A Nightmare for Mothers: Breastfeeding in the COVID-19 Pandemic

Author: Awurabena Quayeba Dadzie (WV Ghana’s Health and Nutrition Technical Manager)

Before the COVID-19 pandemic, Ghana had made significant progress in breastfeeding practices. The country had implemented successful programmes that led to an increase in the adoption and practice of breastfeeding among lactating mothers across the country.

Almost all children (98%) were breastfed at some point in their lives, according to the Ghana Demographic Health Survey (DHS) Report 2014. Among them, 52% of less than six months were exclusively breastfed, and the median duration of exclusive breastfeeding recorded at the time was about four months. The report indicated that micronutrient malnutrition was highly prevalent and persistent. 66 percent of children aged 6-59 months were anaemic, 27 percent were mildly anaemic, 37 %, moderately anaemic, and about 2 % were severely anaemic.

However, the COVID-19 pandemic has put breastfeeding progress at risk and may worsen the prevalence of micronutrient malnutrition, which was already high. The pandemic affected not only the health system but also breastfeeding practises and women's access to breastfeeding support services. This created a breastfeeding gap that needs to be filled. For example, mothers who were suspected or confirmed to have contracted COVID-19 avoided or stopped breastfeeding their babies to avoid infecting them with the virus.

During the COVID-19 period, a decrease in the number of mothers breastfeeding their babies and a rise in the number of mothers using baby formula foods were highly expected. COVID-19 affected breastfeeding and appropriate supplementary feeding practises and denied babies sufficient intake of micro and macronutrients essential for growth and development.

Breast milk prevents repeated episodes of infection in children and helps with brain development and growth. Breast milk also protects babies from morbidity and mortality throughout infancy and childhood. It is highly encouraged to initiate breastfeeding at birth because of its importance to both the mother and the child.

The World Health Organisation (WHO) recommends that children be fed with colostrum immediately after birth (within one hour) and that they continue to be breastfed exclusively, even if regular breast milk has not yet started to flow properly.  Access to breastfeeding services at birth is essential to stimulate breast milk production. Early suckling stimulates the release of prolactin, a hormone that helps with milk production, and oxytocin, which is responsible for the ejection of milk. It also stimulates the contraction of the uterus after birth and reduces postpartum blood loss. The first milk, called colostrum, is produced in the first few days after delivery. It is highly nutritious and contains antibodies that provide natural immunity to the infant.

However, some lactating mothers who tested positive for COVID-19 had challenges maintaining exclusive breastfeeding for children under six months or continuing breastfeeding for infants. This created a breastfeeding gap. World Vision Ghana addressed this gap by implementing the Improved Feeding Practices (IFP) for the First 1000 Days project. The project introduced multiple approaches to promote exclusive breastfeeding and complementary feeding practises in 70 rural communities in Kintampo South, Sekyere East, and Kassena Nankana West districts in Ghana, where malnutrition, stunting, and anaemia cases were prevalent. The project also involved men as key partners in nutrition and child healthcare, supporting farmers to grow nutritious fruit crops and vegetables such as orange-fleshed sweet potatoes and poultry rearing to increase the consumption of fresh eggs.

World Vision Ghana worked closely with the Ghana Health Services, Department of Agriculture, Social Welfare, and community structures to sustain the project initiatives throughout their lifespan. Aside from this, the project also built the capacity of mother-to-mother support groups, male champions (men promoting child health, nutrition, and breastfeeding) to continue child healthcare, nutrition, and breastfeeding campaigns, and village entrepreneurs for the sale and distribution of food supplements such as Koko Plus.

Aside from encouraging mothers confirmed with COVID-19 or suspected of COVID-19 infection to continually breastfeed babies, they were also trained to practise respiratory hygiene during feeding and to use a medical mask, as well as regularly wash hands with soap under running water, apply hand sanitizer, routinely clean surfaces, and observe hygiene protocols.

As a result of this, 85% of mothers in the project communities have adopted and practiced exclusive breastfeeding. Also, 3,960 mothers who received training in the importance and effectiveness of breast milk, breastfeeding, and child healthcare and nutrition practices have begun to provide support to new mothers.

The project has so far reached 11,000 people directly with child health and nutrition messages. This resulted in improved and increased child healthcare, nutrition knowledge, exclusive breastfeeding, and supplementary feeding practice in 4,800 households in 70 communities in three districts of Ghana. This project was funded by the Japan Social Development Fund through the World Bank, with additional support from World Vision Japan.