Conakry — Countless babies in Guinea are not given their first breast milk for hours - however long it takes a designated family member to bring water that is used to rinse special Koranic verses inscribed on a wooden tablet. This symbolic liquid, the first thing many babies ingest, is just one example of a custom believed to protect children but that can instead jeopardize their health.
Breastfeeding is almost universally practiced in Guinea. The problem, health experts say, is that it is rarely early or exclusive - both recommended for optimal health. A 2011-12 health and nutrition survey in Guinea by the Health Ministry with UN Children's Fund showed that 18.5 percent of women practice
exclusive breastfeeding in a baby's first six months - down from 32.9 percent in a 2008 study. The rate varies by region.
The World Health Organization and UNICEF recommend that an infant be breast-fed within one hour after birth and consume only breast-milk for the first six months.
The period from birth to two years old is seen as the "critical window" for the promotion of growth, health, behavioural and cognitive development. The survey showed that 5 percent of children in Guinea aged five and below are acutely malnourished, with 34.5 percent suffering chronic malnutrition.
At a community health centre in the Petit Simbaya neighbourhood of the capital Conakry, Fatimata Camara sat with her one-month-old son, Aboubacar, after having him weighed. When Aboubacar was born, she explained, her husband's younger brother came with the talisman - the Koranic-verses' water that would be the baby's first intake.
It is common in many parts of West Africa to give this rinse-water to someone who is ill or thought to be under a curse. In many Guinean communities it is also believed to protect newborns. Some 85 percent of Guinea's population is Muslim, though by no means all practice the Koranic rinse-water treatment on newborns.
"The baby had this medicine before receiving breast milk," Camara said. She said she has given the infant only breast milk since.
Aboubacar was 1.8kg at birth, and that day weighed in at 3kg. For him the ritual does not appear to have caused a problem, but it is a dangerous practice, health workers say, given the likelihood of causing infections.
The same applies to simple water, water mixed with shea butter, and kinkeliba (a tea from a local plant) all of which are commonly given to an infant before and/or along with breast milk.
"Many people find it hard to believe - given that they themselves need water to survive - that a baby can go without water," said Mamady Kaba, head of maternal and infant health and nutrition with the international NGO Terre des Hommes-Lausanne in Guinea.
He said in many cases if a weeks-old baby dies, even if the child was fed liquids other than breast milk, family members generally blame the mother's milk.
"They say the milk is 'bad'," Kaba said. "Family members generally then discourage her from breastfeeding subsequent children. Sometimes the woman is stigmatized." He said to this day some people use an age-old "test" - pouring some of the woman's breast milk on an ant. If the ant dies, people say that it proves the milk is bad.
A family affair
A battle Kaba fought in his own household illustrates the challenge of improving infant health and nutrition. When his wife gave birth he quarrelled with his mother, his mother-in-law and other family members, who wanted to give the baby water, kinkeliba and other items customarily fed to infants.
"When I said no - that my child would have only breast milk - my mother and mother-in-law took this as an affront," Kaba told IRIN. "They said, 'we won't let this child get sick before our eyes because of your rules.' They schemed with my wife - 'we can give the baby other things while he's not here.' My mother stopped talking to me for a while. I was even called to the village to explain myself to the elders there."
It was a long battle but he and his wife stuck it out. When they took the baby for consultations and weighing - which showed steady growth - he always showed the results to the family. "It was palpable evidence - they really didn't have an argument against that."
Also at the Conakry health centre was Kadiatou Diallo with her two-month-old son, her first child. She said the baby, who has steadily gained weight since birth, has consumed nothing but breast milk. The 20-year-old student lives with her husband, who has had some education, his older brother and the brother's wife.
"They all know about the importance of exclusive breastfeeding," Diallo said. "My sister-in-law talked to me about all this while I was pregnant and when I had the baby."
Indeed, involving family members - especially the woman's husband and his mother - is integral to promoting exclusive breastfeeding, said Sylla Nima, who educates women about infant and child nutrition at Donka Hospital in Conakry.
"We invite the husbands and other family members," she said. "Especially the mother-in-law," another health worker added. Nima talks to families about the potential harm of some customs and explains that breast milk contains everything a baby needs. She also educates women about breastfeeding techniques and the importance of hygiene.
A woman who had come to the nutrition session at Donka for the first time that day had her ailing infant on her lap. The five-month-old was about the same weight as at birth. The woman said she had recently started giving the baby store-bought milk products because she was not producing enough breast milk.
"Women often tell us that," said Nima. "But usually it's just a lack of understanding about how breast milk production works. Most women have ample milk to nourish an infant. We show them different techniques to sustain production."
What the woman might not have understood is that the lapse in breastfeeding while she gave her child artificial milk probably contributed to what she thought was a low supply of breast milk, said Ibrahima Sory Diallo, a doctor at Donka Hospital.
The use of store-bought milk products - liquid and powdered - probably contributed to the drop in exclusive breastfeeding rates in Guinea as shown in the 2008 and 2011-12 studies, according to UNICEF.
The agency says the decline is probably due to three factors: aggressive marketing of milk products has some women adding them to their babies' diet; the 2008 study might have overstated the rate of exclusive breastfeeding; and socio-political instability in Guinea has hit community nutrition education activities.
Motivation by example
Donka health worker Nima said women who come to the sessions share their experiences and watch the growth rate of the children, and they see for themselves the benefits of exclusive breastfeeding.
Seeing positive experiences of other women and their babies is a powerful motivator for changing feeding practices, according to a study by aid group Action Against Hunger - Spain conducted in Conakry's Matoto District. Beliefs that can work against breastfeeding - including that sexual relations could make breast milk dangerous for a baby - are heavily ingrained and are applied by 50 percent of Matoto's population, the study found.
Therefore significant improvement will take time, the report says. "However, people who have benefited from nutrition education programmes in the past and who have changed their practices can be effective in educating others in the community."
This report does not necessarily reflect the views of the United Nations