Haiti

            Infant mortality is high in low- and middle-income countries. There are a multitude of causes and corresponding interventions that can remediate this high rate. One way to address this tragedy is through improved breastfeeding practices. Research has shown that breastfeeding can improve infant outcomes. According to Skolnik (2018), “Infants 0-5 months who are not breastfed have seven-fold increased risks of death from diarrhea and pneumonia, respectively, compared to infants who are exclusively breastfed” (p. 266). “Suboptimal breastfeeding is the second … [greatest] risk factor for [under-5 child deaths]” (p. 195). In other words, varying from the recommended exclusive breastfeeding for six months leads to increase of poor outcomes for children under five years old.

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            The World Health Organization (WHO) (2018) recommends: “Breastfeeding is the best way to provide infants with the nutrients they need. WHO recommends exclusive breastfeeding starting within one hour after birth until a baby is 6 months old. Nutritious complementary foods should then be added while continuing to breastfeed for up to 2 years or beyond.”

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            Dornemann and Kelly studied adherence to this recommendation in Haiti, shortly after the devastating earthquake of 2010. It was noted that a Haitian NGO had begun work in 2010 to improve breastfeeding practice and utilized the phrase “The first milk is the best purgative,” as Haitians have been know to administer and oil-based substance instead of breastmilk directly after delivery to enhance the passing of the first meconium (baby stool) (p. 86). The study explored, via door to door and group interview, perceptions of and barriers to exclusive breastfeeding. The study found, that Haitian mothers often supplemented breastfeeding or refrained from breastfeeding at all directly related to their fear of not providing enough nutrition for the infant, because they knew they themselves were malnourished and could not afford the foods they needed to produce rich milk. Those who exclusively breastfed for six months (and this was only 20% of the interviewees) stated they did so because of the directive of a healthcare provider.

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            Breastfeeding is a highly cultural practice. This study reports “The success of health education depends on the degree to which it builds upon traditional knowledge” (Dornemann and Kelly, 2009, p. 86). In this case, modifying acceptable practice must take in to account the complexities of those who influence the maternal decision to breastfeed or pursue other traditional practices suggested by elders, mothers, grandmothers, and other indigenous health practitioners (Dornemann and Kelly, 2009 and Skolnik, 2018). These influential cultural leaders need to be educated that breastmilk is best, regardless of the mother’s nutritional status. However, increased attention needs to be made to address the stress related to procuring the needed foods to produce good milk and maintain the health status of the mother.