#WBW2022: A Q&A With Volunteer Breastfeeding Counsellor and Young Midwife Leader Hanifatur Rosyidah

3 August 2022

Bio: Hanifatur Rosyidah is an Indonesian midwife with a master’s degree in Public Health from Royal Tropical Institute, Amsterdam. She works as a Lecturer in Midwifery at Sultan Agung Islamic University and is a Volunteer Counsellor to support mothers who breastfeed.  

Her project with ICM’s Young Midwife Leaders Programme aims to build the knowledge and skills of midwives in breastfeeding support relevant to the immediate postpartum period. She is optimistic that if all midwives provide accurate information regarding infant feeding, breastfeeding support could be a cost-effective way of improving the ability of mothers to begin and continue to breastfeed successfully. 

What is the importance of World Breastfeeding Week? Does breastfeeding play a role in larger, global issues? If so, which issues and how is breastfeeding connected? 

The aim of World Breastfeeding Week is to raise awareness of the numerous advantages of breastfeeding for both mother and child health, with an emphasis on good nutrition, food security and reduced poverty. 

The UN stated that “Breastfeeding is ‘the smartest investment’ that families, communities and countries can make. UNICEF emphasized that: “Breastfeeding is one of the most effective–and cost effective–investments that nations can make in the health of their youngest members and the future health of their economies and societies.” 

Breastfeeding is an important, initial step on a child health journey in the future. Breastfeeding also plays a crucial role in global development efforts to build a more healthy, prosperous, and sustainable world. 

Breastfeeding is a key component of the 2030 Agenda for Sustainable Development and is connected to several of the Sustainable Development Goals (SDGs).

  • Goals 1, 8 and 10 focus on ending poverty, promoting economic growth and reducing inequalities. Investment in breastfeeding could save USD $300 billion in economic gains over 10 years, due to decreased disease and health care expenditures as well as greater productivity.
  • Goals 2 and 3 are concerned with hunger, health and well-being. Breastfeeding is a crucial source of nourishment that can save the lives of 520,000 children under the age of five, in addition to improving health outcomes for moms and children. Breastfeeding prevents diarrhoea and pneumonia, two leading causes of infants’ death. Breastfeeding also saves mothers from ovarian and breast cancer, two leading causes of death among women
  • Goal 4 is about education. Breastmilk contains several components that support cognitive development, especially in preterm infants. Breastfeeding is associated with an increase of 3-5 points (95% CI 1·9–5·0) on intelligence tests at childhood and adolescence.
  • Goal 5 centres on gender equality. Breastfeeding is connected to important equality problems, such as birth spacing and workplace rights. 
  • Goal 12 tackles sustainable consumption. Breastmilk is produced without the need for industry and has a small environmental impact both during manufacturing and consumption. This fact can be connected to the accomplishment of SDG 13, which focuses on decreasing the effects of climate change. 

How did your professional focus on breastfeeding support develop? 

Supporting breastfeeding is everyone’s responsibility. Stakeholders, government, academia, health workers, parents, families, employers and communities all have a role to achieve optimal breastfeeding. A multi-sectoral approach is needed to design and implement appropriate policies and innovative programs that protect, promote, and support breastfeeding. Governments have a responsibility to restrict the marketing of breastmilk substitutes and to create supportive environments for breastfeeding. For example, employers, public transportation, and public facilities should provide special seats and places for breastfeeding mothers to feed their baby or to express breastmilk particularly in the workplaces. Government also needs to ensure all health workers have good understanding and skills to support breastfeeding. Parents and families need to be empowered regarding breastfeeding practice. 

As a lecturer, I have a responsibility to build capacity of midwifery students to promote and support breastfeeding, conduct studies on breastfeeding issues, train in breastfeeding support and provide health promotion to ensure optimal breastfeeding practice. 

What do you hope to see come from the execution of your YML project? Can you tell us a little more about the project? 

My YML project is aims to build capacity of midwives to be able to promote and support breastfeeding. Furthermore, we will train midwives to use Breastfeeding Flash Card (BFC) as an innovative media that will help midwives in providing breastfeeding education to mother and family. We will monitor the implementation of midwives’ practice to support breastfeeding in health facilities. We hope this project will improve midwives’ knowledge and skills, as well as improve Breastfeeding Self Efficacy (BSE) of mothers and increase the exclusive breastfeeding rate. Finally, we will do advocacy meetings with the stakeholders to promote this pilot project and we hope this will be sustainable. 

Why do mothers need breastfeeding support? 

Breastfeeding is not easy. It requires commitment, support and effort to implement it. Some mothers may find difficulties, and some may even stop breastfeeding. This is due to lack of information, poor perception and also massive promotion of breastmilk substitutes. Recently, WHO and UNICEF launched the report study examining the impact of breast milk marketing on infant feeding decisions and practices. This study is based on the experiences of over 8,500 women and more than 300 health professionals across eight countries (Bangladesh, China, Mexico, Morocco, Nigeria, South Africa, the United Kingdom and Viet Nam). It revealed that health professionals are a key channel of formula milk marketing. Health professionals spoke of receiving commissions from sales, funding for research, promotional gifts, samples of infant and specialized formula milk products, or invitations to seminars, conferences and events. They have responsibility to provide breastfeeding education, however they promote formula milk.  

What is a midwife’s role in breastfeeding support? 

Midwives’ support of breastfeeding has been proven to provide an impact on women’s breastfeeding experiences. The midwife has a pivotal role in supporting breastfeeding during antenatal care, immediately after childbirth, and also during postnatal care. WHO recommends 7 breastfeeding education contacts, namely at 28 weeks of gestation, 36 weeks of gestation, delivery, in the first 24 hours after giving birth, within 7 days after giving birth, within 2 weeks after giving birth, and until the 39th day postpartum. 

What do midwives need in order to better provide breastfeeding support to mothers in the immediate postpartum period? 

The International Confederation of Midwives (ICM) has published Essential Competencies for Midwifery Practice in 2019. This document stated very clearly the minimum set of knowledge, skills and professional behaviours including required competencies to promote and support breastfeeding.  

Midwives need to have sufficient knowledge of physiology of lactation; nutritional needs of newborn infants, including low birth weight infants; social, psychological, and cultural aspects of breastfeeding; evidence about benefits of breastfeeding, indications and contraindications to use of drugs and substances during lactation; as well as awareness of lactation aids. 

Midwives are required to have a good skill and behaviour to promote early and exclusive breastfeeding while respecting a woman’ choice regarding newborn feeding; provide information about infant needs, frequency and duration of feedings, and weight gain; provide support and information about breastfeeding for a minimum of six months, including combining with work, maintaining milk supply, and storing breast milk; identify and manage breastfeeding problems (e.g. mastitis, low milk supply, engorgement, improper latch); provide information to women breastfeeding multiple newborns; refer women to breastfeeding support as indicated; as well as advocate for breastfeeding in family and community. 

What can our global community of midwives do to better educate themselves on the provision of breastfeeding support? 

Breastfeeding has huge health and economic benefits for babies, mothers, and communities. Skilled breastfeeding support from midwives helps prevent childhood infections and mortality. The midwifery community needs to ensure that midwives have sufficient knowledge, skill and behaviour to promote and support breastfeeding according to ICM minimum competencies, through education training or capacity building. Midwifery associations also need to encourage midwifery schools to educate their students with a curriculum that follows the ICM minimum competencies. Midwifery associations should enhance national efforts to protect, promote and support breastfeeding, and advocate for Baby-Friendly Hospital Initiative (BFHI). Those educational efforts and encouragement to support breastfeeding will not succeed without regulation that ensures midwives are familiar with all their responsibilities under WHO International Code of Marketing Breastmilk Substitutes. Therefore, midwifery associations need to develop policies that regulate the influence of formula milk companies that put midwives as a target marketing.