Celebrating World Day of Human Milk Donation

Alive & Thrive is pleased to join partners around the world to celebrate World Day of Human Milk Donation. The photo mosaic featured in the video below is a tribute to human milk donors and professionals working together across the world to promote human milk donation.

Globally, an estimated 15 million babies are born prematurely every year and prematurity is the leading cause of death in children under 5. Making safe, pasteurized donor milk available to all at-risk, sick, and premature infants worldwide without access to their own mothers’ milk saves lives. Donor milk can also act as a bridge to support mothers who need time and help to be able to establish their own milk supply and breastfeed their babies.

This year, milk bank leaders have come together to build a global alliance to enable sharing of optimal practices in milk banking, which is especially important during the unprecedented challenges faced during the COVID-19 pandemic.

“The gift of breastmilk lies at the heart of the work of human milk banks” said Gillian Weaver, Co-Founder of the Human Milk Foundation and a leader of the Global Alliance of Milk Banks and Associations. “Almost 700 milk banks operate in 65 countries around the world. On this special day, all who support and benefit from their work can come together to celebrate the unique donation that milk donors make to other mothers and their premature sick infants. Every drop really does make a difference!”

“A human milk bank is an essential component of breastfeeding-friendly health systems, giving all at-risk infants access to the benefits of breast milk when they need it most.” said Roger Mathisen, Program Director of Alive & Thrive’s Southeast Asia office. “The global alliance now has more than 80 members from 36 countries who have come together to create a global milk bank movement in support of breastfeeding.”

Read more about human milk banking in this Lancet article: Maintaining safety and service provision in human milk banking: a call to action in response to the COVID-19 pandemic

Workplace lactation support toolkit approved in Myanmar to create breastfeeding friendly workplaces

Myanmar’s Ministry of Health and Sports and Ministry of Labor, Immigration, and Population approved and endorsed the Alive & Thrive workplace lactation support toolkit and training package in February.

workplace lactation support
Alive & Thrive’s workplace lactation support toolkit includes a variety of materials to help businesses support breastfeeding in the workplace.

Faced with little or no breastfeeding support in their workplaces, women may leave the workforce, choose not to breastfeed their infants, or use unsafe or unsanitary spaces to breastfeed – each option potentially leading to significant negative outcomes. The ministries’ approvals came after pilot testing, training, and monitoring in three worksites (two private businesses and one government office).

All three of the worksites currently have operational lactation support programs including breastfeeding spaces and breaks. A&T is working with UNICEF to finalize a dissemination plan for the materials.

Additionally, A&T is facilitating the development of a team of core trainers for decision and policy makers in collaboration with the Business Coalition for Gender Equality, and for working mothers in collaboration with the Yangon Regional Health Department. Roll out of the tools to additional worksites is planned for the duration of 2020.

West African health officials learn about successful “Start Strong/Zero Water” campaign in Nigeria

Representatives of the ministries of health in Burkina Faso, Niger and Senegal met health officials, communication experts, and community authorities during a six-day visit to Nigeria organized and conducted by Alive & Thrive.

health officials from Burkina Faso, Niger and Senegal visited Nigeria with A&T support
Health officials from Burkina Faso, Niger and Senegal visited Nigeria with Alive & Thrive support in February.

The exchange visit allowed the delegations to learn more about the “Start Strong/Zero Water” awareness-raising campaign and about conceiving and launching such national campaigns on infant and young child and maternal nutrition. To date, thousands of radio and TV ads have been broadcast in 11 states, reaching millions of women. Several radio and TV stations donated broadcast time to air the ads and a YouTube channel was set up with A&T support.

The delegations visited health facilities in Lagos and Kaduna where they met facility and community health workers, pregnant women and mothers of children under two years. They also met the advertising firm that developed campaign materials with A&T and the Government of Nigeria, and met the First Lady of Kaduna, a strong supporter of the campaign who explained how she led the Kaduna State government and key stakeholders to work with A&T on the campaign.

They specifically discussed who participated in developing and launching the campaign, the principal partners involved in implementing the campaign, the challenges encountered during implementation, the different channels and approaches used, and the campaign’s most effective strategies.

Research Update: Three new journal articles leverage Alive & Thrive data

Since its inception 10 years ago, Alive & Thrive has published almost 100 articles in peer-reviewed journals. These contributions to global knowledge inform efforts to improve maternal, infant and young child nutrition programs. We are now supplementing our annual research summary (see 2019’s here) with a quarterly review.

Secondary analysis of data from Phase 1 of Alive & Thrive (2008 to 2013) led to new insights on the initiative’s behavioral change communication interventions, which have been published in two peer reviewed journals.

two new journal articlesDifferent combinations of behavior change interventions and frequency of interpersonal contacts are associated with infant and young child feeding practices in Bangladesh, Ethiopia, and Viet Nam, published in Current Developments in Nutrition in December 2019, demonstrated that exposure to interventions matters for impact but the combination of behavior change interventions and number of interpersonal counseling contacts required to support behavior change in infant and young child feeding are context-specific. In Ethiopia, exposure to Interpersonal Communication (IPC) with other interventions was associated with higher odds of achieving minimum meal frequency, minimum dietary diversity, and consumption of iron-rich foods. In Vietnam, exposure to IPC alone or with mass media was associated with higher odds of exclusive breastfeeding. Near-monthly visits were associated with 2–3 times higher odds of IYCF practices in Bangladesh and Ethiopia. In Vietnam, even 1 IPC visit was associated with 2 times higher odds of EBF.

Nutrition intervention using behavioral change communication without additional material inputs increased expenditures on key food groups in Bangladesh, published in January in the Journal of Nutrition, demonstrated that recipients in the intensive intervention mobilized additional resources to improve diets, reflected in increased expenditures and consumption of promoted foods. The research provides no evidence of resource reallocation from nonfood to food expenditures and suggests that mothers instead sought out ways to increase resources so that they could feed their children properly, such as increased employment and (potentially) reduced investments in gold jewelry – a traditional durable asset for women in South Asia.

Social, economic, and political events affect gender equity in China, Nepal, and Nicaragua: a matched, interrupted time-series studypublished in January in Global Health Action, suggested that supportive social and political environments can play an important role in empowering women. Using the Gender Gap Index from the World Economic Forum’s Global Gender Gap Report (2006–2017), results showed that while political empowerment influenced dramatic increases in equity in Nepal and Nicaragua, gender equity in China declined, largely due to decreased equity in education, economic participation, and health. A review of key social, economic, and political events in these countries during 2006–2017 demonstrated that these key events help explain trends in countries’ gender equity.

Advocacy to increase investment in maternal nutrition reaches high-level stakeholders and journalists in Ethiopia

The president of Ethiopia delivered a keynote address at one of several safe motherhood events across Ethiopia where A&T promoted maternal nutrition and advocated to high-level decision makers on the significant benefits of investing in nutrition.

Sahlework Zewdie, president of Ethiopia
President Sahlework Zewdie of Ethiopia delivered a keynote address at a high-level advocacy workshop organized by Alive & Thrive in February.

The events included a workshop for journalists that led to radio, TV and newspaper reports on the importance of maternal nutrition. The first event, a national commemoration, featured Sahlework Zewdie, president of Ethiopia, whose remarks focused on good nutrition during pregnancy and lactation.

At a separate event, Abdiwahab Mohamed, deputy head of the Somali Regional Health Bureau, recognized maternal nutrition as one of the key interventions to ensure safe motherhood. At an event organized by the Amhara Regional Health Bureau, which involved program managers, facility manager and maternal and childcare providers, participants focused on safe motherhood issues.

The media workshop involved the participation of 30 reporters and editors from a range of private media outlets and focused on the importance of maternal nutrition. Following the workshop, radio reporters produced three programs and A&T technical specialists provided information and insights as guests on national TV programs. The Ethiopian Herald, a popular national newspaper, also featured an article, Nutrition intervention for mothers’ safety.

E-learning course provides global access to valuable nutrition information

Nader Aboulebdeh learned about “Investing in Child Nutrition,” the e-learning course that Alive & Thrive developed with a variety of partners, from his supervisor at Action Against Hunger, the global humanitarian organization.

Nader Aboulebdeh
“It was quite perfect,” said Nader, one of about a dozen people Alive & Thrive contacted recently to learn about their e-learning experiences with “Investing in Child Nutrition.”

“It was quite perfect, to be honest,” said Nader, now a nutrition officer with the United Nations Children’s Fund (UNICEF) in Syria. After taking it “I was in the office, running around and asking people, ‘Have you done this course?’

“The course is very useful, I recommend it. With e-learning you have the freedom to browse the materials whenever you have time, which is especially important in this COVID-19 era.”

Nader is one of about 1,200 people worldwide who have registered for “Investing in Child Nutrition” since its launch last year. Alive & Thrive recently contacted several users in Africa, Europe and the U.S. who echoed his assessment, saying that the content had improved their knowledge and skills.

“I’m working with the Ministry of Health and I’m using a lot of the technical information that I learned in the course,” he said. “Technically, it’s very comprehensive – it covers every aspect of infant and young child feeding, from breastfeeding to growth monitoring, and it includes information for specific contexts like HIV.”

Working with UNICEF and a global network of experts, Alive & Thrive developed the course based on the World Health Organization (WHO) Combined Course on Growth Assessment and Infant and Young Child Feeding Counselling and supplemental content from WHO, UNICEF, the Global Health Media Project, and the Raising Children Network (Australia). It is free and available in both French and English.

The course comprises 10 modules that cover a variety of IYCF topics, including breastfeeding, complementary feeding, growth assessment, HIV and infant feeding, and policies and programs.

Zephenia Gomora
Zephenia Gomora learned of subsequent World Health Assembly resolutions on promotion of breastmilk substitutes from the e-learning course, using his newfound knowledge to inform revision of Zimbabwe’s BMS statute.

The course’s content has had important practical use in their work, they said. In Harare, for example, Zephenia Gomora, a nutrition specialist (MIYCN) with UNICEF, said he had used the information regarding the International Code of Marketing of Breastmilk Substitutes to inform efforts to improve monitoring and enforcement of the Code in Zimbabwe.

“I learned of the subsequent World Health Assembly resolutions on promotion of breastmilk substitutes, including WHA resolution 69.9,” Gomora said. “This year we are looking at how we can revise Statutory Instrument 46 of 1998 and adapt the subsequent WHA resolutions and update it. I personally learned this aspect from the course.” Gomora said the setup of the course also impressed him.

“I think it’s very user friendly and I liked the way it was structured and how the information was delivered,” he said. “The photos, the videos, the animations, the audio clips – they engage you. You could also give feedback as you go. The end of module quizzes stimulated me to learn more.”

Rita Abi Akar, a public health nutritionist who lives in London and works on nutrition with various international Non-Governmental Organizations, was similarly impressed.

Rita Abi Akar
Rita Abi Akar facilitating a food safety and hygiene workshop in Chebaa in southern Lebanon. The content of Investing in Child Nutrition was more comprehensive than she expected, she said.

“I have recommended the course to a lot of people already,” Akar said. “It’s an essential course if you’re working in humanitarian nutrition. It will add a lot to your knowledge.”

She was not convinced that would be the case when she enrolled in the course, however.

“I was not sure about the content,” she said. “I hold a bachelor’s degree in nutrition and dietetics and a master’s degree in public health nutrition. I was scared that some information might be redundant. But I was surprised – the content was very good and it added to what I know.”

In South Sudan, John Riak is a maternal, infant and young child nutrition program officer for the Tear Fund in Jonglei State. About 100 women participate in the program, although the reach of its nutrition information extends well beyond the women into the community, he said.

The course added to his knowledge, particularly on preventive nutrition, and growth monitoring and promotion, he said. Riak is a Master of Public Health Leadership (MPHL) Save the Mothers candidate at Uganda Christian University.

John Riak completed Investing in Child Nutrition in his office in Jonglei State, South Sudan. “It’s very clear as you read through it,” Riak said. “With the videos, the audio clips, and the transcripts, if you are attentive it allows you to understand.”
John Riak completed Investing in Child Nutrition in his office in Jonglei State, South Sudan. “It’s very clear as you read through it,” Riak said. “With the videos, the audio clips, and the transcripts, if you are attentive it allows you to understand.”

“It’s very clear as you read through it,” Riak said. “With the videos, the audio clips, and the transcripts, if you are attentive it allows you to understand.”

The course has enormous potential, particularly if access can be extended to health workers in places where there is no internet access, he added.

“This course will help health workers,” Riak said. “In South Sudan, most of those who work in the health sectors, maybe half of them, have not gone through higher education. Many drop out and they are in the system as attendants or assistants and they get some experience.

“They want to learn but internet access is a problem. The best way would not be online. But if this were available offline, this would help them and they would like it.”

Haley Brightman, senior program officer at URC and an MPH in global health, also expressed interest in improving access to the free program.

“I know it’s more geared toward health professionals – community health workers – which is important,” Brightman said. “I’m curious to know how it’s promoted to health care workers in those settings to take.”

Currently, the course is only available to those with internet access. But that could change as the course is developed, said Roger Mathisen, Alive & Thrive’s program director for Southeast Asia who oversaw the conception and development of the course.

“We are aware that internet connectivity impacts access,” Mathisen said. “It’s something we hope to address with partners.”

Introducing versions of the course in other languages and adapting it to different cultural contexts are other areas Alive & Thrive is exploring, he said.

New Alive & Thrive technical brief examines the role nutrition plays in predicting and preventing maternal depression

Maternal Depression: The role of nutrition in prevention and treatment
Maternal Depression: The role of nutrition in prevention and treatment

Research continues to shed light on the role nutrition plays in maternal depression. A new Alive & Thrive technical brief, prepared by Dr. Pamela Surkan and Farah Behbehani, presents what we know about the role of nutrition in predicting and preventing maternal depression.

Understanding the role is critical: Maternal depression is associated with increased maternal morbidity, poorer self-care, and it has significant harmful consequences for infants and children. For example, one meta-analytic study focused on low- and middle-income countries (LMICs) found an increased risk of approximately 50 percent for underweight and 40 percent for stunting in children with mothers who had high levels of depression.

“We know nutrition is important for brain development and plays a role in the pathophysiology of depression” the authors stated. “But we still have a lot to learn about the specific links between nutrition and maternal depression and this brief also presents areas for future research and action.”

The need for further research in LMICs is particularly great. While studies in high-income countries indicate about 10 percent of pregnant women and 13 percent of those who have given birth experience some degree of depression, the prevalence for women living in LMICs has only recently become the subject of research and is estimated to be even higher.

The brief also discusses interventions and platforms to address maternal depression within healthcare systems. A variety of strategies are being implemented to address maternal depression, including psychological therapies, community-based support, and poverty alleviation. Approaches using supervised non-specialist health and community workers in LMICs have shown promising results and could potentially offer platforms for integrating nutrition interventions. Future research should also be conducted to better understand, and potentially harness, ways in which nutritional interventions could be used.

The brief also summarizes research on nutrition and maternal depression. Overall, studies provide strong evidence that nutrition affects maternal depression. But research on the impacts of preventive measures and the role of specific nutrients has been inconclusive.

“We need to understand better the impact of nutrition in maternal depression, and the potential of interventions to address deficiencies,” Dr. Surkan said. “Certain nutrients could play a role in the development of maternal depression but only more research will tell us the extent of their impact.”

Lack of dietary diversity in Ethiopia is tied to limited access to a variety of foods and affordability, new research finds

A rural market in Ethiopia
Many rural markets in Ethiopia lack certain foods and/or some nutritious foods are too expensive for many households, new research shows. All photos: Victor Pinga, Alive & Thrive.

Many Ethiopians have little variety in their diets because foods such as meats and poultry and some fruits and vegetables are unavailable or too expensive, according to new research.

Researchers looked at consumption, production, availability, and affordability in six regions of Ethiopia, to understand how well the regions’ food systems—from farm inputs to food distribution – were aligned with the nutritional needs of the people.

The studies are part of Alive & Thrive’s work with stakeholders to promote nutrition-sensitive agriculture (NSA), an approach that seeks to maximize agriculture’s contribution to nutrition. NSA involves linking agriculture to sectors that address other causes of malnutrition, namely education, health and social protection.

The findings varied by region and were cause for concern, the researchers said. The research was undertaken by the International Food Policy Research Institute (IFPRI) with funding from Alive & Thrive, an initiative supported by the Bill & Melinda Gates Foundation. The Afar, Amhara, Oromia, SNNP, Somali and Tigray regions were the focus of the research.

The full reports and briefs, which include an overview of the data and summarize the key points, are available here.

“While there are many factors affecting the consumption of healthy diverse diets, what is available and affordable in local rural food markets often shape the food choices of consumers – for example, poultry, fish and meat are very expensive for most households in Ethiopia, hence consumption in rural areas is low,” said Victor Pinga, a member of the research team. “Meanwhile, there are many inexpensive foods that are available within the rural food environment, and yet consumption is low. This research showed us which potential food groups offer promise in diversifying diets.”

Vegetables on sale at market
A&T’s studies of nutrition-sensitive agriculture incorporated data on the types of foods, like fruits and vegetables, that can be purchased in rural markets.

Dr. Abdulaziz Oumer, director of A&T’s program in Ethiopia, said the studies revealed significant dietary issues.

“Children aged 6 months to 2 years are expected to consume at least four food groups every day, but the majority of these children in the six regions consume only two food groups,” Dr. Oumer said. “Even the consumption of the relatively cheaper food groups, like legumes and nuts and Vitamin A-rich vegetables, is low. This is a good indicator that not only price affects consumption – knowledge and desirability of the foods may contribute.”

The situation in Tigray Region illustrates these points. In Tigray, children eat from less than two food groups daily, on average, and mothers eat from less than three. The average person gets the bulk of their calories from carbohydrates. The average family would have to spend 59 percent of its income to eat a healthy diet beyond carbohydrates and the poorest would have to spend 153 percent of its income.

Aligning food systems with the nutritional needs of the population would likely lead to improved health and nutritional status, and the reports are intended to help stakeholders in their efforts to do so. For example, in Oromia, the most readily available and affordable food groups include: legumes and nuts; other fruits and vegetables; Vitamin A-rich fruits and vegetables; and, eggs. Making these value chains a priority—by increasing availability and improving affordability, price stability, and safety in all local food markets—offers promise for moving toward a more diverse diet, when combined with increasing demand for these foods.

“Together, these reports highlight significant variation in diet content, and in the availability and affordability of nutritious foods across the six regions,” said Dr. Kalle Hirvonen, a Senior Research Fellow at IFPRI. “There is no ‘one-size fits all’. Instead, strategies to improve food systems need to be carefully tailored to the context.”

Poor dietary quality is one of the leading causes of premature death and diseases globally. In Ethiopia specifically, adults and children get between 60-80 percent of their energy from carbohydrates, which is particularly worrying given that a carbohydrate intake greater than 60 percent increases an individual’s risk of cardiovascular disease—one of the country’s most common causes of premature mortality.

Stronger with Breastmilk Only campaign aims to save lives, reduce child malnutrition in West and Central Africa

Seven out of every 10 babies in West and Central Africa receive liquids and foods in addition to breastmilk during their first six months of life, contributing to child malnutrition, illnesses and even death. The Stronger With Breastmilk Only multi-year campaign launched today by UNICEF and the Alive & Thrive initiative calls on Governments, partners, businesses, communities and families to ensure that mothers get the support they need to give their babies the best start in life.

Read Alive & Thrive’s advocacy briefs for countries across the region

Despite positive economic growth in West and Central Africa, the number of stunted children under five years has increased from 23 to 29 million between 2000 and 2018. In addition, the region is home to an estimated 4.9 million children suffering from severe acute malnutrition.

For babies under six months to stay healthy, scientific evidence recommends giving them breastmilk only and on demand (day and night). No water, other liquids or foods should be given from the moment of birth until they reach six months of life, even in hot and dry climates, as breastmilk contains all the water and nutrients a baby needs to grow well. According to studies in low- and middle-income countries, babies who receive liquids and foods in addition to breastmilk before six months of age are at greater risk of diarrhoea and respiratory infections. They are almost three times more at risk of dying than those who are exclusively breastfed.

Breastfeeding also has significant benefits for mothers by hastening recovery after childbirth, delaying the return of the menstrual cycle thus helping with birth spacing, and reducing the risk of cancer.

The costs of not breastfeeding are enormous: in addition to thousands of preventable deaths of children, it costs West and Central Africa hundreds of millions of dollars annually to treat illnesses, to buy infant formula, and in lost productivity due to cognitive losses associated with not breastfeeding.

Cost of Not Breastfeeding brief illustration
Alive & Thrive’s advocacy briefs provide country-by-country snapshots of the cost of not breastfeeding – and actions stakeholders can take to improve the situation.

“Breastmilk is a pure gift. It is a baby’s first vaccine and best source of nutrients. Promoting, protecting and supporting mothers to give breastmilk only, no water, for the first six months of life requires encouragement and support from family members, health care providers, employers, policymakers and all of society. Together, we can make a difference”, said Marie-Pierre Poirier, UNICEF Regional Director for West and Central Africa.

A recent poll conducted by UNICEF in 10 countries in West and Central Africa revealed that 55 per cent of youth incorrectly believe that babies need water in the first six months of life. Additionally, 45 per cent of respondents thought that babies should be given something in addition to breastmilk in order to grow strong and healthy. The Stronger With Breastmilk Only campaign focuses on stopping the practice of giving water to babies younger than six months as an entry point for shifting norms and behaviours towards improved breastfeeding practices.

“Alive & Thrive’s successful experiences in Bangladesh, Ethiopia and Vietnam demonstrate that it is possible to significantly increase exclusive breastfeeding rates in a relatively short period of time. Alive & Thrive brings evidence-based frameworks, methods and tools to support countries in West and Central Africa to scale up evidence-informed programmes that work, including initiatives in Burkina Faso and Nigeria, which are already showing promise,” said Dr. Tina Sanghvi, Senior Technical Advisor of Africa Country Programs at Alive & Thrive.

Having a comprehensive national strategy that protects, promotes and supports breastfeeding is the most effective way to influence the environmental, social, economic and behavioural factors that influence a mother’s decision to feed a child breastmilk only in the first six months of life.

The Stronger With Breastmilk Only campaign aims to catalyse much-needed policy, social, institutional, community and family dialogue and change towards improving breastfeeding rates in 24 countries. It calls on governments, partners and businesses across West and Central Africa to take action and position exclusive breastfeeding as a public health priority to improve the health and prosperity of children and nations.

Alive & Thrive data now available via Dataverse

Data make great impact when they are easily accessible to researchers and practitioners. We’re pleased to announce the launch of the Alive & Thrive Dataverse through which data produced by Alive & Thrive-supported research are immediately accessible and open. It includes household, frontline workers, and health facility survey-data from Bangladesh, Ethiopia, Vietnam, India, Burkina Faso, and Nigeria.