In an attempt to drum support for exclusive breastfeeding, Nigerian health ministry top official made false and misleading claims
On August 9, 2018, Chimay Thompson, the Assistant Director, Nutrition Division, Family Health Department at Nigeria’s ministry of health, in an interview with the News Agency of Nigeria (NAN) that was published by Premium Times made a misleading claim regarding the status of exclusive breastfeeding in Nigeria; the official also made false claims on the link between exclusive breastfeeding and breast cancer.
24% dilemma
In the report, Nigeria’s health ministry noted that only 24% of infants in Nigeria are exclusively breastfed.
“The nationally accepted document which is the multiple indicator cluster survey states that we are presently at 23.7 per cent on exclusive breastfeeding in the country,” Thompson said, while also describing the data as discouraging.
“This is not encouraging and if we have to achieve the National Strategic Plan of Action on Nutrition by the health sector plan, we are supposed to achieve 50 per cent in 2018,” Thompson added.
Investigation revealed the data quoted by Thompson was gotten from the Multiple Indicator Cluster Survey conducted between 2016 2017 by Nigeria’s National Bureau of Statistics and United Nations Children’s Fund (UNICEF).
According to the report, only 23.7% of infants under 6 months of age who are exclusively breastfed in Nigeria are breastfed. But a closer look at the information about the data showed it is of limited extrapolative use since only 2,723 women were involved in the study that generated the data that the ministry is using to represent the entire country even though over 20,000 babies are delivered daily in Nigeria according to UNICEF.
Additional data revealed relevant variations that experts said ought to be given much consideration by the health ministry.
While the national estimate hovers around 24%, the estimate for breastfeeding in Nigeria’s urban areas is much higher, peaking as high as about 38% while the estimate for rural areas was as low as 18%.
“We can clearly see that just saying babies should be exclusively breastfed will not be the solution since women in urban areas are increasingly embracing exclusive breastfeeding unlike those in rural areas,” said Dr. Victoria Adepoju, Executive Director, African Development and Empowerment Foundation.
In addition to the overall data presenting a more serious crisis at the rural areas, it also drew attention to another crisis that was masked by the 24% national data. According to the official UNICEF dataset for Nigeria, as an infant’s age increases, the proportion of breastfed babies reduces.
Between 0 and 1 month, up to 37% of infants were breastfed but the number dropped to 26% at the third month. At the fifth month, the number significantly dropped to about 12%.
There are also variations among well educated mothers and those with little or no education. Among women that are well educated, up to 36% practice exclusive breastfeeding but among those with no or primary education, only 16% practice exclusive breastfeeding.
Thompson noted that efforts need to be geared towards ensuring that the country meets the target of 50% in 2018. Available data showed some states in Nigeria had already reached and exceeded the target, suggesting that a broad national approach towards improving the popularity of exclusive breastfeeding maybe ineffective. Instead, experts suggested that states with low figures should be given more attention.
In Abuja for instance, over 52% of infants are exclusively breastfed while in Abia it is about 30%. At the lower end is Bauchi where only 13% of infants are exclusively breastfed. The state with the lowest estimate is Cross River where only 8% of infants are enjoying exclusive breastfeeding which was a significant reduction from almost 20% that was reported in 2011.
There are also variations across regions with the southwest ranking highest with about 49% of infants in the region accessing exclusive breastfeeding.
Verdict
While the national estimate quoted by Thompson is true, data showed it is misleading and is not a true representation of the status of exclusive breastfeeding in Nigeria hence it should not be used to formulate national policies.
“Promoting exclusive breastfeeding in Abuja will not impact the national outlook since they don’t such problem in Abuja. Instead, places like Cross River and others where exclusive breastfeeding is unpopular should be attracting the attention of the government. That is where the message is needed and that is where things need to change,” Victoria added.
It has been well documented that the benefits of breastfeeding to a growing infant.
According to Thompson, the baby gets the perfect nutrients needed from the breasts milk, which is the first immunisation given to the child, the vaccine anti-gene rich in vitamin A, comes from the breast milk.
“There are also anti-effective and growth factors which are contained in the breast milk and cannot be got from breast milk substitute or any source of animal milk such as goat or cow,” Thompson said.
Breastfeeding and breast cancer
While drumming support for breastfeeding, Thompson also claimed exclusive breastfeeding prevents most breast and ovarian cancers.
“It is proven that exclusive breastfeeding prevents most breast and ovarian cancers women experience today,” Thompson said.
But a review of published literatures on the subject of breastfeeding and breast cancer led to the conclusion that this claim is false.
In their study that was published in Lancet (full paper below), the Collaborative Group on Hormonal Factors in Breast Cancer reanalysed individual data from 47 epidemiological studies in 30 countries, including 50 302 women with breast cancer and 96 973 women without the disease.
They concluded that the relative risk of breast cancer decreased by 4.3% for every 12 months of breastfeeding.
Since exclusive breastfeeding is only for 6 months, the reduction in relative risk within this period is about 2%.
breast cancer and breastfeedingThe reduction is only applied to women that had given birth to several children and breastfed them all. With the little reduction in relative risk attributable to Nigeria’s current exclusive breastfeeding protocol, medical experts affirmed that Thompson claim that breastfeeding prevents most breast cancers is false.
This position was further buttressed by a publication that reviewed available studies on the relationship between breastfeeding and breast cancer.
While doubting the existence of a breast cancer-protecting feature in breastfeeding, Loren Lipworth and other co-authors noted that even if it exists, it is only for women that are able to be pregnant and not those that had reached menopause which is the stage where more Nigerian women develop breast cancer.
“It appears that the protective effect, if any, of long-term breast-feeding is stronger among, or confined to, premenopausal women…The evidence is limited and should be interpreted with caution,” Lipworth and colleagues added while also noting that public health agencies such as the World Health Organization did not issue any recommendations on the subject of breastfeeding and breast cancer since there is no sufficient evidence in support of the claim.
Breastfeeding and ovarian cancer
For Thompson’s claim on the ability of breastfeeding to prevent ovarian cancer, a review of available literature on the query also showed the claim was false since there is no well established causative relationship between breastfeeding and ovarian cancer as attested to by Thompson.
Just like breast cancer, researchers had been curious about relative risk reduction and not disease prevention as described by the health ministry official.
In a systematic review of 40 epidemiological studies, researchers reported a slightly attenuated but still significant risk reduction of ovarian cancer.
Another study targeting Italian population, the researchers noted that parity, delivering babies, accounts for the relative risk reduction for ovarian cancer that had been attributed to breastfeeding.