Ernestine Musanganire, 32, recalls the challenges she faced breastfeeding her daughter when she was a university student. She wanted to exclusively breastfeed her for the first six months of life, but it was harder than she thought.
There were no designated breastfeeding spaces on campus, so Musanganire had to get a helper to carry her baby and find a shady spot to sit. The helper would lay a cloth on the grass for the baby to lie down, and use an umbrella to protect her from the sun.
"When I was in class, I was always worried about her," Musanganire said. "Sometimes there was strong wind, too much sun, and sometimes it would rain. They had no shelter at all."
Musanganire would get out of class to breastfeed her baby, mostly under a tree. This went on until the baby turned one.
The lack of breastfeeding space was not only a problem at school. When Musanganire went to the market to buy groceries, she would have to sit in dirty places with flies buzzing around her and her daughter.
This challenge is not limited to students. Working mothers, both in the formal and informal sectors, also face the same issue.
Woes of a working mother
Cynthia Uwase, 27, is a mother of three. She works as a sales agent in a Kigali-based company. Every time she has a baby, she spends at least two hours in the bathroom pressing her nipples to get the milk out. Sometimes she uses toilet paper, other times she presses the milk into a tin, and pours it in the toilet when she’s done.
"I have a lot of breast milk, so it is challenging for me. I express my breast milk at least twice during work hours because of the pain,” Uwase said.
Although she is allowed an hour per day to breastfeed after her maternity leave, Uwase says if she were to take it, it would not suffice because going to her house and coming back to work would even exceed the time.
The issue
Despite the many known benefits of breastfeeding, only 44 per cent of infants worldwide are breastfed exclusively for the first six months of their life. In Rwanda, the rate of exclusive breastfeeding is almost double the global average, but it has fallen sharply in recent years.
Africa Quantitative Sciences in their report show that exclusive breastfeeding in Rwanda fell from 87 per cent in 2015 to 81 per cent in 2020.
Breastfeeding has many benefits for both babies and mothers. For babies, it can reduce the risk of asthma, obesity, gastrointestinal infections, ear infections, severe lower respiratory disease, type 1 diabetes, and sudden infant death syndrome (SIDS). For mothers, it can lower the risk of ovarian cancer, high blood pressure, Type 2 diabetes, and breast cancer.
There are many reasons, however, why breastfeeding rates are falling. Some mothers may not have enough support from their families or friends. Others may not have access to clean water or a safe place to breastfeed. Still, others may choose to formula feed for other reasons.
Research also shows that working mothers may have difficulty finding time to breastfeed their babies. Returning to work without adequate support mechanisms hamper optimal breastfeeding practices, considering that health experts advise six months of exclusive breastfeeding for a newborn. Children with working mothers tend to be fed formula or cow milk, depending on the means.
However, breastfeeding is the natural, and healthiest way to feed a baby from birth.
"No milk substitute can compete with breast milk in terms of nutrients, antibodies, attachment prospects, bonding, and stimulation. The advantages of breastfeeding manifest themselves right from the baby’s first contact with the mother’s breast and benefit the baby, its mother, and the relationship between the two,” reads UNICEF’s breastfeeding support in the workplace guide.
Besides, if women are unable to breastfeed or keep their pattern, it can cause a great deal of stress and guilt, let alone pain in their breasts.
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What to do?
Kenneth Ruzindana, a Consultant Gynecologist and Obstetrician at Kigali University Teaching Hospital (CHUK), told The New Times in an interview that there is a definite need for more breastfeeding spaces in order to provide dedicated and comfortable areas for breastfeeding mothers.
He added that it helps create an inclusive and supportive environment for them, as it allows them to breastfeed without feeling uncomfortable or judged, hence encouraging breastfeeding as a healthy and natural choice.
"Additionally, more breastfeeding spaces can help normalise breastfeeding in public and contribute to the overall well-being of both mothers and babies,” Ruzindana said.
"When moms feel happy and relaxed, it's good for them and their babies. Plus, when people see moms feeding their babies in these special places, they'll know that it's a normal and natural thing to do. So, having more breastfeeding spots helps moms and babies stay healthy and happy together,” he added.
The doctor also noted that besides improving maternal and infant health by promoting exclusive breastfeeding — which provides essential nutrients, antibodies, and bonding — breastfeeding spaces would also contribute to reduction of postpartum depression and fostering a positive attitude towards breastfeeding.
Musanganire believes challenges faced by mothers who choose to breastfeed their children in public spaces could be solved by encouraging owners to save some space for that purpose.
Ruzindana echoes the idea, and adds that there needs to be encouragement in the adoption of laws that protect breastfeeding rights and to provide maternity leave (where it is not).
"We have to create breastfeeding space so that women have access to it, and the hygiene should be perfect,” said Aude Kaze, a midwife and founder of Kwezi Midwife Initiative, which specialises in birth preparation and postnatal care.
Is it possible?
Some companies have taken steps to address the issue by putting in place policies supporting mothers to breastfeed exclusively for the first six months of life, as per World Health Organisation and UNICEF recommendations, and to continue breastfeeding for as long as they choose.
"Our mothers’ room is the embodiment of our unwavering commitment to both the professional and personal well-being of our employees. This initiative seamlessly blends convenience with compassion, addressing the unique needs of working mothers while underlining our progressive organisational values.
"Beyond its role in fostering work-life balance, the mothers’ room has proven to be a catalyst for enhanced productivity. Well-rested and supported employees bring their best selves to work, contributing to a more vibrant and dynamic workplace atmosphere,” Lina Higiro, NCBA CEO, said.
She added that the room has not only garnered enthusiastic appreciation but also reinforced organisational culture of care and consideration.
"It stands as a tangible testament to our belief that holistic support translates into improved job satisfaction, and a stronger sense of unity among our teams,” Higiro added.
The bank also implemented a ‘flexi-working schedule’ where after three months of maternity leave, mothers are given an option to work from home half day, every working day, for three more months.
Also noteworthy, Rwanda increased maternity leave for two more weeks, starting in August this year.
The Gender Monitoring Office (GMO) with its partners also launched a ‘Gender Equality Seal Programme’ (GES), to enhance gender accountability in Rwanda’s private sector.
The GES initiative seeks to address six critical areas in the workplace including enhancing work-life balance, which addresses the wide gap in family-friendly policies, such as parental leave and access to proper lactation rooms for mothers.
GMO has reported from time to time that the programme has given positive results, with some companies innovating ways to make it easier for mothers who choose to breastfeed to keep doing so for as long as they decide.