By Anielka Jirón.- At 7:30 in the morning, when there are already several pregnant and postnatal women among the people in the waiting room of the “José Dolores Fletes” Health Centre in the municipality of Ocotal, department of Nueva Segovia, Indira Guerrero and Reyna Rivas agree that the time is right to give the day’s first counselling talk on breastfeeding.
Indira and Reyna are educators on child-related issues who give counselling sessions that explain to women about manually extracting milk, the different positions for breastfeeding babies, the components and benefits of breastfeeding, childbirth, how to feed a baby, family planning, and monitoring the child’s growth during the first five years.
How much milk do we produce? How long does breast milk last after being extracted? Can women with HIV breastfeed? If the baby is sick, can you continue breastfeeding it? These are some of the breastfeeding-related questions women most frequently ask, according to Reyna.
“From the first prenatal check-up, everything is explained to the pregnant women about how to prepare their breasts to help the mother form a tip so that she can successfully breastfeed and the importance of drinking liquids for the production of breast milk, as well as something very important—the mother’s hygiene,” explains Reyna.
The certification of child- and mother-friendly health units is a key strategy for ensuring exclusive breastfeeding during the first six months of a baby’s life, as well as extended breastfeeding with complementary food until the child is two years old. One of the successes of this initiative is that all of the health units in the department of Nueva Segovia’s Local Comprehensive Health Care System have been certified as child- and mother-friendly.
The application of the strategy involves 13 steps that are used to encourage exclusive breastfeeding during the first six months of the child’s life, including: informing pregnant women of the benefits of breastfeeding, fostering breastfeeding whenever the child asks for it, and counselling mothers with HIV on how to feed their babies.
Indira says that changes have been observed as a result of the initiative’s implementation because previously some women did not breastfeed and as a result there were high rates of children with low weight and malnutrition. Thanks to the information they are given through the talks, pregnant women now know that breast milk contains all the nutrients the baby needs and that it is not necessary to give them water or extra food. They have been made aware of the issue, and as Indira says, “There are women who didn’t breastfeed following their first pregnancy, but did after their second one, and they themselves can see the change as their sons and daughters haven’t been getting ill.”
Child- and mother-friendly health units
With the implementation of the 13 steps for breastfeeding, the health personnel receive training on issues related to the institutional policy on breastfeeding, humanized childbirth and early skin-to-skin contact. In addition, the units comply with the initiative’s policy, providing health workers with babies half an hour in the morning and half an hour in the afternoon to breastfeed.
As part of the process of replicating the training sessions, the health personnel strengthen the capacities of the community health network on a monthly basis on issues related to maternal and infant health. “The community breastfeeding promoters visit the women in their houses and advise them on different issues,” Reyna explains. “We can also see the changes because we now have healthier boys and girls, as we’re implementing the initiative to monitor children in the neighbourhoods."