But Urban Mothers Struggle
By Ndey Sowe
As the world marks World Breastfeeding Week, which in The Gambia is observed as World Breastfeeding Month, nutrition experts say the country has achieved remarkable progress in exclusive breastfeeding but warn that cultural myths, urban lifestyle pressures, and workplace barriers still threaten the practice.
Malang N. Fofana, Director General of the National Nutrition Agency (NaNA), said this year’s theme is “very apt” and underscores the need to build sustainable systems that support women to breastfeed optimally.
“So in terms of policy, what we are trying to do, especially because of this year’s theme, is to talk to institutions and policymakers to create what we call crèches,” he said. “A place where women would put their children around them while they are either doing business or some work, and somebody would take care of them. We are advocating for the creation of crèches around markets, workplaces, lumo’s and business centers so that women can work properly.”
Exclusive breastfeeding has grown steadily in The Gambia over the past two decades. According to Mr. Fofana, in 2000, only 36% of Gambian mothers exclusively breastfed their babies. By 2013, the rate had increased to 46%. The most recent Demographic and Health Survey (2019–2020) placed the figure at 54%, surpassing the global target of 50%.
“As a country, we can proudly say we have surpassed the global target by 4%,” Mr. Fofana said. “But we are not complacent. Our policy target is to ensure every child undergoes exclusive breastfeeding for the first six months, and we aim to reach 70%.”
He attributed the gains to sustained advocacy, the Baby Friendly Hospital Initiative, the Baby Friendly Community Initiative, and support from maternal and child health projects, social safety nets, and international partners.
Urban Mothers Face Unique Challenges
Despite national progress, urban areas remain hotspots of low breastfeeding rates.
“Urban areas like Banjul, KMC, and some of the urban towns face challenges,” Mr. Fofana explained. “Many working mothers find it difficult to practice exclusive breastfeeding, despite the law backing maternity leave of six months. Others see formula feeding as a sign of fashion or civilization. These practices undermine breastfeeding.”
By contrast, exclusive breastfeeding remains more common in rural areas where traditional practices and stronger family support structures prevail.
Mr. Fofana underscored the lifesaving benefits of breastfeeding for both mother and child.
“Every child should be optimally breastfed, meaning the child is put to the breast in the first hour of birth, exclusively breastfed for the first six months, and then continued alongside complementary feeding for two years or more,” he said.
For mothers, early initiation prevents postpartum hemorrhage and retained placenta—two major causes of maternal death. For infants, colostrum—the thick yellow milk produced in the first hours—serves as the first immunization, rich in antibodies and nutrients.
“Colostrum helps clear the intestines of meconium and prepares the child for milk feeding,” he explained. “It is the perfect first food, and breast milk contains all the nutrients and water an infant needs in the first six months.”
Breaking Myths and Cultural Barriers
One of the biggest myths previously hampering breastfeeding was the belief that colostrum was harmful.
“In some households, it was so bad that they squeezed it out and threw it away,” Mr. Fofana recalled. “Through education, people now understand that colostrum is the first immunization. That myth has now disappeared.”
NaNA has also used community-based support groups to merge traditional knowledge with modern science. By drawing comparisons with animals—such as calves surviving on milk without water—communities began to accept that human infants too can thrive on breast milk alone.
But he stressed that advocacy must target not only mothers but entire families.
“If the husband, mother-in-law, or others in the household don’t support exclusive breastfeeding, the mother finds it difficult,” he said. “We must expand our communication to everyone in the family.”
The Workplace Dilemma
Returning to work remains one of the biggest obstacles for breastfeeding mothers.
“The challenge is sustaining exclusive breastfeeding when the child is one or two months old and the mother must go out to earn income, especially in the informal sector,” Mr. Fofana said.
NaNA is pushing for the establishment of workplace crèches and flexible working arrangements.
“We want workplaces where mothers can safely keep their babies and continue breastfeeding. We are also advocating for flexibility, allowing mothers to arrive late or leave early, so they have time to feed their babies,” he added.
Policy and Legal Framework
The Gambia’s Women’s Act expanded maternity leave to six months, surpassing the International Labour Organization (ILO) standard of 12 weeks. Implementation, however, remains inconsistent—especially in the private and informal sectors.
NaNA collaborates with the Ministry of Labour, the Ministry of Health, the Ministry of Gender, and the Ministry of Justice to ensure enforcement of maternity protection.
At the same time, NaNA and partners are reviewing regulations that control the marketing of infant formula.
“Yes, we have had cases where companies advertised formula. We intervened and made them remove the adverts,” Mr. Fofana confirmed.
Breastfeeding and Food Security
In a country facing rising food prices, breastfeeding is also framed as an economic and food security strategy.
“Breastfeeding is free, you cannot cost it,” Mr. Fofana stressed. “To cope with the food crisis, the best strategy is to promote breastfeeding, especially for young children.”
The National Nutrition Policy integrates breastfeeding with maternal nutrition, infant feeding, and household food security strategies.
The Baby Friendly Community Initiative (BFCI) has been a cornerstone of Gambia’s success. Piloted in the early 2000s, it has now expanded to over 1,000 communities.
Communities are encouraged to form breastfeeding support groups, conduct home visits, organize role plays and dramas, and promote maternal nutrition and hygiene alongside breastfeeding.
“This has worked so well that other African countries have come to understudy The Gambia’s model and replicate it,” Mr. Fofana said proudly.
The Gambia has benefitted from strong partnerships with UNICEF, WHO, WFP, FAO, the World Bank, and the EU, among others.
“We developed a strategic plan and an investment framework in nutrition. These documents helped us mobilize resources. Today, The Gambia is part of the Global SUN Movement and the ECOWAS Nutrition Forum,” Mr. Fofana explained.
Despite progress, challenges remain in sustaining gains. High staff turnover in health facilities, cultural resistance to breastfeeding beyond two years, and weak enforcement of formula marketing regulations remain obstacles.
“Professionally and nutritionally, breastfeeding beyond two years is very important for a child’s survival. But culturally, it is a challenge,” he admitted.
A Call to Mothers and Families
Mr. Fofana urged mothers, especially first-time mothers, to prepare themselves for breastfeeding during pregnancy and to put babies to the breast immediately after delivery.
“Exclusively breastfeed your babies for the first six months. This is proven globally to be the most ideal food for every infant,” he said.
He also encouraged mothers to share what they learn with spouses and peers, emphasizing that collective support is critical.
In closing, he thanked the Gambian government and partners for creating an enabling environment for nutrition advocacy.
“Finally, I would like to seize this opportunity to thank the government for its support, and our partners for standing with us. Together, we can ensure that every Gambian child gets the best start in life through breastfeeding,” he concluded.
