Health centres in Burkina Faso tell mothers to feed their babies only breast milk until they are six months old to boost their immune systems, but this advice goes unheeded when the women return home.
This is the second article in a five-part series marking World Breastfeeding Week and the undertapped yet life-saving potential of the practice in West Africa.
Even if mothers agreed to feed their babies only breast milk - called exclusive breastfeeding - the real decision-makers in child care are grandparents. "Children do not belong to only their parents in African society," said D. Marc Sawoudogo, a nurse and director of the village clinic in Zincko, Kaya health district, 100km northeast of the capital, Ouagadougou.
"Here, the grandparents take the babies as soon as they get home and dismiss the parents as if to say, 'Who do you think you are?' It is the old ladies who block exclusive breastfeeding from taking root," Sawoudogo commented. "You do not go against an African grandmother - I am a nurse and still have a hard time being diplomatic with my mother on these issues."
Breast milk not only contains life-saving nutrients, but also antibodies that boost babies' immune systems against pneumonia and diarrhoea, the biggest child killers, the World Health Organization (WHO) has noted.
West and Central Africa have some of the world's lowest exclusive breastfeeding rates - only 20 percent - and also one of the highest regional averages in infant mortality - 108 deaths per 1,000 live births - according to the United Nations.
A 2006 study estimated that improved breastfeeding practices in West and Central Africa could save 300,000 lives annually.
Initial findings in an ongoing study funded by the UN Children's Fund (UNICEF) on breastfeeding practices in Burkina Faso have shown that efforts by health centres to educate women about breastfeeding practices have little impact, said Marcel Daba Bengaly, the study coordinator.
"They are told what to do about breastfeeding at the delivery ward, but when they get home they are faced with parents who do not agree to feed the baby only breast milk, so the advice is not heeded," said Bengaly.
Yet a multi-agency report in 2008 noted that exclusive breastfeeding has increased in other communities.
Over a decade, the number of babies from newborns to five months old who were exclusively breastfed increased from 10 percent to 43 percent in parts of Benin, from seven percent to 54 percent in Ghana, and from eight percent to 38 percent in Mali.
This was achieved by means of theatre and flipcharts, volunteers and village leaders, local media and grandmothers, but much remains to be done: overburdened and sometimes illiterate community health workers, lack of follow-up and discontinued programme support were listed as challenges in the report.
In Zincko village, clinic director Sawoudogo said he would like to talk to the grandmothers about allowing their daughters to breastfeed exclusively, but this would require money.
"These ladies will not come out for nothing - we need to approach them with some token, an incentive, like when we bring kola nuts to meet with village chiefs. We do not make enough to pay for kola nuts with our own salaries," said the clinic director. "No kola nuts, no grandmothers."
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions