“Business as usual” will not suffice to improve exclusive breastfeeding in West Africa

Addressing the problem of exclusive breastfeeding in West and Central Africa called for a new approach – “business as usual” would not suffice, UNICEF West and Central Africa Nutrition Advisor Simeon Nanama told participants at the 11th Africa Food and Nutrition Security Day global webinar event in October. The new approach is Stronger With Breastmilk Only.

“Thirty per cent of babies are exclusively breastfed (in the West and Central Africa region),” Nanama said. “That is 20 percentage points away from the 50 per cent World Health Assembly 2025 target. And doing business as usual will not get us to meeting that goal.

“So, because of that, we decided to be very systematic trying to understand how we can reimagine the breastfeeding programming…. Building on these these two analyses of quantitative and qualitative data, a regional programme was designed (Stronger With Breastmilk Only).

“The objective is really to focus on advocacy to change social norms and behaviors. It is a large regional campaign and right now 19 countries have subscribed to the campaign.”

Watch Mr. Nanama’s presentation below.


Before I get into how we went systematically on the use of data, I would like to give you an overview of the UNICEF West and Central Africa region. It is a region with 24 countries. Together, those countries are home to 11 percent of the world’s under five children. However they are also home to 20 of the world’s stunted children and 35 percent of the world’s under five death. It means that there is a big discrepancy between population size and all the burden of child-related issues in this particular region.  We all know that breastfeeding is important and adequate child feeding – and breastfeeding in particular – is critical for survival development and growth of children and there is a lot of evidence on that. But when we look at the data in this region only 3 out of 10 children are exclusively breastfed and the remaining seven children who are not exclusively breastfed are not exclusively breastfed for different reasons because they are receiving other food in addition to breastmilk.

Breastfeeding is a priority in the UNICEF regional plan for the period 2018-2021 and we really wanted to make sure that we focus and work on this aspect, which is the first line of defense and the first line of prevention when we are talking about malnutrition. But because the situation has not been improving for many years, we thought that we needed to really be innovative, thinking out of the box and trying to be a bit more focused and going to scale to make sure that we make a difference when it comes to improving breastfeeding. Because 30 percent of the babies who are exclusively breastfed that is 20 percentage point away from the 50 of the world health assembly 2025 targets and doing business as usual will definitely would not get us to meeting that that goal.

So because of that, we decided to be very systematic in looking at the data and trying to understand how we can re-imagine the breastfeeding programming. We started by looking at the first step – looking at quantitative data and this is illustrated by the first graph that you see on the upper side of upper left side of the of the slide where the yellow bars are showing the proportion of babies age less than six months that are exclusively breastfed in a number of countries in the region. And the blue part of the bars are the proportion of the children who are fed breast milk plus water. The blue presents those breastfed with receiving water in addition to breast milk and clearly if we are able to remove or reduce the proportion of babies who have fed water we would bring the rate of exclusive breastfeeding to in most of the countries, except maybe two, to the level of 50 which is the 2025 target. So this analysis, the quantitative data has helped us to identify a critical bottleneck which is really water being the problem in most of the countries of the region.

Then we went ahead in a second step to try to understand what are the social cultural barriers to child feeding in general and to breastfeeding in particular: What are the influences of child feeding in the community in the families and what are the enabling factors that we can leverage on to improve breastfeeding? We did that work together with Alive & Thrive and that has helped us to really understand where are, who are the people in the community we need to target if we need to make a difference in in breastfeeding. We also identified the factors that can enable us to make a difference at the community level and in families. And that qualitative study led also to programmatic recommendations. Now building on these two analyses of quantitative and qualitative data, an original program was designed which is called Stronger With Breast Milk Only and you can see the logo on the right hand side of the slide.

The objective is really to focus on advocacy to change social norms and behaviors. It is a large regional campaign and right now 19 countries have subscribed to the campaign. The campaign was launched in Cote d’Ivoire last year and it is being now rolled out. And the idea through this program is really to support, promote and protect adequate child feeding practices, breastfeeding practices and to support the families to engage the community systems in this initiative, to also strengthen this health care system and improve the norms, and to engage the business sector as well and to improve the perception and the social environment around child feeding and strengthening the national policy and regulation related to breastfeeding especially some regulations like the code of marketing of breast milk substitute.

The overall outcome we are aiming at is really to push most of the countries engaged in this initiative to be able to remove water from the feeding of children and to be able to achieve the 2025 uh world health assembly target for exclusive breastfeeding which is 20 to 50 percent at minimum of the of the children being exclusively breastfed. Now the program was launched and it’s being rolled out now we are in a stage where we are working on the next steps which is really to work on the monitoring framework and be able to monitor the countries and see how they are progressing and see what are the bottlenecks they are facing in the implementation of the campaign and help them readjust the program. We also need to engage in knowledge generation and knowledge management to document best practices in countries that are making progress so that the other countries could use that and also speed up the process toward achieving the objective and do the adjustment of the program as we go. This is an example that we are just taking to share with you on how we use data to design a program aiming to reduce malnutrition. We often hear that we are lacking data in many sectors and this is true but it is also true that we can do a lot with the data that we already have in hand.