Tag Archives | Papua New Guinea

World Breastfeeding Week 2013: The Health Care System Circle of Support in Papua New Guinea

By Amber McCann, IBCLC

On this blog during World Breastfeeding Week, we have been highlighting the work of breastfeeding supporters in each of the 5 Circles of Support mentioned in this year’s theme. We have been honored to have interviews with support happening in the workplace, in the community, in the government, and with families in crisis. The final circle of support is the health care system.

I have been so honored to serve as the co-editor, along with Decalie Brown, of this blog for the past year. It was exciting to attend this year’s ILCA Conference in Melbourne, Australia and I came away so encouraged and excited about where our field is headed. After the conference, I was able to travel to a remote area in the highlands of Papua New Guinea to spend some time with my best friend, a family practice doctor at a mission hospital in Kudjip.

As an IBCLC who has worked in both private practice and in a private medical office, my experience with breastfeeding support within a hospital was practically zero. I have spent the past 10 days shadowing my friend as she and the nurses on the maternity ward provided compassionate care to the women who come to birth at their hospital.

IMG_3272I was quite sure when I arrived that I wouldn’t have anything to teach or any way to provide support in this culture. Papua New Guinea has one of the highest maternal and infant mortality rates in the world and yet, I mistakenly assumed that breastfeeding was so a “way of life” that my help wouldn’t be needed. Culturally, breastfeeding is the assumed method of infant feeding. Formula is hard to acquire and formula marketing is outlawed. Women have been breastfeeding for generations and breastfeeding in public is the norm.

But, I came to realize that, even with so many of the things that I imagined would make breastfeeding “easier” in the United States where I live, women will always be in need of trained, evidence-based lactation care.¬†

Fortunately, for women being cared for in the Kudjp hospital and several others Papua New Guinea hospitals, there is a wonderful organization called Susu Mamas. They provide nurses and mentoring mothers who share prenatal education as well as postnatal support in breastfeeding and infant care. They come daily to the hospitals and work with new mothers to establish breastfeeding, trouble shoot challenges, and provide education to hospital staff. In addition to the hospital care they give, in some locations, they also provide family planning and HIV testing. They also established a national breastfeeding hotline in 2008.

IMG_3451While thankful for the support being provided to the women I encountered, I had to get in on the action! I was surprised one afternoon to hear Dr. Jim Radcliffe, a surgeon who has served at this hospital for over 25 years, call down the hall “Amber, you’re needed in the ER for a lactation consult!” I hurried over to find a young mother of a 7 month old who reported that she had no milk and that her baby had failed to gain weight in some time. After taking as full of a history as my understanding of their culture and my terrible Pidgin (with the help of an interpreter) allowed, I examined her breasts. She reported that she had never made any milk and had been feeding the baby bananas and pineapple since he was two months of age. I was heartbroken to examine her breasts and realize that she had insufficient glandular tissue. I quickly asked if she knew of anyone else who would be willing to breastfeed her baby (as feeding another’s child is common in PNG) and referred the baby to the doctor on call in the pediatrics ward. This mama listened intently to my counseling and offered up her dry breast to her fussy baby. Even with no milk, the baby quieted and relaxed into his mother’s arm with her breast for comfort. I praised her for the way her mothering was meeting the needs of her baby and while finding appropriate nutrition for her young child would be challenging, I’m thankful for the smile she gifted us with.

IMG_3460I also realized that many breastfeeding challenges like sore nipples, engorgement, and thrush were universal! One mother came to the hospital and required a C-section (my first surgical observation!). We followed her closely in the days after and she struggled a bit with pain. Many of the women in Papua New Guinea have very long, pliable breasts (likely from not wearing a bra regularly). They simply lay the babies in their lap and their breasts reach easily to their child…no football (or rugby!) hold here! Ronda was mimicking the positioning she had seen all her life but her breasts were much shorter, leading to a very shallow latch. We changed her position and provided some pillow support as she learned and a huge smile appeared on her face.

I am heading home soon and will carry these experiences from my time at the hospital in Kudjip into my practice in the US. I am grateful to have had the experience of observing and participating in the important work of providing breastfeeding support in a hospital setting. I am honored by the warm welcome I received from the nurses and hospital staff and also from the mothers who I encountered. Breastfeeding support literally saves lives, especially in a place like Papua New Guinea and I’m so glad to be a part.

* And on a funny note, in Pidgin (a language spoken by many in PNG), “susu” is the term used for breasts, breastfeeding…anything having to do with milk. I heard the term “kalabus belong susu” being used to describe a bra. The translation? Prison of the breast! Take that, Victoria’s Secret! ūüôā

Amber McCann, IBCLC

Amber McCann, IBCLC is a  board certified lactation consultant with the Breastfeeding Center of Pittsburgh. She is particularly interested in connecting with mothers through social media channels and teaching others in her profession to do the same. In addition to her work as the co-editor of Lactation Matters, the International Lactation Consultant Association’s official blog, she has written for a number of other breastfeeding support blogs including for Hygeia, The Leaky Boob, and Best for Babes and is a regular contributor to The Boob Group, a weekly online radio program for breastfeeding moms.


A Closer Look at Cultural Issues Surrounding Breastfeeding

By Emma Pickett, IBCLC

As lactation consultants, we‚Äôve been reading about breastmilk for a long time. It makes a nice¬†contrast from the science of oligosaccharides to learn about the importance of goat meat soup to a¬†lactating mother in Somalia or about the huge variety of cultures worldwide that¬†emphasizes the importance of a mother avoiding ‚Äėcold‚Äô foods postpartum to seek spiritual balance.¬†When it comes to reading about different cultural practices surrounding breastfeeding, there‚Äôs a lot¬†that is simply fascinating.

Photo by mrcharley via Flickr Creative Commons

There‚Äôs a fabulous article by a breastfeeding mum¬†named Ruth Kamnitzer which I would encourage¬†you to read. In it, she¬†talks about her experiences as a Canadian mother moving to Mongolia.¬†She describes how feeding in public becomes a very different experience when complete strangers¬†bend down to kiss your baby‚Äôs cheek ‚Äď while he is feeding!¬†Then, as he pops off in surprise, the giver of the kiss gets a face full of milk and everybody laughs.¬†Try and picture that scene taking place in your local mall!

We enjoy reading about the fact that Japanese kindergarten admission forms might ask matter-of-factly whether a child has weaned from the breast. Or, that in Korea, an IBCLC declaring a baby to be beautiful would be going against the cultural practice of not commenting that a baby is healthy, fat or beautiful for fear of making the mischievous Gods jealous.

But once we’ve satisfied that natural boob and baby-obsessed curiosity, how do we balance our desire for evidence-based practice with some of the cultural messages that may seem harder to support?

Cultural practices fit into only 3 categories: beneficial, harmless or harmful.

Many Muslim families wish to practice the sunnah of ‚Äėtahneek‚Äô. A softened date is sometimes¬†rubbed on the baby‚Äôs palate before the first feed so the baby will enter ‚Äėa sweet world‚Äô. Traditionally,¬†if a date cannot be found, anything sweet will do. An IBCLC might guide a family towards a clean¬†finger dipped in glucose water rather than the boiled hard candy from uncle‚Äôs pocket.

Other beliefs are more of a struggle. One study of 120 cultures showed that 50 withheld the infant¬†from the breast for 48 hours or more due to the belief that colostrum was “dirty”, “old”, or “not real¬†milk”. In central Karnataka in India,¬†35% of¬†infants were still not breastfeeding at 48 hours, yet at 1 month 94% were. A mother who may be¬†reluctant to give colostrum feeds in a western hospital may be passionately committed to exclusive¬†breastfeeding later on.

Some of us can be a little smug when it comes to looking at cultural practices from around the¬†world. We may feel uncomfortable when we hear of the lives of women in Kenya who are strongly¬†instructed to avoid breastfeeding after quarrels to prevent “bad blood” entering the milk and¬†affecting baby. This may mean breastfeeding is paused or a mother‚Äôs rights are infringed by family¬†members or neighbors , yet she doesn‚Äôt speak up for fear of conflict. Several cultures ‚Äď traditional¬†groups in Papua New Guinea and the Gogo tribe of Tanzania among them ‚Äď emphasize the need¬†for the woman to be celibate during breastfeeding. A mother may be torn between her desire to¬†breastfeed ‚Äď in an environment when food after weaning may not be plentiful ‚Äď and her desire to¬†satisfy her husband. A husband who is often not expected to also remain celibate.

Those descriptions may be hard to hear but I have no doubt there are women pitying the cultural¬†constraints put upon many woman living in Western industrialized cultures. These poor mothers are¬†still often expected to be separated from their healthy babies after birth. Their baby may sleep in¬†a separate area of a large building (“the hospital nursery”) because culture says “that‚Äôs best”. These¬†poor mothers feel obliged to feed according to the clock and feel like failures if their babies feed¬†more frequently. The babies in this culture are often weaned prematurely because the breast is¬†over-sexualized and it‚Äôs deemed inappropriate for older children to feed at the breast. Many of us¬†live in a culture that values privacy, scientific “measurement”, control, infant independence. It‚Äôs hard¬†to imagine a set of cultural norms more incompatible with breastfeeding.

Is any of this really any less harmful in the long-term than avoiding colostrum feeding?

As an IBCLC, how do you educate yourself about the cultural issues within your community?

With a background of teaching in inner-city London, Emma Pickett, IBCLC came to breastfeeding support after she had her first child in 2004. She trained as a breastfeeding counselor with the UK-based charity the Association of Breastfeeding Mothers (ABM). Now sitting on their central committee, Emma continues to volunteer on the National Breastfeeding Helpline and the ABM’s own helpline as well as running three support groups in North London. Emma qualified as an IBCLC in 2011 and has a private practice alongside her voluntary work. Her work focuses on how breastfeeding impacts on a woman’s sexuality and relationships but also crucially how the sexualization of Western society affects the initiation and continuation of breastfeeding. She is keen to encourage open dialogue in an area which even breastfeeding supporters sometimes shy away from. You can her discuss Breastfeeding and Sexuality on a recent episode of The Boob Group. 


World Breastfeeding Week: Breastfeeding in Papua New Guinea

In celebration of World Breastfeeding Week, Lactation Matters will post every day this week, highlighting the stories of breastfeeding in different cultures and countries.

Written by Jeralie Fairbanks, RN, IBCLC

In June 2012, I had the opportunity to visit Kudjip Nazarene Hospital in the Western Highlands Province of Papua New Guinea. As a lactation consultant in the United States, I was amazed at how women in Papua New Guinea breastfed and the many cultural differences surrounding infant feeding. There are many spiritual practices that interfere with the initiation of breastfeeding, however, breastfeeding is the only option for most women as formula and milk of any kind are not readily available. If women deliver in a hospital and their newborn is premature, then their newborn can receive formula. There are no breast pumps available in this part of Papua New Guinea so women hand express to feed their premature infants.

Papua New Guineans are tribal oriented, which means that the tribe raises the children. When a woman comes into the hospital for childbirth, she brings family tribe members or village wontoks (clan members) with her. After the baby is born, the family members help to care for the newborn while the mother sleeps and recovers. This entails holding the newborns, swaddling in cloth, or bringing the baby to the mom to breastfeed. Because the infant mortality rate is 43.29 deaths/1,000 live births, many do not initiate bonding with the infant out of fear that the baby might die.

The country of Papua New Guinea is approximately the size of California with a population of 7 million. Access to health care is limited and many women deliver in their village. It is one of the most culturally diverse countries with varying practices related to childbirth and breastfeeding.

While in Papua New Guinea I had the opportunity to visit a health clinic in a village. This clinic had a birthing center that had just opened. There were posters about infant growth and the importance that a baby is weighed monthly. There were, also, pictures demonstrating the importance of maternal nutrition while breastfeeding. I was pleased to see the progress since my last visit in 2008. Although a third-world country, it is progressive.

I taught at the School of Nursing in Kudjip and stressed the importance of skin-to- skin at birth and initiating breastfeeding within the first hour. The students in the School of Nursing were very receptive and interested in this and were talking with patients about what they had learned the next day in the hospital setting. It was encouraging to know that all that is needed is education to provide an improvement in outcomes.

Women in Papua New Guinea have no difficulty breastfeeding in public as that is simply what the breasts are for. Babies are carried in bilums on either the mom’s or family wontok’s back. And babies are breastfed on demand. It was exciting to be able to provide an IBCLC’s viewpoint and positively impact initiation of skin-to-skin and breastfeeding at Kudjip Nazarene Hospital.

Jeralie Fairbanks RNC, IBCLC is a Labor and Delivery Nurse at Rogue Regional Medical Center in Medford, OR where she enjoys assisting families with their first breastfeed and those first few days.  She is married and has two sons ages 12 & 9. She has a passion for missions and has had the opportunity to travel to the Nazarene Seo Company Hospital in Kudjip, Papua New Guinea twice.


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