Selma Roth

Saudi Gazette

 

JEDDAH – Breastfeeding is essential. The World Health Organization (WHO) and UNICEF recommend that all infants up to 6 months are exclusively breastfed until they reach two years of age or beyond while simultaneously introducing (solid) foods and to initiate breastfeeding within one hour of birth.



The reality is somewhat different. Worldwide, only about 38 percent of infants 0 to 6 months old are exclusively breastfed. In Saudi Arabia, the picture is even gloomier: Exclusive breastfeeding is almost nonexistent and only in 23.2 percent of cases is breastfeeding initiated within one hour of birth.



Dr. Modia Batterjee, who holds a doctorate degree in health administration and is an International Board Certified Lactation Consultant, is trying to change the current situation. In 2010, she wrote the book “A Fading Art: Understanding Breastfeeding in the Middle East” and in 2005, she opened Al-Bidayah Center, the first and only breastfeeding resource and women’s awareness center in Saudi Arabia, located in Jeddah. The problem, Batterjee said, “is not that there is no awareness. There is awareness and it is in our Qur’an and nobody would tell you breastfeeding is not the best thing to do, but when you come to the actual practices, there is no support. Breastfeeding is promoted but not supported.”



One may wonder why it needs to be supported. Isn’t breastfeeding a natural thing to do that needs no explanation? Not according to the experts: Breastfeeding has to be learned and many women encounter difficulties in the beginning, writes the WHO on its website. Nipple pain and fear that there is not enough milk to sustain the baby are common, as are dry or cracked nipples.



So what goes wrong in the Kingdom? “The medical staff and the practices at the hospital and the family don’t allow early initiation or continuation, which are two major factors for continuation of breast feeding,” explained Batterjee. This happens indirectly, according to her. “The pediatrician in the hospital responsible for newborns will say, ‘Oh, it’s great you’re breastfeeding, BUT the baby has hypoglycemia, BUT the baby is not gaining weight, so breastfeed, but we have to give a bottle’.” They don’t tell new mothers not to breastfeed, but they always find reasons the baby needs to be supplemented with artificial formula, even when the symptoms are normal, as are hypoglycemia and losing some weight within the first few days after birth.



The real issue, Batterjee suspects, is not a lack of knowledge. “We have two things that are happening. First of all, the community has a lack of knowledge in the art of breastfeeding, not in the importance.” This is why Batterjee called her book “A Fading Art”, in which she teaches the basics of breastfeeding: early initiation, how to latch on the baby correctly, how to allow the baby to have a deep suckle, when to feed from the right and when from the left, etc. “This is where we’re lacking. You have to know how to do it and you have to learn it from another woman with experience.”



The second issue is the power of pharmaceutical companies over both private and public doctors. Their grip on the Ministry of Health is so firm here that all babies receive a bottle of infant formula before being discharged from the hospital – an agreement between the ministry and the pharmaceutical sector. The formula not only confuses babies and exposes them to bacteria, the skipped feed also messes up the mother’s body.



Getting rid of our reliance on artificial formulas and focusing on exclusive breastfeeding, Batterjee believes, will lead to decreases in complications and infections as well as NICU (Neonatal Intensive Care Unit) expenses, not to speak of the other health benefits for the baby and the mother. “This should be a health topic of the government,” she argued.

 

“This center (Al-Bidayah Center) should not exist as a private center.



This should be a government project.” However, despite 10 years of trying, Batterjee and her parents have not succeeded in getting a Ministry of Health certification to open. The only legal way to exist was under the Jeddah Municipality and the Jeddah Chamber of Commerce and Industry.



Besides the numerous health benefits to newborns and mothers, are there actually any disadvantages to breastfeeding? Or are there cases where breastfeeding is not recommended? Batterjee argues there aren’t, although there may always be exceptions, but those should be studied case by case. In fact, the WHO advises even HIV-infected mothers to breastfeed while receiving antiretroviral (ARV) drugs, which reduces the risk of transmission.



The mother also does not need to – and should not – restrict her diet while breastfeeding, because the foods she eats do not affect the child. Eating healthy and enough, nevertheless, is important as the infant does receive some of the nutrients. And even though the intake of nicotine or caffeine can affect the infant, Batterjee said it is still preferred to giving instant formula.



“As a professional, I would prefer not to expose the baby to formula, and expose them to their mom’s milk with all of the junk in it,” she said while adding that she advises pregnant and lactating moms to limit their caffeine intake but not necessarily abstain from it. Nicotine is another story, because it lowers the quality of breast milk, particularly vitamin C levels.



The doctor advises pregnant women to come to her center or to read books, websites, or blogs, as long as the information comes from an authoritative source, like La Leche League International, the World Alliance for Breastfeeding Action (WABA), or the International Lactation Consultant Association (ILCA).



Working moms have no excuse!



In Dr. Modi Batterjee’s opinion, every mom should breastfeed her child, even when she has a fulltime job. “I think being a mom in general and working, whether you are breastfeeding or not, is challenging. How to balance your time and when to get back to work and leave the baby alone for long periods are things young mothers need to think about.” There are many things that can help: pumping, storing, or freezing (the milk), or taking a baby to a nursery, are some examples.



International code to regulate breast-milk substitutes



The WHO website states that an international code to regulate the marketing of breast-milk substitutes was adopted in 1981. It calls for:

 

• All formula labels and information to state the benefits of breastfeeding and the health risks of substitutes;


• No promotion of breast-milk substitutes;


• No free samples of substitutes to be given to pregnant women, mothers or their families; and


• No distribution of free or subsidized substitutes to health workers or facilities.
  
  

Unfortunately, the code is not strictly implemented in Saudi Arabia



Breast milk and breastfeeding facts

• Breast milk is more easily digested than infant formula;


• Breast milk contains a perfect mix of vitamins, protein, and fat as well as antibodies that help your baby fight off viruses and bacteria;


• Breastfeeding reduces your baby’s risk of having asthma or allergies;


• Babies who are breastfed exclusively for the first six months have fewer ear infections, respiratory illnesses and bouts of diarrhea. They also have fewer hospitalizations and trips to the doctor;


• In some studies, breastfeeding has been linked to higher IQ scores in later childhood;


• Breastfed infants are more likely to gain the right amount of weight as they grow rather than become overweight children;


• Breastfeeding has been thought to lower the risk of diabetes, obesity, and certain cancers as well but more research is needed to confirm these findings;


• Breastfeeding burns extra calories so it can help you lose pregnancy weight faster;


• Breastfeeding lowers the mother’s risk of breast and ovarian cancer. It may also lower a woman’s risk of osteoporosis;


• Since you don’t have to buy and measure formula, sterilize nipples, or warm bottles, breastfeeding saves you time and money.