World Vision Uganda Northern Uganda Health and WASH Technical Project - NUREP maternal child health nutrition status Pacer Health Centre Agago district.

Overcoming cultural barriers to early and exclusive breastfeeding

In a small, rural village in Northern Uganda, Christine proudly shows off her healthy twin babies at a health facility where she has brought them for a regular check-up, and to listen to health workers on how best to care for them.

With their chubby legs and broad cheeks, the babies—her second-born—are a picture of health and strength. Christine knows why: She has faithfully breastfed the children since they were born, thanks to the advice and encouragement from her community health worker.


Christine Ayugi (26), a mother of twins in Agago at Pacer Health Centre III for check-up. World Vision reconstructed, equipped and provided latrines and a water system for Pacer Health Center III, Agago, Uganda.
A beaming Christine with her healthy twin babies


But health did not come easily to her first child. At the time, the 26-year-old mother did not know a thing about the benefits of breastmilk, including that exclusive breastfeeding would have prevented another pregnancy before she and her family were ready. "Nobody had ever told me the goodness of breastfeeding”, says Christine. “I even didn’t know breastmilk reduces childhood illnesses and infections, such as diarrhoea."

At the urging of her husband’s parents, Christine did not breastfeed her firstborn in the first hour after birth. Following traditions, she fed the baby on only water for the first week of his life until his umbilical cord fell off. Eventually, she added breastmilk and soft porridge to his diet, which made the infant ill and susceptible to life-threatening infections.

Christine hails from a region where mothers frequently delay breastfeeding and prematurely introduce liquid and other solid foods; a practice, according to health experts, that puts babies at risk of illness, stunted growth, and death.

Moreover, the World Health Organisation (WHO) recommends exclusive breastfeeding for the first six months of life, meaning the infant should only receive breastmilk without any additional food or drink – not even water – apart from syrups and medicines for a half year. The breastfeeding should be as often as the child wants, both day and night. WHO further recommends colostrum (the yellowish sticky breastmilk produced at the end of pregnancy) as the perfect first food for the newborn.

Evidence shows that breastfeeding provides the critical nutrients, antibodies, and fluids that babies need to stay healthy and to develop sensory and cognitive abilities. But available statistics paint a dismal picture. According to the 2016 Uganda Demographic Health Survey, only six in 10 Ugandan children below the age of six months are exclusively breastfed.

What’s more, only six in 10 mothers initiate their babies' breastfeeding within an hour of giving birth. A slight improvement was recorded from 63% in 2011 to 66% in 2016. It is no wonder then that the under-five and infant mortality rates stand at 64 and 43 per 1,000 live births respectively; which is very high by developing world standards.

This widespread cultural practice is what makes the day’s topic – exclusive breastfeeding – a special one to mothers like Christine. A few weeks after Christine became pregnant with twins, she spoke with a lead mother who told her about nutrition and caring for the pregnancy. The lead mother also talked to her about HIV counselling and testing, the benefits of giving birth at a health facility, and options for planning her births, including exclusive breastfeeding as a natural family planning method.

“It was our village doctor (a community health worker) who opened my eyes about breastmilk,” Christine says. “They always visit and encourage us to have a healthy diet to ensure we are healthy and strong for the time of delivery and [have] enough breastmilk for our babies. I had six prenatal care visits to learn more about what to expect during and after delivery.”

Innocent  Ongom, Clinical Officer at Pacer Heath Centre III in Agago District. World Vision reconstructed, equipped and provided latrines and a water system for Pacer Health Center III, Agago, Uganda.
Innocent  Ongom, a Clinical Officer at Pacer Heath Centre III in Agago District. World Vision reconstructed, equipped and provided latrines and a water system for Pacer Health Center III, Agago, Uganda.


A glance at the medical records for Christine's twins shows that they are healthy. “The twins' height and weight are normal, and they are lively”, says Innocent Ongom, a senior clinical officer-in-charge of Pacer Health Centre III in Agago District. “They’re strong, their faces are rosy, and their breathing is normal, so I must commend and encourage their mother to continue with exclusive breastfeeding.”

Now, Christine describes how strong and healthy her baby twins are, and shares what she learns with new mothers to help them overcome the cultural barriers to early and exclusive breastfeeding—and to ensure every baby has a chance to grow up healthy and strong. “When I look at my girls,” says Christine. "I’m convinced that they’ll live a healthy, happy life because I’m giving them the best start with breastmilk. When they grow up, I want them to be very clever. It’s my prayer."

World Vision, through its Northern Uganda Health and WASH Technical Project (NUREP), trained and supported more than 300 community health workers locally known as “village doctors” to boost awareness among families and communities about healthy and safe feeding practices for young children as well as promoting health-seeking behaviour.  

“We focus on improving nutrition during the critical period from a mother’s pregnancy until her child is two years old,” says Penninah Adur, a community health worker from Beioko village, Kole District. “We educate mothers [on] optimal and safe feeding practices, and mothers learn how to keep their young children healthy and well-nourished.”

The Australian-funded project was designed to improve the nutritional status of children under five, and pregnant and breastfeeding mothers in the districts of Oyam, Kole, and Agago in Northern Uganda. NUREP also aimed at increasing access to, and use of maternal and child health nutrition as well as water, sanitation and hygiene services, and practices by developing, equipping, and upgrading four health facilities in the region once devastated by the 20-year Lord’s Resistance Army war. The health facilities are Opetta, Atipe, Pacer and Acimi health centres.

To date, NUREP project initiatives have positively impacted more than 56,000 households with 86,000 pregnant and lactating women and children under five.

Empowered with knowledge, strengthened health systems, and community and family support, many more women in Christine’s community are breastfeeding their children longer and they can space their births adequately to greatly reduce the mortality rate. “Thank you, our village doctors, for watching over us,” says Christine. “We really appreciate your relentless effort, personal sacrifices and commitment.”

And now, Christine has a dream for her twin daughters. “When they grow up, I want them to be just like the people from World Vision who helped us,” she says. “I never knew there were such good people in the world. Thank you for saving our lives.


Written by Fred Ouma – Development Communications Coordinator, World Vision in Uganda