When Allen Mutamba returned to work three months after giving birth, she began supplementing breast milk with formula. A mother of three and administrator in Kigali, she adjusted her schedule to ensure she could breastfeed her nine-month-old daughter during lunch breaks. “I take my one hour of breastfeeding and add it to my lunch hour to give my baby time,” she said. ALSO READ: Why infants in Rwanda are introduced to food too early Mutamba stores expressed milk at home and says staying hydrated helps her maintain her supply. “If I take enough water and fluids, I have enough, which I pump and store,” she said. Expressed milk, also known as pumped milk, is breast milk that has been removed from a mother's breast using a breast pump or by hand, rather than directly from breastfeeding. She described the breastfeeding bond as beautiful, even though there are moments when her baby turns away, noting that it is heartbreaking when her baby refuses to take what belongs to her. With her husband handling errands and caring for their older children, Mutamba said she feels emotionally supported and psychologically at ease. ALSO READ: When the baby pays the price: Navigating the rigours of breastfeeding at work For some women, exclusive breastfeeding is not always possible, not because of unwillingness, but because they struggle to produce enough milk to meet their baby’s needs. In such cases, many feel compelled to introduce other foods like soup or formula before the recommended six months, often due to stress, limited time or space to breastfeed at work, and inadequate support at home or in the workplace. The latest Rwanda Demographic and Health Survey (RDHS) showed that exclusive breastfeeding rates among children aged four to five months dropped from 87 percent in 2015 to 80 percent in 2020. Stress, poor nutrition, and lack of support at home are among the leading factors preventing women from producing enough milk, according to Jean Yves Ntimugura, a Nutrition Advisor at the National Child Development Agency (NCDA). “While breastfeeding is a natural ability for every woman, milk production can be disrupted by emotional distress or poor living conditions. When the mother is supported and in normal conditions, without stress, pressure, or anxiety, she can produce the milk,” he said. Ntimugura noted the need to initiate breastfeeding within the first hour after birth to stimulate milk production. When the mother breastfeeds the baby within the first hour, it begins to suckle and stimulate lactation. He added that mothers who are away from their babies are encouraged to express milk to ensure continuous feeding, noting that another person can help feed the child that milk. Ntimugura noted that during the first six months, infants should not receive any other food or drink apart from breast milk unless prescribed by a healthcare provider. He advised mothers to let babies finish one breast before switching to the other because when a baby starts to breastfeed, the milk has more water to quench thirst. “The nutrients come later, which is why we discourage switching breasts too soon,” he explained. Supporting breastfeeding mothers, he said, means ensuring they are fed, free from conflict, and surrounded by people who understand the value of breastfeeding. “It’s not a responsibility for the mother alone, it’s a shared responsibility across families, communities, and institutions.” Private Kamanzi, the Chairman of the Rwanda Nutritionists Society (RNS), explained that some women struggle with milk production due to a range of physiological, nutritional, and psychological factors. “Psychologically, if a woman is stressed, she may not be able to produce breast milk as required. There is a hormone responsible for that activity, and if the mental state of the woman is not well coordinated, the production process is disrupted,” he said. He added that mental health is linked to the body’s ability to respond to the demands of breastfeeding. Kamanzi described breastfeeding as a set of practices, not just the act of feeding, but also how the baby responds. “The child needs to suckle to stimulate hormone production. Breastfeeding within the first hour after delivery helps the baby develop and maintain interest in suckling. Without that demand, hormone stimulation decreases, and milk production gradually drops. Exclusive breastfeeding supports adequate milk supply, as the brains of both the mother and child must be in sync. Without regular suckling, the hormones involved won’t function effectively,” he said. He explained that while the quality of breast milk is not affected by the type or quantity of food a woman eats, the quantity can decrease if the mother is hungry or unwell. “Although hunger is a physical state, it has psychological effects. If the mother is not well, even though the quality is not affected, the quantity of breast milk will be,” he said. Kamanzi noted that the support of husbands, partners, and employers in creating a conducive environment at home and at work is vital during the period when a woman’s hormones and body are changing. He called on employers to support breastfeeding mothers by providing breastfeeding rooms at workplaces, giving an example that a woman whose home is in Nyamata or Kanombe but works in town cannot travel during the one-hour break to breastfeed. However, if workplaces have breastfeeding rooms, it becomes easier. Some employers who have adopted this model have shared positive testimonies, he added. He noted that both government and private institutions ought to support exclusive breastfeeding by offering flexible work conditions and safe spaces for mothers, noting that this is a period where every effort counts, from the employer to the community, as everyone has a role to ensure the mother is well supported. Kamanzi noted a new trend among some mothers who avoid breastfeeding out of fear that their breasts will sag. “This is something new in our communities. We advise mothers that breastfeeding is important because it helps maintain a stable milk supply,” he said.
