Though progress has been made over recent decades in reducing the rate of infant and under 5s’ mortality in SA, the rates are still high at around 33 deaths per thousand live births. The COVID-19 pandemic and ensuing lockdowns didn’t help matters and saw an increase in maternal and perinatal death rates, as healthcare facilities were overwhelmed, and unemployment skyrocketed.
Preterm births are a major cause of infant and child mortality globally.
Preventable neonatal death is a public health indicator for evaluating the performance of countries’ health systems. Death can be prevented, and prematurity, mortality of pre-terms and maternal mortality speak to the quality of the health system.
Babies born before 37 weeks of pregnancy often weigh under as little as 420g. These babies are admitted to the NICU and spend months in hospital and are considered high risk patients.
Most premature babies do not make it past the first hour, and those who need special care are incubated and intubated as they are unable to breath autonomously.
Not all pre-term babies will display side effects however many will struggle with a variety of conditions such as retinopathy of prematurity and septicaemia. Extremely low birth babies are very vulnerable to infection and receive nasogastric feeding as latching is not an option.
Premature babies have very vulnerable digestive tracks which means they cannot be fed anything but breastmilk. Necrotising Enterocolitis is the second biggest killer in this population and is directly associated with artificial feeding.
Breastfeeding is lifesaving but often moms of pre-terms themselves are too ill to lactate temporarily. Donated breastmilk plays a key role in bridging the gap whilst mom get better. As they grow up, these children may be more susceptible to visual, hearing, behavioural, learning, and motor skills complications, than their full-term counterparts.
Staša Jordan, Executive Director at South African Breastmilk Reserve (SABR), an organisation leading the charge of South African NPOs championing the causes of new-born, early-life, and maternal healthcare, says that in the African Region, almost a third of the 1 million new-born infant deaths that occur every year are due to premature birth, or resulting complications.
She made the comments in the lead-up to World Breastmilk Donation Day, due to be commemorated on Friday 19 May 2023. (https://www.internationaldays.co/event/world-breastmilk-donation-day/r/recQ4B7iLfD4SWtOX)
For over 20 years, the SABR innovative human milk banking models have provided life-saving breast milk to preterm infants, bridging the gap between birth and the time when new mothers are able to lactate.
The SABR currently supply life-saving human breast milk for premature and sick babies to around 85 neonatal ICUs at SA hospitals, with a particular focus on providing this nutrition in rural and under-resourced areas, to some of the country’s most vulnerable populations.
“Breastfeeding is one of the key clinical strategies for addressing premature morbidity and mortality at the hospital level,” Jordan says.
Donated breastmilk is the single best food to ensure premature babies’ optimum wellness, in cases where mothers are unable to breastfeed, or before lactation begins.
“Exclusive breastfeeding for the first six months of life wherever possible gives children’s nutrition a boost and helps prevent any infections,” she adds. Babies that are artificially fed in the first two months of life face a six-fold chance of dying. It is not just a nice to have; breastmilk is the first and most important vaccine to support the acquired immune system.
The strategy is endorsed by the South African Department of Health – SABR’s government partners – and represents a high-impact public health intervention, saving countless lives and improving neonatal health outcomes for SA’s infants, especially premature ones.
Over the years, the SABR’s focus has expanded to encompass a life-cycle approach to infant health and survival, with a strong focus on holistic health efforts like ante-natal well-being, HIV prevention, immunisations, and family planning awareness campaigns in line with the first 1000-day initiative of the NDOH and to support Early Childhood Development.
Strident supporters of the Kangaroo Care Method which promotes as much skin-to-skin contact between mother and baby and frequent breastfeeding, the group encourages and facilitates breastfeeding, not only in post-partum hospital settings but in the context of early childhood development overall.
Jordan adds that the priority is always maternal lactation. Donated breastmilk is an emergency intervention like donated blood and only for short term use.
Breastfeeding alongside human milk banking is a public health intervention that protects new-borns and is a poverty alleviation strategy especially in developing countries where children under five are at higher risk of mortality and morbidity associated with respiratory and diarrhoeal disease born from poor access to water sanitation and flush toilets.
Breastfeeding is far more affordable than formula feeding especially for mothers receiving R460 SASSA grants per child per month.
“Currently, only around one third of SA women breastfeed. Our organisational vision is to achieve the UN’s target breastfeeding rate of 50% by the year 2025 in SA”, she says.
“Women who breastfeed deserve a wealth of support and encouragement and should never be stigmatised”.
“As a neonatal healthcare focussed NPO, our success is measured in lives saved. The SABR salutes those mothers whose donated breastmilk is keeping SA’s babies alive and giving them the chance of optimal nourishment to grow strong and be healthy,” she comments.
“Over the years, milk from our donors – some 6000 mothers – has helped support over 45 000 infants in SA”.
Mothers who are in good health, already breastfeeding, and have access to a fridge and freezer can become breastmilk donors. If you’d like to become a breastmilk donor or become involved in supporting the work done by the SABR, please get in touch via https://www.sabr.org.za/
[i] https://knoema.com/atlas/South-Africa/topics/Demographics/Mortality/Under-5-mortality-rate#:~:text=South%20Africa%20%2D%20Under%2Dfive%20mortality%20rate&text=In%202020%2C%20under%2D5%20mortality,thousand%20live%20births%20in%202020 .