A number of cultural practices exist in Afghanistan that undermine maternal and child nutrition, such as the practice of discarding colostrums and introducing other liquids to their diets before babies reach six months of age. World Vision’s programmes train community members on proper practices and empower them to share that information with their neighbours, significantly improving the chance of survival and overall health of babies and their mothers.
“Pound a piece of rock candy as well as three or four Cardamom seeds and one nutmeg (Jose bia). Mix them together and put it (the mixed powder) inside a clean piece of cotton,” explains Halima a community health worker with more than seven years of experience. “Whenever the newborn gets hungry or cries, put the mixture inside the baby’s mouth and wait for a moment. The baby will suck it and become silent.” Halima’s advice is practical and personal. It is also an example of common practices that are rarely questioned, but which need to change.
“I fed my babies like this,” admits Halima. “My mother-in-law taught this method to me and I taught it to my daughter-in-laws before I became a Community Health Worker.”
Halima’s experience is anything but isolated. Statistics show that only 35 per cent of mothers exclusively breast-feed their babies and only 28 per cent of those who do, wait until the child reaches 6-months-old to introduce complementary food.
It’s hard to overstate the importance of breastfeeding. A study done by UNICEF shows that children who are not breastfed are 14 times more likely to die in the first six months of life when compared to babies who are exclusively breastfed. And, it has been shown that early and exclusive breastfeeding in the first days of birth can reduce risk of death by up to 45 per cent in babies.
In Afghanistan, not only do most women not breastfeed their babies, those who do often discard the colostrums, believing that because it is a different colour the milk is dirty or infected. “As soon as a mother delivered, we drew out her breast milk for three days. During this time, we often fed the babies sugared water and animal oil,” remembers Halima. “After that, it was difficult to get the baby to take breast milk or encourage the woman's milk production,” she adds.
“I know, now, this [sugary water, oils and seeds] is not a good method to feed the babies. "
Today, Halima is making a difference by taking the message of proper infant nutrition to mothers and expectant mothers in her community. “I know, now, this [sugary water, oils and seeds] is not a good method to feed the babies. [Now], I advise people to give only breast milk for up to six months,” she says.
In Afghanistan, World Vision is working hard, alongside other organisations, to save the lives of Afghan mothers and children. In recent years, World Vision Afghanistan has trained more than 514 Family Health Action Groups (FHAG) with 51,400 members in Ghor, Badghis and Herat provinces through its maternal, newborn and child health projects.
The projects build the capacity of Family Health Action Groups, Community Health Workers (CHW) as well as the Basic and Essential Package of Health Service implementers at the community level to successfully engage caregivers in nutrition promotion, behavioural change communication, and nutrition surveillance.
Mahgol, 19, is one of the youngest members of a World Vision initiated Family Health Action Group in Maloma, a village in the Karukh district. The road to her village is narrow and often impassable; the distance to the nearest clinic is around 15 KM.
Mahgol’s mother is also an experienced community health worker and was recently trained by World Vision to lead a Family Health Action Group. Because she had to drop out of school when she was in class ten (her brother didn’t like that she had a male teacher), Mahgol decided to follow in her mother’s footsteps and put her energy into learning about proper health practices and then sharing that information with her neighbours. Although she is young, Mahgol has already participated in many trainings conducted by World Vision to become a Family Health Action group member.
“Breast milk has two main advantages,” explains Mahgol, with confidence, although she is single and has no children of her own yet. “It is free and it’s a valuable food that also works as an antibiotic for the babies. This white liquid is a blessing and a natural method to protect mothers from becoming pregnant again too soon after delivery.”
“In the past, people weren’t aware of these issues so women did not eat differently before or during pregnancy,”
Good nutrition during pregnancy can help keep both the mother and her developing baby healthy. The need for certain nutrients, such as iron, iodine and foliate, is increased during pregnancy and just after birth.
“In the past, people weren’t aware of these issues so women did not eat differently before or during pregnancy,” says Halima. “Pregnant women [used to] eat the same food that other family members eat. Sometimes they even ate less than the others during the last months of pregnancy, as their stomachs didn’t have enough space. Thanks to the trainings, many people’s minds have been changed and their knowledge about health is growing every day,” added Halima.
“Before people had very wrong and dangerous customs,” said Dr. Elyar, Director of World Vision’s Child Health Now programme. “They gave their babies a mixture of poppy flower, cannabis, Nigella Sativa and some other herbs at bed time so their babies could have a comfortable sleep. This may be one of reasons for the high child-mortality rate in Afghanistan. But, hopefully these misconceptions are gradually disappearing through the awareness-raising sessions conducted by World Vision and many other NGOs in the country.”
“Myself, my mother and all Family Health Action Group members work for free,” says Mahgol. “Every day, my motivation to provide health services grows because I see that you [World Vision staff] come to our village regardless of the risk of security issues and the impassable roads, just because you want to improve our capacity to save the lives of women and children. I don’t know how to thank you, but I hold you in my prayer,” said Mahgol with calmness in her voice.
“World Vision works with communities to increase and improve their knowledge in the area of health-related issues as well as behaviour change communication,” said Dr. Rahimi, Integrated Management of Child Illness officer from the Department of Public Health. “All these activities are sustainable. If one day this organisation leaves the country, the people’s knowledge about health issues will remain in the community and they can transfer that [knowledge] to the next generation.”
Through World Vision’s maternal, child health and nutrition programmes, the percentage of children under six months old who are exclusively breastfed increased from 56.7 to 83.5 per cent and the percentage of newborns who were put to breast within one hour of delivery and did not receive pre-lacteal feedings also increased from 50 per cent to 58.2 per cent in the communities where World Vision is active.
NRVA 2007/2008 (National Risk and Vulnerability Assessment)
MICS 2003 (Multiple Indicator Cluster Survey)
AHS 2006 (Afghanistan Health Survey)