Breastfeeding in the Sahel

Shawn Baker visits two villages in Niger where exclusive breastfeeding has become the norm
Diffa Mother Breastfeeding

The next chapter in Shawn Baker’s travels with NY Times Journalist, Nicholas Kristof. Kristof’s column on June 22nd, The Breast Milk Cure, also discusses the merits of exclusive breastfeeding. 

We spent the night in the Magama Hotel in Dogon Doutchi. The last time I stayed here was in August 2010 and its services are as rudimentary as I remember. It is a magical time in the Sahel as the start of the rainy season transforms the countryside. It rained last night and we were kept company throughout the evening by a chorus of breeding toads taking advantage of the fresh puddles. The omelets and bread across the street were a welcome start to the day, and almost made up for a less than comfortable night’s sleep.

After the grim visit to the nutrition rehabilitation ward yesterday, today’s visits were a joy. We went to two villages where HKI is supporting the Ministry of Public Health to implement the essential nutrition actions framework. Two key elements are timely initiation of breastfeeding (within one hour after giving birth) and exclusive breastfeeding for the first six months. In both villages we were greeted by mothers who were practicing exclusive breastfeeding and their glowing babies. The sense of pride is palpable and the mothers routinely report that their infants have fewer cases of diarrhea, grow better and play more.

Mothers with Breastfed Babies

Nigerien mothers with exclusively breastfed babies

HKI tries to make sure health workers’ knowledge is up-to-date and we reach out to traditional birth attendants to ensure they are properly educated about breastfeeding. The head nurse of the health center completed his formal training in 1982, and he told us that at that time he was taught that breastfeeding should be delayed, that water should be given whenever the infant was thirsty and fruit juices should be started at three months. He and his team have come a long way since then and are now strong advocates for exclusive breastfeeding.

Traditional birth attendants and other older women in the village are the custodians of infant and young child feeding practices and provide guidance to new mothers. As they too become convinced of the merits of optimal breastfeeding, they have also become powerful allies in preventing malnutrition.

Seeing babies bursting with health and mothers beaming with joy transforms the dry statistics about improved breastfeeding rates into a human reality. Breastfeeding is a truly miraculous intervention and one that doesn’t require any drugs, any surgery or any fancy equipment. It gives me hope that if the success we saw in these two villages could happen on a national scale, it would become rarer and rarer for children to need treatment for severe acute malnutrition. This would be truly transforming.

We rounded out the day by going back to the nutrition rehabilitation center we visited yesterday to interview more mothers. I wanted to check on the progress of Mariama, the little girl who had been admitted for acute malnutrition a few days back.  It was heartening to see that she was now sitting upright and even playing with a toy. She started crying before I left and her mother put her to the breast. We left the clinic as Mariama lay sleeping peacefully in her mother’s lap, clutching her toy.

Mariama in the evening of June 20, 2011

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Categories: Africa, Reducing Malnutrition


  1. Wonderful article, thank you & Bravo! The world needs more stories like these. Kind Regards, Julieanne

  2. Nabeeha M. Kazi says...

    Thanks HKI friends for this post. And thank you for your amazing work on the ground! Your team has cross posted this piece on our blog –

    In addition to some of the issues you have highlighted, there are a few more barriers to consider – that need to be tackled in a cross-sectoral way (policy, business, civil society, media, entertainment, etc.):

    1. Work. Often times women are walking for hours to get to work – factory jobs, farm jobs, household jobs – especially those living on the outskirts of urban centers. We have yet to really tackle how we make breastfeeding accessible and realistic when employers are not sympathetic, there is nowhere to pump or express breast milk, much less store it in a cold facility.

    2. Status Symbol. You’ve pointed out that formula is one of the alternatives parents give to their babies. In many communities formula is perceived as a status symbol. It comes in a nice fancy box with its own scoop and pictures of thriving, beautiful babies. It’s presented as a desirable product and the emotional response by the uninformed consumer is that it must be better than anything else out there. All mothers want the best for their babies. If I have access to little information, am largely powerless, but have great hopes for my baby, picking the fancy box might be an obvious choice.

    3. The Convincing Advocate. We need to re-think the “poster children” for exclusive BF. Who is the right advocate for exclusive BF in the community? Is it the Priest or Imam’s wife or daughter? The First Lady? The celebrity? What if we saw these women breastfeeding? They would reinforce healthy habits and challenge traditions and convention in a meaningful way.

    We must ensure we have our social, political, cultural and marketing hats on as we promote exclusive BF. And, we must be creative if we are to build a global BF movement owned and espoused by the mamas.

  3. Susan E Burger says...

    Hi Shawn:
    I have some other different ideas from having spent hours and hours of sitting with women — admittedly of a different social and economic class — but the hearts of mothers are essentially the same anywhere they are. I know that celebrities can convince some women, but in reality, most women see themselves as having far more to contend with than the celebrity that has access to paid help. One idea that worked brilliantly in Great Britain was making the women themselves — ordinary women the stars. They really had nice blogs and beautiful photos of these women. You would need to be very culturally specific and appropriate in terms of what is considered a “good” mother, but the women themselves and other women who read about them felt far more connected to one of their own — rather than the celebrities.

    One universal is the fear of inadequate milk. I know that there are many ways that cultures have developed “tests” for milk. Remember Nancy and the “hot knife test” she discovered in her research in that one village in Niger? American women are no more sophisticated, they have now latched onto the idea that their milk doesn’t have enough fat and they want test strips to make sure that their glass of wine won’t harm their milk. What if you created fool proof test strips that change color and tell mothers that their milk is perfect? I might counteract some of the testing and discarding that goes on — particularly if religious leaders and health care workers endorsed the idea.
    Best, Susan Burger

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