Afghanistan Holds National Consensus Workshop to Improve Infant and Young Child Feeding
April 7—With shame and sadness in her eyes, 14 year-old Shugufa cradles her sick baby boy. Now expecting a second child (it still barely shows), Shugufa was advised by her mother-in-law that the new pregnancy would make her breast milk "haram" (dirty). With this myth in mind, the young mother decided to wean her first-born at the age of 6 months by putting a swatch of black sheep's wool on her breast to scare him off. It worked— the baby won't touch his mother's breast and her milk has run dry. But, he becomes ill much more frequently and is gaining little weight. Shugufa doesn't know what to do.
Shugufa's story is all too common in Afghanistan, where 6 to 15 percent of children under 5 years of age suffer acute malnutrition (wasting), and more than 50 percent are chronically malnourished (stunting). Malnutrition is directly or indirectly responsible for around 50 percent of child deaths in the country, whose infant mortality rate is a staggering 129 deaths per 1000 live births and whose under 5 years of age child mortality rate is 191 per 1000 live births.
Much of this malnutrition can be attributed to inadequate infant and young child feeding (IYCF) practices. Mothers often initiate breastfeeding too late, and introduce other liquids and foods too early, exposing their children to infections. Many mothers also suffer from 'breastmilk insufficiency,' which can be related to mental health issues, or inappropriate beliefs that lead them to wean their children early. The impact of such practices is reflected in admission rates in therapeutic feeding units, where severe acute malnutrition is treated. Forty percent of admitted children are below 6 months of age, a time at which breast milk should provide all of a baby's nutritional needs. Many mothers also do not know to introduce energy-dense foods in adequate quantities and with sufficient frequency at 6 months. The consequences are often irreversible if growth faltering and micronutrient deficiencies begin at this age.
At a workshop organized from March 29 to 31 by the Ministry of Public Health's Public Nutrition Department, with assistance from USAID/BASICS and USAID, nearly 60 sixty participants reached consensus on priority policies and strategic actions for improving infant and young child feeding practices in Afghanistan. Contributors to this all-important strategic plan included stakeholders who work with the Ministries of Public Health, Agriculture, Women's Affairs, Rural Development, and Commerce, along with colleagues from national and international NGOs, FAO, UNICEF, and WHO.
The participants identified priorities that aim to scale up existing interventions, including nutrition education, breastfeeding counseling, and demonstrations of improved complementary feeding recipes, to reach mothers in their homes, even in remote communities of this mountainous country devastated by years of conflict. These include:
- IYCF activities, in particular, breastfeeding and complementary feeding counseling should be clearly integrated at all levels of health services, from the community level (working with Community Health Workers) to provincial and regional hospitals.
- Mother support groups should be established, building on existing networks, such as women's community groups, literacy circles, health support groups, producer organizations. Through these support groups, mothers will receive breastfeeding and complementary feeding counseling, and will also be linked to education and food security interventions that can assist families in accessing more diverse and nutritious foods.
- A harmonized education campaign should be implemented to spread information about adequate feeding practices, using a broad range of networks, including: religious leaders, teachers, health workers, agriculture extension workers, and community mobilizers.
These interventions need to be supported by adequate policies and guidelines, and more importantly, adequate funding, to ensure that the necessary personnel and training are in place to implement work on the ground. Representatives from the various ministries have agreed to work together at the central, provincial and community levels to garner necessary support and resources to make these plans a reality.