Earlier this week, I was fortunate to attend the launch of a report by Save the Children on the state of malnutrition globally. Their report, entitled “A Life Free from Hunger” rightly draws global attention on one the most important, yet perhaps most neglected causes of child mortality and ill health – malnutrition. According to their estimates, malnutrition is an underlying cause in 2.6 million child deaths every year. And of course mortality is only the most extreme manifestation of this problem, it leaves children less able to learn and to grow into productive members of society.
What I disagree with is the message among advocates of child health that the we already know what works and that “simple” interventions simply need to be implemented. If the solutions are so simple, why are they not adopted or implemented?
The report states:
Simple solutions delivered to children who are at risk of malnutrition and their families are well known and well supported by nutrition experts. In 2008 the Lancet medical journal identified a package of 13 direct interventions – such as vitamin A and zinc supplements, iodized salt, and the promotion of healthy behavior, including hand washing, exclusive breastfeeding, and complementary feeding practices – that were proven to have an impact on the nutrition and health of children and mothers.
I agree, many of these interventions are relatively inexpensive and straightforward, but in particular with regards to the behavior change components, I don’t think the solutions are so simple. I believe that we have not even begun to understand why these practices are so hard to put into practice. One prime example of this is breastfeeding.
Honestly, if I hear another public health official (frequently male) allude to the fact that breastfeeding is among the simplest interventions available I think I am going to lose it. I can tell you from first hand experience, breastfeeding was among the most physically and emotionally challenging aspects of raising my own son.
My son was born a week early by cesarean section due to the fact that he was breeched. This delivery likely delayed my own milk production and I spent four very distressed and agonizing days watching my son shrivel up because I was so hell bent on making breastfeeding work. The simple solution would have beee to supplement his feeding. The advice and support I received from the breastfeeding experts usually took the form of one counsellor telling me to only do Y and whatever I do don’t do X only to be followed up by another counsellor telling me to only to X and never to do Y. Oh, and I did I mention how painful it was? Picture cracked, bleeding and infected nipples and a whirlwind of hormones. Yeah.
Most public health experts recommend mothers to “exclusively” breastfeed their children for 6 months. But that means that the mother can never very far from their baby this entire time. The fact that this might negatively impact a mother’s labor force participation or productivity seems completely ignored in these cost-effectiveness calculations. Simple in this case is leaving a bottle so that fathers, grandparents, and other care givers can share in the feeding of children.
This of course is just one of these interventions, and this is just my own personal reflections on the process – many women love and adore breastfeeding – I even started to enjoy it after a month or two and before my son decided he had enough and decided to communicate this to me by biting during feeding sessions – but it points to what I believe is a very important and overlooked issue in global health, that of why some healthy behaviors and technologies are adopted while others are not. That is not so simple and we have only begun to scratch the surface being able to influence these behaviors through policy.Share on Facebook