Lourdes Zegarra, 27, lies on the hospital bed grimacing as her labour pains begin to take hold. “It’s starting to hurt a lot,” she says. Although in pain, she does not seem scared.
This will be Lourdes’s third birth. The other two children, aged 6 and 3, were also born in hospital. But Lourdes says she is expecting this time to be better because Cliza hospital has since been certified baby friendly. “I will receive help to properly breastfeed my baby and my husband will be allowed to be present during the delivery. This did not happen before,” she says.
The baby-friendly health initiative (BFI) was initiated by UNICEF and the World Health Organization (WHO) in 1991 to promote correct breastfeeding practices. A hospital can only be certified as babyfriendly when it has put in place 10 specific steps to support correct breastfeeding and the hospital and staff have been externally assessed. In Bolivia another step was included: regulating the advertising of breast-milk substitutes in hospitals. The steps support initiation of breastfeeding within the first hour of birth, exclusive breastfeeding for the first six months; and continued breastfeeding for two years or more along with nutritionally-balanced, age appropriate complementary feeding from the sixth month.
Benefits of breastfeeding have been widely documented. Besides drastically reducing chronic malnutrition rates, an exclusively breastfed baby is 14 times less likely to die in the first six months than a non-breastfed baby (Lancet, 2008).
However, in Bolivia only 60.4 per cent of mothers exclusively breastfeed their babies for the first six months. Moreover, recent figures show that although chronic malnutrition has decreased among children under-three from 42 out of 100 in 1989 to 18 out of 100 in 2012 rates are considerably higher in rural areas where averages reach 25.9 per cent compared to 14.6 per cent in urban areas.
So far in Bolivia only 16 hospitals are declared baby-friendly. “We need to focus on getting more maternity facilities baby friendly especially in rural areas,” says Dr Claudia Vivas, UNICEF head of Child Survival in Bolivia. “Not only are these children missing out on the health benefits of breastmilk but young children’s lives are being put at risk. Diarrhoea and respiratory infections are the two main causes of infant deaths in Bolivia; these preventable diseases can be dramatically reduced by breastfeeding.”
Cliza hospital, which is situated in Cochabamba, is being used as a model. All around Cliza hospital, posters are plastered on walls promoting breastfeeding or prohibiting free or low-cost breastmilk substitutes, baby bottles and teats.
Doctor María del Carmen Mendieta, who is responsible for the breastfeeding programme at Cliza hospital, trained 73 staff on the BFI. The staff had to complete a written and oral test, and a team of assessors, including a representative from UNICEF, interviewed pregnant women and new mothers, chosen at random, about their experiences at the hospital.
The doctor explained they adapted the BFI to the reality in Bolivia, making the experience culturally-sensitive. “For example, women can choose what position they would like to adopt during childbirth – in some cultures the women prefer to give birth standing up. We always try to accommodate non-harmful cultural practices.” The hospital also encourages more involvement of fathers. “Men used not to come to the consultations,” says the doctor. “When I invited them, they resisted at first, but now they see it is worth it.”
Danny Villarroel, 28, is one of the fathers in Cliza who has welcomed this initiative. “I attended every prenatal consultation with my wife and I was present for the childbirth,” he says looking fondly at his wife, Patricia, who is breastfeeding their one-week-old baby, Santiago. “When my baby was born and they laid him on my wife, I felt the bond between them. It was such an emotional experience.”
Besides regular postnatal consultations and breastfeeding workshops at the hospital every two months, his wife, Patricia, like all new mothers, will receive support in her community. For example, Dr. Mendieta and her team make weekly house visits and liaise with breastfeeding committees which are set up in each village.
Mayda Hinojosa, 29, is the head of the Villa El Carmen breastfeeding committee, seven kilometres from Cliza Hospital. “I was elected by my village,” Mayda explains. “My role is to make the liaison between new mothers in the area and the hospital. For example, I visit new mothers during the first few days after childbirth. If they have any problems, I phone the hospital and they send a doctor or nurse.” Mayda is giving the interview before attending a routine consultation for her robust 14-month-old baby, Andy. She concedes that if it was not for the hospital’s advice, she would not have fed her baby correctly. “Before, I didn’t know about early initiation of breastfeeding.”
The support given to pregnant women and new mothers, particularly about breastfeeding, has strengthened the relationship between the hospital and the community. Doctor Mendieta points out that in 2011, only 20 per cent of pregnant women in the area came to this hospital to give birth compared to 60 per cent in 2013 when the hospital was certified baby friendly. “This month (June 2014), we have had 36 births – it is a record number,” says Dr. Mendieta enthusiastically. Lourdes will soon have the 37th birth and she seems confident that the hospital will give her the necessary support during the birth and in the months after when she breastfeeds and cares for her newborn.