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It’s World Breastfeeding Week. How will you celebrate?

August 2, 2013

August 2 Breastfeeding WeekFrom August 1-7, we at Window of Opportunity are celebrating World Breastfeeding Week (WBW) 2013.  This year the theme is BREASTFEEDING SUPPORT: CLOSE TO MOTHERS which highlights the importance of continued support for lactating mothers and their children throughout the first years of life.  There is no dearth of data on the benefits of breastfeeding for children.  Breastfed babies are:

And we know that breast is best for moms as well.  Breastfeeding mothers are at reduced risk of:

But knowing that something is good for you is not enough to change behavior.  Women and their children need support from their health care providers, employers, families, friends, communities and governments to ensure optimal breastfeeding.  As breast feeding advocates at WBW put it: “The key to best breastfeeding practices is continued day-to-day support for the breastfeeding mother within her home and community.”

What World Leaders in Child Health Have to Say:

“Recognizing the benefits [of breastfeeding] more governments are putting breastfeeding at the center of their childhood nutrition programs… [The] right mix of supportive government policies, comprehensive childhood feeding programs, trained healthcare workers and community outreach significantly increase breastfeeding rates.” –UNICEF

“For breastfeeding to be successful, mothers need support.  Greater efforts are needed to create environments that consider the needs of pregnant and lactating women.  WHO advocates with the International Labor Union for strong support to working mothers.” –World Health Organization

How Window has been Involved

The Window of Opportunity has celebrated World Breast Feeding Week in all five of our program countries (Bangladesh Indonesia, Nicaragua, Peru and Sierra Leone) with activities that promote breastfeeding at the family level and at the community level.  By strengthening the enabling environment, Window is helping to ensure that women have the support they need to breastfeed as needed and that children receive the best start in life.

Supporting Breastfeeding At All Levels and In All Situations

According to WBW, supporting breastfeeding is everyone’s responsibility:

  • FAMILY AND SOCIAL NETWORK: Family and friends compose the mother’s immediate and continuous support network. Social support includes community support – at the market place, within a religious context, at a neighborhood park, etc. Societal support increases the mother’s confidence in her ability to breastfeed beyond the early weeks and months.August 2 Breast Feeding Week
  • HEALTH CARE SYSTEMS: This includes a multitude of opportunities to support breast feeding. These opportunities range from prenatal care, supportive labor and delivery services to postpartum and postnatal care that facilitates optimal infant feeding. 
  • WORKPLACE AND EMPLOYMENT: Employed women face challenges and need support to succeed at working and breastfeeding.
  • GOVERNMENT/LEGISLATION: Women who plan to breastfeed or who are already breastfeeding benefit from the support of international documents, protections for optimal infant feeding, plus active and well funded national commissions.
  • RESPONSE TO CRISIS OR EMERGENCY: This CIRCLE OF SUPPORT represents the need for support IF a woman finds herself in an unexpected and / or serious situation, with little control.

What Can You Do?

Here are just a few suggestions for how you can support breastfeeding women and help the children in your family and community:

  • Support breastfeeding family members by offering to tend to household chores so mothers can breastfeed.
  • Support colleagues by arranging meetings and work days around their feeding schedules.
  • Support people in your community by making public spaces a safe and accepting space for breastfeeding mothers and their children

Post in the comments and tell us how you can support breastfeeding women in your community.  We love hearing your ideas and stories!

Image sources pub336womenshealth.wikispaces.com and http://worldbreastfeedingweek.org/

Looking into the Window of Opportunity – Sierra Leone

July 24, 2013

July 24 Sierra Leone WoOP ActivitiesIn Sierra Leone, the Window project provided an opportunity to build on the successful USAID funded Child Survival Project (For Di Pikin Dem Wel Bodi -The Health of the Child) (2003-2008).  CARE used an integrated and multi-sectoral approach to support improved nutrition, water and sanitation, food security and livelihood projects in the area.

Window used a collaborative programmatic approach and worked with multiple stakeholders including community members and traditional leaders, other NGOs, the Ministry of Health and Sanitation (MOHS) and government councils. Advocacy and communication activities increased awareness and reinforced support for optimum infant and young child feeding (IYCF).  

Description of Activities:

  • Mother-to-mother support groups (MtMSG) provided pregnant women and mothers with children under 2 the opportunity to come together to learn about optimal nutrition practices.
  • Chiefdom level monthly meetings for all MtMSG facilitators provided the opportunity to share success stories, present challenges, and generally, learn from each others’ experiences. The meetings acted as a means to help build a support network among mother facilitators and a platform to encourage ongoing learning from peers.
  • District level quarterly meetings helped mother facilitators broadened their peer networks by engaging with facilitators from other chiefdoms as well as technical staff. Representatives relayed questions up from from their chiefdom meetings and returned with new insights to share in their monthly meetings.
  • Mini-advocacy campaigns solicited community support for breastfeeding and complementary feeding practices.
  • Promoted participation in World Breastfeeding Week annually (2009 – 2011).

Impact at a Glance:July 24 Sierra Leone WoOP Activities 2

  • Survey results show substantial improvements in IYCF practices. 
  • Nutritional status of children improved in stunting, underweight, and wasting.
  • Consistent messaging through multiple communication channels created an environment that reinforced and encouraged optimal child feeding and care practices.
  • Three quarters of mothers reported that they received IYCF counseling in the last six months, and more than half of mothers were involved in MtMSGs.

Join us next month when we take a look at Window of Opportunity in Peru.

Photo credit: http://www.who.int and http://www.flikriver.com

Looking Into the Window of Opportunity – Indonesia

June 21, 2013

In 2008, the Window of Opportunity launched Prima Bina in WesJune 21 Indonesia WoOP Activitiest Timor,Indonesia.  Prima Bina (which means “an excellent start” in the Bahasa Indonesian language), builds on CARE’s successful experiences supporting infant and young child nutrition in Indonesia during emergency situations, such as the 2006 tsunami.  To reduce the prevalence of malnutrition in 23 remote villages, Prima Bina focused on:

  • building the capacity of community health volunteers to support optimal infant and child feeding
  • fostering behavior change among caregivers of children under age two

Overview of Activities

Prima Bina’s activities included:

  • building the capacity of health staff and volunteers to carry out individual Infant and Young Child Feeding (IYCF) counseling though home visits
  • supporting formation of mother-to-mother support groups

Prima Bina found individual counseling to be highly effective.  After examining several strategies, Prima Bina primarily focused on counseling provided by community health volunteers (kaders), as well as other community leaders.  To complement its approach to individual behavior change, Prima Bina used World Breastfeeding Week and Indonesian Breastfeeding Month as opportunities to conduct innovative activities with community groups, religious organizations and government to raise awareness and enthusiasm about infant, young child and maternal nutrition. 

Individual counseling through home visits

Counseling offers a personalized, private interaction where mothers can share their current feeding practices and receive support and suggestions tailored to their specific circumstances.  Prima Bina saw greater potential for kaders and religious leaders to provide quality IYCF counseling.  Deacons and priests from various churches enthusiastically participated in IYCF training and began home visits, even beyond Prima Bina’s project communities.  Both kaders and religious leaders were trained using CARE’s renowned 5-day course–IYCF Community Focused Approach (CFA)

Volunteers were taught to suggest feasible new practices and negotiate with families to try the new things.   Prima Bina trained 159 kaders, mother volunteers or religious leaders to become IYCF counselors.   Many religious leaders embraced their new role as IYCF counselors. In fact, as Prima Bina concluded activities, it was still receiving requests for additional training from additional Catholic and Protestant churches.

World Breastfeeding Week and Indonesian Breastfeeding June 21 Indonesia WoOP Activities 1Month

Prima Bina used these special celebrations to carry out creative activities including an interactive IYCF quiz competition, an exclusively breastfed baby contest and a singing competitionabout good nutrition.  Participation was diverse and impressive, reaching over 3000 participants, including grandmothers, midwives, local health staff, district health managers, local politicians, traditional and religious leaders, women and youth leaders, and other NGOs.  In addition to the main celebration, each year Prima Bina conducted a district-level workshop to target different groups, such as local government, the House of Representatives and religious leaders.

By incorporating trusted religious leaders into its programs, Prima Bina helped to ensure lasting change in nutrition practices.

Make sure to tune in next month when we take a look at some of the unique activities conducted in Sierra Leone!

Photo credits: http://www.flikr.com and http://www.kalyanamitra.or.id


Looking into the Window of Opportunity – Nicaragua

June 13, 2013

This month we are taking a look at the types of activities Window of Opportunity programs around the world implement to improve Maternal and Child Nutrition.  We will begin our tour with Proyecto Ventana de Oportunidad in Nicaragua. June 14 Nicaragua WoP Activities

Activities related to the Nicaraguan context were implemented to support the program goal to improve nutrition status of 1035 children under 2 years of age and 233 pregnant women in 40 poor, underserved and remote communities.

The Window of Opportunity Approach

All program activities relate to The Window of Opportunity approach, which combines service delivery, capacity building, facilitation and advocacy to promote good nutrition practices, increase access to nutritious food, and leverage political commitment to address malnutrition.

The approach includes:

  • Improving the enabling environment
  • Strengthening health systems to support Infant and Young Child Feeding (IYCF) and related Maternal Nutrition (rMN)
  • Empowering individuals and communities to make good choices when it comes to nutrition

Improving the enabling environment in Nicaragua

The activities implemented to achieve an improved enabling environment in Nicaragua were:

  • Incorporation of nutrition counseling and Mother to Mother Support Groups (MtMSG) to provide mutual support and problem-solving to improve feeding practices to mothers with children under age two, pregnant women and lactating women, as well as any other mothers or grandmothers who wanted to learn
  • Develop monitoring and evaluation system: The data generated from the M&E system provided needed evidence of program implementation and success, and provided evidence for enabling policy change.
  • Provide input on the National Plan to Eradicate Chronic Nutrition in Nicaragua 2008-2015, particularly the national strategies on nutrition education and behavior change and implementation of new child growth standards.

Strengthening health systems to support IYCF and related maternal nutrition in Nicaragua

Proyecto Ventana de Oportunidad strengthened Nicaraguan Ministry of Health presence and programs by:

  • Incorporating individual counseling and mother-to-mother support groups (MTMSGs) into existing MOH programming
  • Encouraged three more volunteers in each community to become community health workers (brigadistas)
  • Training brigadistas to provide individual IYCF counseling in the communities strengthened the MOH’s local level presence.
  • Project staff monitored counseling sessions by the brigadistas using an objective performance monitoring tool together with immediate feedback to improve the quality of the sessions.
  • Project staff trained health personnel at the MOH health centers and posts in 2009 and 2010.
  • Brigadistas and staff at MOH- funded maternity waiting homes were trained in how to provide nutrition counseling sessions at maternity waiting homes.

Empowering individuals and communities to make good choices when it comes to nutrition

In addition to strengthening the work of brigadistas, the project placed the most emphasis on the formation of MtMSGs and the creation of an engaging radio drama which highlighted challenges with feeding young children and pregnant women and navigates culturally-acceptable solutions.

Activities included:

  • Brigadista and mother facilitator training for MtMSGs
  • Mother volunteers facilitated MTMSGs to promote IYCF practices
  • Project staff monitored MTMSGs by providing feedback to the mother facilitators using performance indicators
  • IYCF messages were disseminated via a radio drama that followed the early pregnancy of a young Nicaraguan mother

By implementing projects across all areas of the Window of Opportunity approach, Proyecto Ventana de Oportunidad helped to ensure lasting change in nutrition practices.

Join us next week when we take a deeper look into the work Window of Opportunity has done in Indonesia.

Picture source: http://www.american-pictures.com

Maternal Postnatal Nutrition

May 30, 2013

May 30 Postpartum NutritionAll this month we’ve been focusing on mothers.  We have examined:

  • The links between nutrition and maternal morbidity and mortality
  • The importance of eating order in the household during pregnancy
  • The relationship between postpartum depression and nutrition
  • The benefits of breastfeeding for mothers

This week we wrap up our month of mommy focused blogs with a look at the importance of postnatal nutrition on women’s health.

Eating Right After Delivery

Mothers who are breastfeeding, anemic, or recovering from a cesarean delivery require special nutritional management after delivery.  Mothers typically have little time to focus on themselves, so simple, nutritious foods including fresh fruit, raw vegetables, yogurt, seeds and nuts can be a great way to get some quick nutrition.  Friends and family members can also help mothers get the nutrition they need by offering to cook.

Mothers should take time to sit to eat meals.  Sitting to eat a meal unhindered by an infant helps with fatigue as well as digestion.  Again, friends and family members can help by offering to hold the child so the mother can eat uninterrupted.

Mothers can also help prevent common postpartum complaints with good nutrition.

Constipation

The following recommendations can help alleviate constipation:

  • Adequate fiber intake: high-fiber cereals, fruits and vegetables are good fiber choices. (It is important to increase fluid intake with increased fiber intake.)
  • 3-4 quarts of fluids a day is generally recommended for breastfeeding mothers to help prevent constipation

Restoring Iron ReservesMay 30 Postpartum Nutrition Iron Rich Foods

Postpartum anemia may result from having been anemic during pregnancy, from blood loss during childbirth, or from giving birth to more than one baby.

Food sources of iron include:

  • Lean red meats
  • Organ meat
  • Spinach
  • Egg yolks

Calcium can inhibit iron absorption.  Therefore mothers should not take iron supplements with milk, yogurt or antacids.  Dairy products are of significant nutritional importance, so they should not be cut out of the diet, but rather should not be eaten with iron supplements or with iron rich foods.

Cesarean Delivery

Undergoing a cesarean section can temporarily upset the passage of food through the digestive tract, resulting in gas production and constipation. This can be treated by walking, which increases bowel activity and aids in passing gas.  Some mothers will not feel like eating when they feel constipated or bloated, but consumption of food helps restore normal bowel action, relieving constipation and gas.

According to nutritionists at Discovery Health, nutritional management after surgery includes increasing the vitamin C and protein in the diet. Vitamin C contributes to wound healing, and protein helps your body repair itself.

Remember that maternal nutrition does not end after delivery.  There are a lot of resources out there for new mothers.  One particularly user-friendly resource is this one on Ngala’s website, and this resource from the CORE Group is one we share regularly.  Thanks for reading and stay tuned next month as we begin to share the results of CARE’s Window of Opportunity program evaluation!

Picture sources: http://www.facebook.com/unicef, inadequatevocabulary.wordpress.com

Breast is Best for Mommy Too: Examining the Benefits of Breastfeeding for Mothers

May 23, 2013

May 23 Breastfeeding for Mom 2Breast feeding has lasting positive impacts on infant nutritional status, immune health and cognitive development; but it also benefits mothers’ health as well, contributing to reduced risk of:

  • cardiovascular disease,
  • diabetes
  • and cancers later in life.

For example, according to research led by Eleanor Schwarz, women who did not breastfeed had a 42.1 percent chance of developing hypertension, whereas mothers who breastfed for at least 12 months had a 38.6 percent chance of developing hypertension.

Breast feeding promotes a number of positive health outcomes including:

Fat, Diabetes and Breastfeeding

Producing milk for a typical infant requires an additional 480-500 calories a day causing women’s bodies to retain fat particularly around the mid section and thighs.  However not all fat is created equal.  Some of the fat acquired during pregnancy is visceral fat, which accumulates around organs in the midsection and can increase the risk of heart and other diseases. Schwarz et al found that women “who had children and [had] not breastfed had 28% more visceral fat than those who had consistently breastfed.”

Lactating women appear to be better at mobilizing, utilizing and shedding new fat stores than mothers who are using formula.  Retaining extra pounds may put women at risk for diabetes and other related health problems later in life (Stuebe et al).  According to Stuebe, women who experience gestational diabetes can also significantly reduce their risk for chronic diabetes later in life if they breastfeed.

Breastfeeding and Heart Health

Women who breastfeed are also at reduced risk for aortic calcification–a risk factor for stroke, heart attack and other cardiovascular complications.  According to Stuebe’s research, mothers who breastfed for more than 12 months were 10% less likely to develop cardiovascular disease than mothers who did not breastfeed.  This protection from heart disease is thought to be due in part to healthier cholesterol levels and lower incidence of high blood pressure in mothers who breastfeed.

Breastfeeding and Cancer RiskMay 23 Breastfeeding for Mom

Research conducted by Stuebe and Schwarz suggest that “for every 12 months a woman breastfed, her risk of breast cancer dropped 4.3 percent.”  According to the American Institute for Cancer Research (AICR): “the protective effect of breastfeeding is likely due to the balance of hormones produced during the breastfeeding process. By lowering levels of some cancer-related hormones in the mother’s body, risk of cancer is reduced.  Also, at the end of breastfeeding, the body gets rid of many cells in the breast, some of which may have DNA damage.”

Good Nutrition During Lactation

Breastfeeding clearly provides mothers with a lot of health benefits, but it also requires additional caloric intakes and can put women at increased risk of micronutrient deficiency.

Most women can produce enough milk for their babies.  Only the most malnourished women will not have adequate milk.  However, a healthy and varied diet provides the mother and the child with the nutrients they both need.  You can read more here and here for detailed information on recommended daily micro and macro nutrient intakes and diet recommendations.

Image sources: pinterest.com, environmentalgeography.blogspot.com

A look at nutriton and postpartum depression

May 17, 2013

May 16 Postpartum Depression 1All this month we are focusing on mothers and maternal health.  This week we take a look at an issue that doesn’t receive a lot of attention–particularly in global health and development spheres–but is vital for the health and well being of mothers and their children: Postpartum Depression or PPD.

PPD is only one manifestation of postpartum mood disorder on a continuum that goes from the more common “baby blues” to the more severe “postpartum psychosis:”

May 16 Postpartum Depression 3.jpg

Prevalence

PPD has been called the “most common complication of pregnancy” with approximately one in eight mothers (10-15%) experiencing PPD during the first year of their child’s life.  Postpartum depression can affect any new mother regardless of her:

  • Age
  • Level of education or income
  • Experience of pregnancy
  • Number of pregnancies or number of children

However according to the Mayo clinic, some women may be more susceptible to PPD if their pregnancy was unplanned and/or unwanted and if they have:

  • A history of depression
  • Had PPD after previous pregnancies
  • Experienced stressful events during the last year
  • Relationship problems
  • Weak support system
  • Financial problems

Impact on Maternal and Child Health

Maternal depression is associated with child psychological and physical health as well as nutritional status.  PPD can impact a woman’s ability to:

  • Take care of herself
  • Effectively carry out daily responsibilities
  • Take care of her baby (including proper infant feeding)

PPD and Nutrition

Nutrition impacts all facets of health including mental health.  For example, research by Bodnar and Wisler has found that:

  • Poor omega-3 fatty acid status increases the risk of depression. Fish oil and folic acid supplements each have been used to treat depression successfully.
  • Folate deficiency reduces the response to antidepressants.
  • Deficiencies of folate, vitamin B12, iron, zinc, and selenium tend to be more common among depressed than non-depressed persons.

Nutrition during pregnancy can have a profound impact on mood.  As Bodnar and Wisler explain:

  • “Childbearing-aged women are particularly vulnerable to the adverse effects of poor nutrition on mood because pregnancy and lactation are major nutritional stressors to the body. The depletion of nutrient reserves throughout pregnancy and a lack of recovery postpartum may increase a woman’s risk of depression.”

Treatment

Treatment for PPD includes:May 16 Postpartum Depression 2.jpg

  • Counseling
  • Antidepressants
  • Hormone therapy
  • Lifestyle changes including healthy eating

Nutrition interventions can be inexpensive, safe, easy to administer, and generally acceptable to patients.

What the CARE Nutrition Plus Team is doing

CARE has trained 47 community and nutrition workers and 317 community counselors in Bangladesh on the delivery of basic psycho-social support services to women and their families.

Training included information on:

  • PPD
  • How to provide quality, personalized support for women experiencing PPD
  • The “steps to wellness” that help to empower women to help themselves
  • How to help individuals create a plan of action that will help them assess their strengths and needs
  • How to build a supportive community for women experiencing PPD

These trained nutrition counselors are now equipped to identify PPD, provide support and tools to women who are struggling with mood disorders after delivery.

Click here for more information on PPD from the Centers for Disease Control.  For more detailed information on the science behind nutrition and depression click here.

Clip Art source: newsinhealth@nih.gov