Written by: Saina Shrestha
As I made my way through the corridor to my cabin, I noticed Linda hurrying from the other side. I waved my hand and started walking towards her. With hands full of filed documents, I could see Linda short-winded, managing to shove off saying, “You look flawless! Fill me in with the beauty regimen later.”
I leaned back on my swivel chair and put my feet up; I could see on the black computer screen before my headline, a visage; still and animated. I was looking at a face, my face, which bobbed up; immaculate for real, mere an omen of pockmarks and blots. I smiled and expressed tenderness at the peculiar complexion bethinking to Linda’s comment earlier.
My skin looked smooth and unruffled; no visible lines or crease. As I angled towards the screen, my features amplified, revealing every tiny detail fashioned on my face. My cheek bones were glowing, poise with just the right amount of La Rosa peachy tint. My cheeks, which have forgotten days of jollity and delight, were gleaming under the phosphorescent pendant light. The black kohl along the rim of my eyes extended to arched wing. It looked intense, at variance to my ever-so-tired-of-crying eyes. Two coats of the Volum’ Express mascara, along with a lift added a seal of secrecy to those fatigued lashes.
The flaming hue of Love that Red lipstick popped out so strong that it was able to mercurially hush up my lily-livered lips that trembled otherwise. The foundation in True ivory complimented as an exclusive base on my skin and gave a full yet natural looking coverage to the existent bruises on my chin, all black and blue. Also, not to forget, the secret weapon is the new color correcting concealer palate that I got a few days ago which is so creamy and blends right in to erase the bulgy under eye confines giving a refreshed look. Oh, it was also able to keep from showing few thin red scars below my left eye contour. Voila! The miracle of makeup is astounding.
I sleep with the bittersweet fist knocks from my husband every night.
I wake up with the consequences of our failed marriage every morning.
Nonetheless, I still manage to look flawless as I march out of my house everyday.
It is a known fact that that an HIV-positive mother can infect her baby through breastfeeding. However, if correct measures are taken, the risk of transmission can be reduced and the child can received adequate nutrition and antibodies through breastfeeding.
Every HIV positive mother has the right to have all the relevant and correct information about breastfeeding. She has the right to make an informed decision for health and well-being of herself and her baby. On the occasion of World Aids Day 2017, we are sharing the things that one must know about breastfeeding and HIV.
WHO recommends that all mothers, regardless of their HIV status, practice exclusive breastfeeding – which means no other liquids or food are given – in the first six months. Combination of exclusive breastfeeding and the use of antiretroviral treatment can significantly reduce the risk of transmitting HIV to babies through breastfeeding.
- Giving HIV-positive mothers a combination of antiretrovirals during pregnancy, delivery and breastfeeding reduced the risk of HIV transmission to infants by 42%.
- Exclusive breastfeeding in the first six months of an infant’s life was associated with a three- to fourfold decreased risk of HIV transmission compared to infants who were breastfed and also received other milks or foods
- Breastfeeding Antiretroviral and Nutrition study showed a risk of HIV transmission reduced to just 1.8% for infants given the antiretroviral drug nevirapine daily while breastfeeding for 6 months.
Things you must know about HIV and Breastfeeding
- Mothers known to be HIV-infected (and whose infants are HIV uninfected or of unknown HIV status) should exclusively breastfeed their infants for the first 6 months of life.
- HIV-positive mothers or their infants take antiretroviral drugs throughout the period of breastfeeding. This means that the child can benefit from breastfeeding with very little risk of becoming infected with HIV.
- Appropriate complementary foods must be introduced after 6 months and safe water, sanitation and hygiene measures are to implemented to reduce
- opportunistic infections.
- Breast feeding must be continued for at least 12 months and the mother may continue breastfeeding for up to 24 months (similar to the general population) while being fully supported for ART adherence.
- In settings where health services provide and support lifelong ART, including adherence counselling, and promote and support breastfeeding among women living with HIV, the duration of breastfeeding should not be restricted.
- Breastfeeding not only provides babies with the nutrients they need for optimal development but also gives babies the antibodies they need to protect them against some of these common but deadly illnesses.
- Most children born to HIV-positive mothers and raised on formula do not die of AIDS but of under-nourishment, diarrhoea, pneumonia and other causes not related to HIV
- “Strong and dishonest” marketing campaigns that make unfounded claims that the formula milk contains special ingredients that improve baby’s health must be prohibited
- Breastfeeding advocacy should also be directed to the people who may influence a woman’s decision to breastfeed, i.e. her husband, extended family, health workers etc.
- Families, society and state must ensure enabling environment for HIV infected mothers to appropriately, adequately and safely breastfeed their children.
Now that you are aware of the facts, make sure you share the information to promote and support breastfeeding.
Reference: World Health Organization Website (Accessed at: http://www.who.int/nutrition/publications/hivaids/guideline_hiv_infantfeeding_2016/en/ )
-Written by Saina Shrestha
[Note* This article intends to correlate the inter-generational cycle of malnutrition in Nepali communities (especially rural), and how the cultural feeding practices have direct or incidental impact on the maternal and child health. Aayam’s mother as the narrator tells her story as a girl child, as a young adolescent, and as a mother]
Today, my youngest sibling, my 5-year old brother was admitted to school. I am the eldest one to my parents, among the four daughters and a son. My parents grease elbows farming in whatever’s left of our little piece of land that produces limited chunk of barley and maize to fulfill seven starving mouths. I usually take care of the household chores and look after my younger siblings. I or my sisters, we’ve never been to school. Our father says that it is more suitable we learn to juggle the household responsibilities since we’ll be sent off to our husband’s house after marriage.
It’s my best friend Rama’s wedding today. Rama’s face was glowing with bridal makeup and happiness. She was getting hitched with her boyfriend Keshab. When her parents discovered about her relationship with Keshab, both the families met and decided to tie their knot. Visualizing my own marriage, I winked and smiled at my boyfriend Suresh who was playing panche-baaja at the wedding. However, my smile faded when I overheard an ugly looking old man with mustache asking my hand for marriage with my father at the wedding. Why does my father seem to be impressed with this man’s proposal? Arghhh!!
Today, I discovered that I’m expecting a child. Having missed my period two times in a row, I was told that I was going to be a mother. I was 16 and Suresh, 17 at the time we ran off one year ago. My parents had forced me to marry that old man at Rama’s wedding and I did not want that at all. Convincing my parents for marriage with Suresh emerged to be impossible, as Suresh belonged from the community of lower caste. So, we didn’t have any other choice but to elope.
Today marks 8 months and 24 days of my pregnancy. Tallying the number of days my baby has perched in the womb; it should accompany us in the coming week. Luckily, my pregnancy wasn’t that hard on me because my stomach didn’t fill out much as compared to others women’s whose belly looked the size of a pillow.
Today my son, Aayam is 3 months old. He is my bundle of joy. I feed him my breast milk only few times a day because the breastmilk production is getting low. Hoping for his good health, I have started giving him plain rice and packet milk. My mother in law also gives him few spoons of water after an oil massage guessing he might be thirsty. I wish I could give my son ‘serelek’ (cerelac) which the happy chubby baby in TV eats. But the income of my husband Suresh, waged as a porter, does not allow us to have means for market supplies like sereleks.
Today, we took Aayam to our traditional healer, Jhankri bajey for the fifth time this week. My mother-in-law believes that my son (who has been quite ill since four weeks) should restore to health after a few more visitation to Jhankri bajey. Aayam has gone pale, has thin limbs and sparse copper-colored hair. His face looks wrinkled and his tummy, all big and bulged out. We have even made an offering of a rooster to the family deity but Aayam’s health does not seem to bloom.
Today, Sharmila (my neighbor) rang in to my house making me known of an event being held in the “chautari” (a tree-shadowed area) nearby. I went along with Sharmila to find a bountiful figure of women rounded up from our locality. A lady in a blue sari was leading the mob. The lady gestured everyone to take seats and we did as she said.
She introduced herself as Indira, a female community health volunteer from the health post uphill from our ward. She had accumulated women with children under two years of age from our community. I have never paid a visit to the health post because my mother-in-law suggests that it’s non-essential when we can always reckon on Jhankri bajey for our health issues.
Indira didi looked like someone well-read and in the know. She gave a detailed counseling on nutrition for pregnant and lactating mothers and their babies. We were also acquainted on the practices of breastfeeding, why and how it was beneficial (for both the mother and her child).
Everything she talked about, I took under advisement. It was then I learned how important something I had never heard of before (nutrition) was. I realized the malnutrition problem cycle which began since my childhood. I didn’t get an access to education as a child. So, I wasn’t able to learn about need of nutrition. Then, I married at a very young age and gave birth to Aayam without being physically and mentally mature. My nutrition was also never my priority during pregnancy and lactation. As a result Aayam was born underweight. I was also not adequately breast feeding him. I was amazed to find out that our locally available foods are more nutritious for the baby than the artificial market foods. I felt so stupid for introducing solid food before Aayam reached 6 months of age. The guilt was building on me for not consulting with Indira didi sooner. I felt greatly responsible for Aayam’s ill health.
During the closing of the session, I moved up to Indira didi and told her that my son’s growth wasn’t accelerating as much as it should and that he falls sick very often. She came along to my house with me and examined Aayam for a concise two minutes. She took out tape look-alike equipment that had green, yellow and red colors on it and put it over his arms. She then turned over to me and summoned all my family members. She gave health and nutrition counseling to our entire family. She also particularly requested my husband and mother-in-law to be more supportive in rearing and caring of me and my child. Finally, she suggested us to visit the health post with Aayam as soon as possible.
Today is Aayam’s third birthday. He looks unerringly like his father, the same square-shaped fair face, big brown eyes and narrow lips. He has a chubby face and stout limbs. He runs around chasing the rooster chicks in the front yard and giggles when trips over and hits the ground.
I was born in a village called Pipalkot, Bajhang district of Nepal where the whole area is affected by chronic food deficits most times of the year. I was born poor and raised illiterate, unable to tell apart the rights and wrongs, indecisive in the matter of my family’s health. The past year I’ve realized what it’s like to be under supervision and mindfulness.
I now have the right picture on how to enforce nutrition during the golden thousand days, that to raise a healthy child is to give rise to healthy women first. The previous year at the health post, my son was diagnosed as malnourished. With analysis and follow up on time at the health post, he was able to reclaim his health and regain his childhood. Today, my son Aayam is healthier than ever I as a mother, happier than ever.
Ever since I remember my childhood, I was told that the trees and plants can hear, see and feel like us, humans. At the age of 25, I now know that they don’t, but, I don’t think it would be wrong to say that my love for nature grew with this particular myth.
As I go deep down the memory lane and recall the times spent with my dad, I remember him picking up every chocolate wrapper I threw on the floor. How amazed I used to be when he carefully let out the caterpillar which I tried to kill in the garden. One particular memory that still makes me laugh is when he told me earthworms were his friends. My response was, “Friends? Dad, they are worms and worms are creepy!” Well, now I feel proud that vermicomposting is something I learnt from him. My dad has been my greatest inspiration since my childhood. His attitude towards nature and environment guided my passion all along and is one of the reasons for my love towards it.
“We are what our environment is.” As a student of public health, this is the first thing I learnt in my environment class. Learning about the mounting environmental problems everyday is undoubtedly heartbreaking. Overpopulation, rapid urbanization and industrialization, loss of biodiversity are all leading to disruptions in environmental integrity which is affecting health and nutrition status of human. Along with this, daily realization about the ignorance of people towards the environmental issues is more disheartening. I believe that many youths today are overlooking the fact that they constitute a major part of our country’s population and that their actions at present can give rise to significant consequences in the future.
One determined initiative, one firm decision; one courageous step can CHANGE the world. But the youths today are lost in the virtual world. We are more curious about the new gadgets launched in the market rather than the decreasing number of bees due to cell phone radiations. We are highly concerned about not missing a single day without being active in the social networks, but we don’t seem to have any time to speak out for the depleting ozone layer.
But, gone are the days to complain and whine about how someone else is not taking the initiative. If one needs an inspiration, they can look at the “hamribahini” initiative to prevent the use of polythene/plastic bags. We must take initiative ourselves. Step forward, and lead the way for others. Change is not a plant that grows overnight. It requires frequent nurturing, determination, love and care. Without the self realization among youths about the need to address the environmental issues, accomplishing the dream of ‘sustainable environment’ is a far cry. It is essential for every individual to realize their role and do their part to protect the environment. After all, we are what our environment is.
-Written by Bonita Sharma
I got my first period at the age of 13. I used to study in grade 8. I vividly remember losing consciousness in school assembly due to heavy bleeding and severe menstrual cramps. I was unaware of what was happening to me. My first period was a scary and bitter experience which I will never forget!
I was a quite lean and thin adolescent girl who got involved in limited physical activities because it made me easily tired. When my menstrual cycle started, things became more difficult for me as I felt weaker during that time of the month. Every month I was facing severe abdominal pain which was was followed by unconsciousness, nausea, vomiting and loss of appetite.
Our society considers menstruation as a matter of shame that must be kept hidden. So, discussion about menstruation and menstrual problems with family or teachers was out of context for me. The topics related to sex and menstruation used to be always skipped in classes while the cultural and religious taboos related to menstruation in my family made me hesitant to speak to someone about it. This wasn’t just my personal problem, but all the other adolescent girls of my age were oblivious about our own health and nutrition. At that time there wasn’t anyone who could provide us proper information or counseling on menstruation.
As an educated and responsible youth, and a girl who faced health consequences due to lack of awareness about menstruation, I want to inform the young girls about an essential but neglected necessity during menstruation which is “Diet and Nutrition”.
Nutrition plays a tremendous role in determining a woman’s health and nutritional status. A girl needs more calories and more healthy foods during the periods than our usual intake in normal days. Providing proper care, diet, hygiene to adolescent girl during menstruation can even contribute in breaking the intergeneration cycle of malnutrition.
Some of the tips for intake of healthy foods menstruation are as follows;
- A balanced diet containing lots of fruits and vegetable should be taken during menstruation.
- Consuming a diet rich in Iron is extremely important. During menstruation, body’s requirement for iron increases as it needs to create more blood to make up for the loss of blood during menstruation. A deficiency of iron in the body can cause anemia. Some of the food products rich in iron are:
- Lean red meat,
- Dark poultry (organ meat like liver)
- Spinach and green leafy vegetables
- Almonds and iron fortified cereals
- Citrus fruits or vegetables should be consumed before taking iron rich food as it helps in iron absorption. Orange juice is best choice for iron absorption.
- Avoid caffeine, coffee and caffeinated drinks as they decrease absorption of iron.
- Fruits and Vegetables should be taken in greater amount. Green vegetables are rich in calcium, magnesium and potassium, and relieve and help prevent menstrual pains. These minerals can help ease tensions and relax us. Green vegetables also help with irritability and contain high quantities of vitamin K, which is needed to prevent excessive bleeding and clot the blood.
- All seasonal fruits like Apple, Banana, Pear, Orange, Pineapple melons etc can help us deal with sugar cravings and provide with all the macro and micronutrients to help us combat period induced weakness.
- Drinking adequate amounts of water will help to alleviate symptoms of bloating and relieve us from water retention that’s common during periods. So we should drink 8 to 10 glasses of water during periods.
- The high fiber content in beans and peas helps reduce congestion and cramps. Legumes also contain high levels of the vitamin B complex, which prevents cramps and fatigue at that time of the month.
- Food items that are rich in calcium should be included in our diet every day. A glass of milk or curd is best option which appears to relieve menstrual discomfort.
- Apart from healthy diet light exercise or yoga during periods is also important to keep us cool and comfortable as well as to get relieved from pain and cramps.
Foods we should avoid during Menstruation
- Caffeinated foods and beverages that contain caffeine should be restricted though it can help relieve menstrual symptoms. Caffeine-containing foods and beverages, such as chocolate, coffee, tea and soft drinks, worsen symptoms such as anxiety, depression and breast tenderness.
- Salt intake should be kept under control to avoid bloating and the puffy, heavy feeling that comes with it. Avoiding processed foods is one of the best ways to control salt consumption because processed foods and convenience foods are typically packed with sodium.
- Foods high in sugar is not suitable to intake during menstruation. Imbalance in sugar level can make us feel lazy and sluggish. Sugar can also cause rapid mood swings. So we should stay away from sugary foods such as cakes, pastries and colas.
- We should not drink alcohol of any forms. Intake of alcohol increases premenstrual depression. Alcohol can act as a blood thinner, increasing our flow and causing more discomfort.
- Dairy products like ice creams, cheese and cream are high in fats and therefore have the same effects as fatty meats. High-fat foods have a strong influence on hormonal activity in our body. Hormone changes during the menstrual cycle are linked to symptoms such as bloating and breast tenderness
- The diet should be light and balanced during periods. Heavy food is simply going to make us feel sluggish and cause mood swings.
Due to my lack of awareness on diet during menstruation, I used to consume very small amount of food during monthly period cycle fearing the severe abdominal pain. I had no idea that I could have anemia due to severe bleeding while menstruating. The Nepal Demographic Health Survey 2016 has also revealed the alarming situation of anemia among women of reproductive age (15-49) which is 41%. Besides this a lot of women and young girls are also malnourished in Nepal. This is serious concern nationwide which needs immediate attention from all levels. Girls must be educated on this issue beginning from their homes and school. Thankfully, times are changing. People have started talking about menstruation and its various dimensions at school and homes.
I am really hopeful that we can make our upcoming generation of young girls nutritionally strong and healthy who are capable to challenge the menstruation taboos, break the myth and stigmas to become empowered and unstoppable!
Written by: Rama Thapa
Collected by: Kritee Lamichhane
1. World Health Organization (WHO) recommends breastfeeding should begin within one hour of birth
2. Breastfeeding should be “on demand”, as often as the child wants day and night (Usually 8-12 times in 24 hours), bottles or pacifiers should be avoided
3. A child must be exclusively breastfed for the first six months of life. Mother’s milk is enough for the child for the first 6 months. Water, honey or any other kinds of solid/liquid food must not be given to the child during the first 6 months.
4. At six months, solid foods, such as mashed food like rice, beans, pulses, eggs, fish, fruits and vegetables, should be introduced to complement breastfeeding for up to two years or more.
5. Breastfeeding should not be decreased when starting on solids. The food for the child as well as the container should be clean and safe. Breastfeeding must be continued until the child reaches 2 years of age.
6. Benefits of breastfeeding on infants:
- Breast milk is the ideal food for newborns and infants.
- It gives infants all the nutrients they need for healthy development.
- It is safe and contains antibodies that help protect infants from common childhood illnesses such as diarrhea and pneumonia
- Breast milk is readily available and affordable, which helps to ensure that infants get adequate nutrition
7. Benefits of breastfeeding on mothers:
- Exclusive breastfeeding is associated with a natural (though not fail-safe) method of birth control (98% protection in the first six months after birth).
- It reduces risks of breast and ovarian cancer, type II diabetes, and postpartum depression
7. Long-term benefits for children:
- Breastfeeding contributes to a lifetime of good health
- Adolescents and adults who were breastfed as babies are less likely to be overweight or obese.
- They are less likely to have type-II diabetes and perform better in intelligence tests.
8. Why avoid infant formula?
- Infant formula does not contain the antibodies found in breast milk.
- When infant formula is not properly prepared, there are risks arising from the use of unsafe water and unsterilized equipment or the potential presence of bacteria in powdered formula.
- Malnutrition can result from over-diluting formula to “stretch” supplies.
- While frequent feeding maintains breast milk supply, if formula is used but becomes unavailable, a return to breastfeeding may not be an option due to diminished breast milk production
9. HIV and breastfeeding:
- An HIV-infected mother can pass the infection to her infant during pregnancy, delivery and through breastfeeding.
- However, antiretroviral (ARV) drugs given to either the mother or HIV-exposed infant reduces the risk of transmission.
- Together, breastfeeding and ARVs have the potential to significantly improve infants’ chances of surviving while remaining HIV uninfected
- WHO recommends that when HIV-infected mothers breastfeed, they should receive ARVs and follow WHO guidance for infant feeding.
10. Regulating breast-milk substitutes (BMS Act): An international code to regulate the marketing of breast-milk substitutes was adopted in 1981. It calls for:
- all formula labels and information to state the benefits of breastfeeding and the health risks of substitutes;
- no promotion of breast-milk substitutes;
- no free samples of substitutes to be given to pregnant women, mothers or their families; and
- no distribution of free or subsidized substitutes to health workers or facilities.
11. Support for the breastfeeding mother is essential:
- Family of breastfeeding mother must create enabling environment so that the mother can adequately breastfeed her child.
- Routine practices, such as separation of mother and baby, and supplementation with infant formula, actually make it harder for mothers and babies to breastfeed.
- Health facilities must ensure baby friendly facilities and nutritional counselling services for the new mothers to encourage higher rates of the breastfeeding practice in proper frequency and position.
12. Working women and breastfeeding:
- Mothers need a safe, clean and private place in or near their workplace to continue breastfeeding.
- Enabling conditions at work, such as paid maternity leave, part-time work arrangements, facilities for expressing and storing breast milk, and breastfeeding breaks is a must at work place.
WHO Fact File: 10 Facts on breastfeeding
Accessed at http://www.who.int/features/factfiles/breastfeeding/facts/en/ on 23rd May, 2017
According to World Bank, over 1/3rd of child mortality in Nepal is due to malnutrition and reasons associated with it. Despite of several efforts to reduce malnutrition in Nepal, the findings of recent NDHS 2016 report reveals, 36% of children in Nepal are stunted, 10% are wasted and 27% are underweight. It is a proven fact that children who are undernourished during the golden 1000 days are at risk for impaired cognitive development as 90% of brain development occurs in the first 2 years of child. Undernourished children have high chances of falling sick with increased threat to life in the children of the respective age group.
Acknowledging the fact that most of the irreversible damage due to malnutrition takes place during gestation and in the 24 months of life, proper breastfeeding and complementary feeding practices are greatly promoted by the government/ non-government sector to combat malnutrition among children in Nepal. However, if we look at the findings of NDHS 2016, only 55% of newborn were breastfed within an hour and just 66% of under 6 months children were exclusively breastfed.
Adequate breastfeeding, complementary feeding and proper nutrition are the right of every child and children’s health and wellbeing is dependent on parent’s commitment. The food which the mother eats today will make a difference for long term health status of the child. Hence, every mother must internalize if she is eating right, if she is feeding her child properly. If not, then she should be implementing appropriate maternal and child feeding practices through support from her husband, family with regular assistance of health workers in the community. This will not only aid in the mothers health but also enhance the health of the baby and thus foster positive family environment.
With the motto to reach the mother and children and create a youthful spark to ignite the fight against malnutrition, a team of youth called ‘SOCHAI – Youth For Nutrition’ has embarked upon a journey at Lubhu, Lalitpur. We realize that the small steps from combined effort from young people can actually make a big difference. So, the SOCHAI – YFN team is targeting the “golden 1000 days mothers” at Lubhu to help them learn, internalize and implement proper nutritional practices. The Poshan mala and Nutri card is the educational tool through which the mother are being educated and supported to practice optimal breastfeeding and ensure timely and adequately complementary feeding including all food groups in 1000 golden days to ensure the health of the mother and children.
The response YFN team have been getting through mothers are phenomenal as the mothers share how their knowledge has improved, their attitude reformed and their beliefs towards food and nutrition changed for good. We believe our minor commencement can make the paramount impact in the lives of mother and children not just in Lubhu but throughout the country in the coming days.
If not now, WHEN? If not us, WHO? There is no better time than now.
It’s high time to make a difference and do something to bring about change by promoting the health and nutrition of mothers and children through information, education and communication at grassroot level.
Written by: Usha Sharma