in the context of the population where one in five people live below the poverty line (Chaudry, 2020).

It is important to also consider the various social factors that can hinder or encourage women to breastfeed. Examples include a normalised culture to formula feeding, a lack of education on breastfeeding practices, mothers needing to return back to work or the negative social attitude towards breastfeeding which can make women feel embarrassed to breastfeed in public. Another big issue is the formula milk industry and their influence through lobbying their products. Large corporations such as Nestle aggressively target families and healthcare professionals to encourage formula milk, which is problematic for many reasons. Specific to Bangladesh, many babies are brought to hospital with diarrhoea which can be fatal because of reduced access to clean water. In general, it is illegal for formula companies to promote formula over breastmilk. Despite this, many doctors in Bangladesh have reported companies such as Nestle, approaching them with gifts and seeking for them to encourage formula feeding in new mothers (Moorhead, 2007).

Other barriers posed to breastfeeding, is how difficult breastfeeding can be practically. Mothers can suffer from cracked nipples or struggle to comfortably position their baby to latch onto their breast. In the UK and many other western countries, breastfeeding support is available, but these services are arguably often limited in reaching a sufficient number of new mothers. For example, younger mothers tend to be early in their careers, and may feel more pressure to go back to work sooner, making the exclusive breastfeeding period more difficult to achieve. However, it is worth noting that there has been a societal shift, that we can only hope will continue to grow where work places have made more of an effort to facilitate breastfeeding practises for their employees. Many companies have set aside quiet rooms where mothers can breastfeed in private. Cost-benefit analysis shows that companies will actually save money in the long run by not having to replace employees who often leave workplaces that are not accommodating to their new family dynamics.

To conclude, whilst many women around the world may be able to breastfeed, the reasoning behind whether they choose to breastfeed or not, can be complex. This results in many variations in the rates of breastfeeding worldwide. This is important to acknowledge and appreciate when we explore how breastfeeding rates differ in different contexts.

References:

  1. Anstey, E., MacGowan, C. and Allen, J., 2016. Five-Year Progress Update on the Surgeon General’s Call to Action to Support Breastfeeding, 2011. Journal of Women’s Health, 25(8), pp.768-776.
  2. CDC. 2019., Breastfeeding Among U.S. Children Born 2009–2016, CDC National Immunization Survey.
  3. Chaudry, T. (, 2020). Bangladesh: One in five people live below poverty line. Al-Jazeerah, [Online]. [Accessed 19 September 2020]. Available at: https://www.aljazeera.com/news/2020/01/bangladesh-people-live-poverty-line-200126100532869.html
  4. Fox, R., McMullen, S. and Newburn, M., 2015. UK women’s experiences of breastfeeding and additional breastfeeding support: a qualitative study of Baby Café services. BMC Pregnancy and Childbirth, 15(1).
  5. Haider, R., Kabir, I. and Ashworth, A., 1999. News from the region. Are breastfeeding promotion messages influencing mothers in Bangladesh? Results from an urban survey in Dhaka, Bangladesh. Journal of tropical pediatrics, 45(5), pp.315-318.
  6. Hossain, M., Islam, A., Kamarul, T. and Hossain, G., 2018. Exclusive breastfeeding practice during first six months of an infant’s life in Bangladesh: a country based cross-sectional study. BMC Pediatrics, 18(1), p.93.
  7. Moorhead, J., 2007. Milking It. [Online] The Guardian. Available at:
    <https://www.theguardian.com/business/2007/may/15/medicineandhealth.lifeandhealth>[Accessed 29 October 2020]. Available at: https://www.theguardian.com/business/2007/may/15/medicineandhealth.lifeandhealth
  8. NHS.UK. (2018). Benefits of breastfeeding. [Online]. Available at:
    https://www.nhs.uk/conditions/pregnancy-and-baby/benefits-breastfeeding/World Health Organization & Unicef. 2009. Baby-friendly hospital initiative: revised, updated and expanded for integrated care.

How ‘global’ is breastfeeding?

By Tasneem Ahmed

Breastfeeding is thought to be a universal concept. Most mothers, regardless of their nationality or ethnicity, are able to produce breastmilk for their newborn babies with biology superseding all. However, we find that in actuality, breastfeeding rates differ significantly globally. To explore why, we must look at the finer nuancesbehind why some women breastfeed, and why others do not.

Breastfeeding has gained much attention in the medical field over the last two decades, with increased research investigating its numerous health benefits, including paediatric cognitive and immunological development. Studies have found that babies who are breastfed are also less prone to infections, diarrhoea,
obesity and cardiovascular diseases later in life (NHS, 2018). Babies who are weaned off breast milk prematurely are more likely to suffer from illnesses such as gastrointestinal infections, lower respiratory infections, as well as Sudden Infant Death Syndrome (Anstey et al., 2016). The protective health benefits to mothers are also manifold, including decreased risk in chronic conditions such as diabetes, hypertension, osteoporosis and ovarian and breast cancer (NHS, 2018).

‘Exclusive breastfeeding’ refers to mothers solely feeding their babies with breast milk. The introduction of formula milk or any other nutritional substance impacts the benefits that come from exclusively breastfeeding, particularly in the first 6 months of a baby’s life. This is reflected in the global guidelines set by the World Health Organisation (WHO & Unicef, 2009) which encourage exclusive breastfeeding for the first six months of life, thereafter supplementing breastfeeding with other nutritional sources up until two years of age. Despite the many benefits of breastfeeding for baby and mother, the UK has amongst the lowest breastfeeding rates in the world with 1% of mothers exclusively breastfeeding at 6 months (Fox et al., 2015). Comparatively, 25.4% of women in the US exclusively breastfeed at 6 months (CDC, 2019). Considering medical advancements in the west, it’s hard to believe something so crucial is going amiss.

In Bangladesh, breastfeeding is more common with 35.9% of mothers exclusively breastfeeding their child for the first six months (Hossain et al., 2018). One reason as to why this may be, is that breastmilk is free, naturally renewable and more accessible than formula milk. This is significant in the context of the population where one in five people live below the poverty line (Chaudry, 2020).

It is important to also consider the various social factors that can hinder or encourage women to breastfeed. Examples include a normalised culture to formula feeding, a lack of education on breastfeeding practices, mothers needing to return back to work or the negative social attitude towards breastfeeding which can make women feel embarrassed to breastfeed in public. Another big issue is the formula milk industry and their influence through lobbying their products. Large corporations such as Nestle aggressively target families and healthcare professionals to encourage formula milk, which is problematic for many reasons. Specific to Bangladesh, many babies are brought to hospital with diarrhoea which can be fatal because of reduced access to clean water. In general, it is illegal for formula companies to promote formula over breastmilk. Despite this, many doctors in Bangladesh have reported companies such as Nestle, approaching them with gifts and seeking for them to encourage formula feeding in new mothers (Moorhead, 2007).

Other barriers posed to breastfeeding, is how difficult breastfeeding can be practically. Mothers can suffer from cracked nipples or struggle to comfortably position their baby to latch onto their breast. In the UK and many other western countries, breastfeeding support is available, but these services are arguably often limited in reaching a sufficient number of new mothers. For example, younger mothers tend to be early in their careers, and may feel more pressure to go back to work sooner, making the exclusive breastfeeding period more difficult to achieve. However, it is worth noting that there has been a societal shift, that we can only hope will continue to grow where work places have made more of an effort to facilitate breastfeeding practises for their employees. Many companies have set aside quiet rooms where mothers can breastfeed in private. Cost-benefit analysis shows that companies will actually save money in the long run by not having to replace employees who often leave workplaces that are not accommodating to their new family dynamics.

To conclude, whilst many women around the world may be able to breastfeed, the reasoning behind whether they choose to breastfeed or not, can be complex. This results in many variations in the rates of breastfeeding worldwide. This is important to acknowledge and appreciate when we explore how breastfeeding rates differ in different contexts.

References:

  1. Anstey, E., MacGowan, C. and Allen, J., 2016. Five-Year Progress Update on the Surgeon General’s Call to Action to Support Breastfeeding, 2011. Journal of Women’s Health, 25(8), pp.768-776.
  2. CDC. 2019., Breastfeeding Among U.S. Children Born 2009–2016, CDC National Immunization Survey.
  3. Chaudry, T. (, 2020). Bangladesh: One in five people live below poverty line. Al-Jazeerah, [Online]. [Accessed 19 September 2020]. Available at: https://www.aljazeera.com/news/2020/01/bangladesh-people-live-poverty-line-200126100532869.html
  4. Fox, R., McMullen, S. and Newburn, M., 2015. UK women’s experiences of breastfeeding and additional breastfeeding support: a qualitative study of Baby Café services. BMC Pregnancy and Childbirth, 15(1).
  5. Haider, R., Kabir, I. and Ashworth, A., 1999. News from the region. Are breastfeeding promotion messages influencing mothers in Bangladesh? Results from an urban survey in Dhaka, Bangladesh. Journal of tropical pediatrics, 45(5), pp.315-318.
  6. Hossain, M., Islam, A., Kamarul, T. and Hossain, G., 2018. Exclusive breastfeeding practice during first six months of an infant’s life in Bangladesh: a country based cross-sectional study. BMC Pediatrics, 18(1), p.93.
  7. Moorhead, J., 2007. Milking It. [Online] The Guardian. Available at:
    <https://www.theguardian.com/business/2007/may/15/medicineandhealth.lifeandhealth> [Accessed 29 October 2020]. Available at: https://www.theguardian.com/business/2007/may/15/medicineandhealth.lifeandhealth
  8. NHS.UK. (2018). Benefits of breastfeeding. [Online]. Available at:
    https://www.nhs.uk/conditions/pregnancy-and-baby/benefits-breastfeeding/World Health Organization & Unicef. 2009. Baby-friendly hospital initiative: revised, updated and expanded for integrated care.

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