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  • Title: Practical therapeutics: present day hospital practices influencing breastfeeding in Nairobi, Kenya.
    Author: Lakhani S.
    Journal: East Afr Med J; 1984 Feb; 61(2):163-8. PubMed ID: 6468324.
    Abstract:
    Practices which influence infant feeding in a private hospital in Nairobi, Kenya, were described both before and after the hospital modified its practices in response to the growing awareness of the negative impact of bottle feeding on infant health. In 1978, many practices in the hospital's prenatal clinic and maternity ward encouraged bottle feeding. Representatives from infant formula companies routinely gave talks and passed out infant formula promotional literature in the waiting room of the hospital's prenatal clinic, and clinic personnel distributed the companies' literature to patients who inquired about infant feeding. Observations, that same year, of hospital routines in the maternity ward revealed that mothers and infants were separated within minutes of delivery. 55% of the mothers were not given an apportunity to initiate breastfeeding until 6-24 hours following delivery, and for 40% of the mothers breastfeeding commencement was delayed for more than 24 hours. The remaining 5% did not breastfeed. All the babies received their 1st feed from bottles. Mothers were told that supplementary bottle feeding was necessary. Each time the babies were brought to the mothers, the mothers were given a bottle of baby formula. Babies were brought to the mothers for feeding 5 times a day, and in between these visits, nurses gave bottle feeds to the infants. Mothers were given littl assistance in establishing breastfeeding and received no support for breastfeeding following discharge. At discharge, free samples of formula were distributed to the mothers. The negative effects of the anti-breastfeeding campaign were brought to the public's attention by a 1978-79 Kenya survey, which revealed that breastfeeding was declining markedly, and by the informational activities of the Breastfeeding Information Group (BIG). During 1979 practices at the prenatal clinic were markedly altered due to the efforts of the clinic's manager, the hospital's dietitian, and a guest researcher. Representatives of the formula industry were barred from the waiting room, distribution of the promotional literature was halted, and the bottle feeding promotional posters provided by the industry were removed from the clinic's walls. The Nairobi BIG was invited to talk to the clinic's patients at routinely scheduled times and to sell, for a nominal fee, literature on breastfeeding. The literature was sold rather than distributed free in the belief that people are more likely to read purchased materials than materials that are simply handed to them. Efforts to alter the hospital's postnatal practices were less successful; however, milk nurses were barred from the maternity ward, and mothers were no longer given free samples of formula at discharge. Efforts by BIG personnel to visit mothers after they returned to their homes were frequently obstructed by relatives who believed that breastfeeding should be discouraged. Breastfeeding is actively promoted now at the well baby clinic, and mothers received supportive breastfeeding assistance from the clinic's staff. This case study reveals that there are many ways in which hospitals can offset the impact of the anti-breastfeeding campaign.
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