In ranking Botswana the 58th best place among Less Developed Countries to be a mother, the 2012 State of the World Mothers Report also ranks the country among the bottom four on the Infant and Toddler Feeding Scorecard. This is because today, only 20 percent of infants in Botswana are exclusively breastfed.
“Botswana has been hard hit by AIDS, and many infected mothers likely do not breastfeed for fear they might pass along the disease to their babies. However, if given the right treatment with anti-retrovirals (ARVs), HIV-positive mothers can safely breastfeed. And even without ARVs, in places where there is little access to clean water, sanitation or health services, the risk that a child will die of diarrhoea or another childhood disease outweighs the risk of contracting HIV through breast milk, at least during the early months. Most HIV-positive mothers in developing countries are advised to exclusively breastfeed, but this message has met resistance in Botswana,” the report says.
This resistance acts as a barrier between infants and good health because as the report notes, when practiced optimally, breastfeeding is one of the most effective child survival interventions available today. Human breast milk provides all the nutrients newborns need for healthy development and also provides important antibodies against common childhood illnesses. Exclusive breastfeeding prevents babies from ingesting contaminated water that could be mixed with infant formula.
The report blames Botswana’s “poorly trained health workers often do not encourage this recommended practice” as well as inadequate policies and programmes while lauding the government’s “good efforts” to discourage formula feeding by enacting most of the International Code of Marketing of Breast-milk Substitutes into law.
“Largely as a result, only 20 percent of Botswana’s newborns are put to the breast within an hour of birth. At ages 6-9 months, 46 percent are breastfed with complementary foods and at age 2, only 6 percent of children are getting any breast milk at all. Botswana’s infant mortality rate is 36 per 1,000 live births and 31 percent of children are stunted,” the report says.
Some 30-39 percent of Botswana’s children under the age of five are either moderately or severely stunted. Stunting, which generally occurs before the age of two, is defined as a child who is too short for their age and the condition is caused by poor diet and frequent infections. Its effects, which include delayed motor development, impaired cognitive function and poor school performance, are largely irreversible.
The well-being of children is something that money alone cannot buy which explains why some poor countries scored higher marks than those that are relatively well-off. Botswana, as well as neighbouring South Africa, is among countries that are underperforming relative to their GDP.
Following an analysis of stunting rates and gross domestic product (GDP) in 127 developed and developing countries surveyed, the report determined that political commitment, supportive policies and effective strategies have a lot to do with success in fighting child malnutrition.
Malawi, whose economy has been slumped against the ropes for years now, notched 95 percent (to Botswana’s 20 percent) on the Infant and Toddler Feeding Scorecard.
Says the report: “Within an hour after birth, 95 percent of babies in Malawi are put to the breast. At 6 months, 71 percent are still being exclusively breastfed, and between 6-9 months, 87 percent are breastfed with complementary foods. At age 2, 77 percent of children are still getting some of their nutrition from breast milk. Malawi has enacted many provisions of the International Code of Marketing of Breast-milk Substitutes into law and has put significant energy and resources into improving health services for its people.”
Overall, Botswana scored 3.8 and was rated poor and its progress towards MDG 4 (2010) was deemed “insufficient.” The one source of consolation would be “very good” for the state of policy support for the International Code of Marketing of Breast-milk Substitutes code.
The report, which ranks the best and worst countries in the world to be a mother, is published annually. As it did last year, Norway tops the list as the best place in the world to be a mother. Niger comes in last place, displacing Afghanistan from last year.