The Wonderful Experience of Mother-to-Mother Support: LLLI Expertise Finds Its Way to Ghana
Mimi de Maza
Cuidad de Guatemala
From: LEAVEN, Vol. 37 No. 1, February-March 2001, pp. 2, 24
Health personnel around the world have come up with different ideas on how to put the "tenth step to successful breastfeeding" into action. Some hospitals have established their own support groups. In one hospital in Paraguay, the "support group" consists of a list of doctors and their phone numbers posted on the wall of the maternity ward so mothers can call them if they have any questions after they leave the hospital. In Peru, one hospital's "support group" is a doctor giving a speech about breastfeeding to the mothers he has seen that day.
La Leche League knows the power of community-based mother-to-mother support. Over forty years of facilitating effective mother-to-mother support groups and the development of an experience-based method of training have made us leaders in this area. What we consider "everyday" is an innovative strategy to others. Now members of other organizations who work with women and children want to learn to work in this way and they are turning to us for expertise.
The Baby Friendly Hospital Initiative's Tenth Step became a focus for encouraging mother-to-mother support. According to 1998 figures, the breastfeeding rate in Ghana, Africa, is low (see "Breastfeeding in Ghana") and the associated infant mortality rate is about 57 per 1000. A recent LINKAGES project in Accra, Ghana had the objective - with the coordination of the Ministry of Health, UNICEF, and LINKAGES - to provide a "Training of Trainers" workshop to 25 men and women from the Ministry of Health, UNICEF, Catholic Relief Services, Ghana Red Cross Society, and students from the University for Development Studies.
The trainings were in the Northern Region of the country. The Northern Region is difficult to get to; it is an area of great need - a desert area that lacks natural resources. Homes have no running water and women must carry water from a community well. As part of the Nutrition Behavior Change Communication Strategy for the northern regions, the Ministry of Health, Ghana, and LINKAGES Project/Ghana implemented a Training of Trainers Workshop for Mother-to-Mother Support Groups from March 20-30, 2000, in Bolgatanga, Upper East Region, Ghana. Along with others from the US and Ghana, I had the opportunity to facilitate the ten-day workshop. We provided breastfeeding basics and education that would enable the participants to understand, experience, and train others to facilitate mother-to-mother support groups. Among the participants were health development workers, nurses, midwives, teachers, health educators, nutritionists, and nutrition students.
Maryanne Stone-Jimenez, LLL Leader and Community Training Coordinator with LINKAGES, had developed the syllabus, Training of Trainers (TOT) in Breastfeeding and Complementary Feeding Basics and Mother-to-Mother Support Groups, to share with other organizations. We used this syllabus as a guide. After the workshop, the new trainers would use what they had learned to train community-based mothers who will facilitate mother-to-mother support groups.
The "Tenth Step to Successful Breastfeeding"
Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.
"Ten Steps to Successful Breastfeeding, Protecting, Promoting and Supporting Breastfeeding: The Special Role of Maternity Services," a joint WHO/UNICEF Statement. Published by the World Health Organization, 1989.
The Training Workshop
As you can imagine, the training was not at all new for me. Learning through our own experiences while we participate in a support group is basic to La Leche League. I knew that just as breastfeeding and mother-to-mother support spans cultures, so does learning from and through experience. In Guatemala we use the same participatory method in a project to implement a community-based mother-to-mother support program in poor, peri-urban areas of Guatemala City. The idea is to train the trainers the same way they will train the mothers who will develop the mother-to-mother support groups.
The secret in this "new" methodology is that participants begin to know what a support group is by experiencing it from the very beginning. Each day of the Training of Trainers Workshop, in addition to information-based discussions about breastfeeding, we had a support group with a particular theme (for instance, "Special Situations of the Breastfeeding Mother"). Just as we do at LLL meetings, people learned and experienced support by talking through and hearing about personal experiences - their own and those of family members. Trainees participated in these support groups as facilitators, participants, and observers. Afterward, they reflected on the experience, thinking and talking about such things as: what they liked or did not like about the experience; whether questions were answered; how they thought others in the group felt; the role of the facilitator. The trainees considered questions about how ready they felt to facilitate mother-to-mother support groups and what help they still needed. This approach was so popular that trainees created support groups any time they could, even when they were having lunch.
During the first week, the trainers-in-training also had some practice facilitating mother-to-mother support groups with pregnant women and breastfeeding mothers in three nearby communities. It was such a pleasure to watch them working with these groups, the mothers sitting in circles under the shadows of huge trees, some on very small benches and some on the big tree roots or stones. By the end of the week, the trainers-in-training were so immersed in the experience of and discussion about the support group dynamics, methodology, and techniques, they were becoming experts.
Breastfeeding in Ghana
Nearly all mothers initiate breastfeeding in Ghana. However, sub-optimal breastfeeding practices begin on the first day. Only 25 percent of women initiate breastfeeding within the first hour after birth; half wait until the second day or later, with the Upper East Region having the lowest rates of early initiation (seven percent within one hour of birth and 70 percent on the second day or later). Exclusive breastfeeding for the recommended period of the first six months is not widely practiced, largely due to the introduction of water at an early age. Among children less than two months old, 43 percent are exclusively breastfed. By four to five months, the figure drops to 22 percent.
World LINKAGES, GHANA, July 2000: Country Profile
The second week, they traveled to three rural communities - Vea, Bemkute, and Agomo - to train mothers as mother-to-mother support group facilitators. Eight trainers-in-training who spoke the local language facilitated the training and the rest of us were observers. It was an experience I hadn't had in the past: relying on learning to read the body language of the mothers as the only way to communicate with them.
My group went to Bemkute. Although there were supposed to be fifteen mothers taking the training, twenty-one wanted to participate and all of them stayed for the whole five days! Eighty percent of these mothers practiced exclusive breastfeeding (the Red Cross had been working with them to encourage exclusive breastfeeding) and their babies were healthy - very different from other babies we saw in the villages. Like future LLL Leaders, their own experience had taught them breastfeeding is important.
While the mothers were learning, the children played in the shade. The women looked so happy and motivated; even though it was very hot, they all stayed until 2:00 PM every day. It was a lot of fun to be with them, too, enjoying their company and, when invited, joining them in singing and clapping and dancing.
At the end of the two weeks, we celebrated with people from the Ministry of Health and LINKAGES and handed out certificates to the new Trainers.
I am grateful to have had the opportunity to be in Africa, where I found so many similarities to my country, and to confirm yet again the global nature of the La Leche League experience.