Titilayo Medunoye gave birth to her first child, her lovely daughter Lani, in 2014. The new mother was understandably excited about her baby and like all new mothers, was keen about properly breastfeeding her child.
But, she began to have difficulties breastfeeding. “I had a difficult pregnancy and I was looking forward to having the baby and having everything go easy,” she said. “But after she was born I had a very difficult time breastfeeding. I had problems supplying enough milk and my baby had problems latching to feed.”
Traditional misconceptions as to why women are unable to breastfeed are many, including myths that there are insects in the woman’s breast, that the breastmilk has soured, or that if they breastfeed and have sex the sperm will go to their milk, Medunoye said, adding that the government is working to help dispel those myths and encourage breastfeeding. “Right now in Nigeria breastfeeding rates are low, and even the Federal Ministry of Health is doing a lot of work to see how they can break up the myth and stigmatisation that comes with breastfeeding to see how they can encourage more women to breastfeed,” she said.
Globally, rates of breastfeeding are far lower than is needed to optimally protect the health of women and their babies. The 2018 Global Breastfeeding Scorecard revealed that less than half of newborns are breastfed in the first hour after birth, and 41% of infants less than six months of age are exclusively breastfed, far short of the 2030 global target of 70%.
While breastfeeding exclusively is the ideal we would like to see, Medunoye says difficulties breastfeeding are more common than we think. For women who have challenges breastfeeding, sometimes health workers and family members tell them to feed their babies with water or infant formula. Having proper counselling and lactation options for mothers will help ensure they are able to mitigate these challenges and properly breastfeed their babies exclusively. Exclusive breastfeeding is critically important for the development of children in the first six months of their lives.
A helpful yet underutilised industry
Medunoye said she was fortunate to meet with a lactation consultant in the US, where she had her baby. “It was at that point that I realised the profession actually exists,” she said. Lactation consultants are professional breastfeeding specialists trained to teach mothers how to feed their babies. They help women experiencing breastfeeding problems, such as latching difficulties, painful nursing, and low milk production. A lactation consultant also helps babies who aren’t gaining enough weight.
After working with the consultant for a while, she came back to Nigeria. “I still needed the support and I was also using lactation products that I bought in the US, but I realised that it was not sustainable for me to keep buying it and importing into Nigeria,” she said. “I decided that since no one was making these products, let me try and make the recipe for myself, so I tried it out and it worked, and I started using it, and also shared the products with family and friends.” Medunoye said she tried out a cookie recipe, as well as a lactation tea that included the popular moringa plant leaves. Soon she was fielding requests from her family and friends for more products. “A lot more people wanted it and it was costing me too much to make the product and give it out for free, so I started to put a little fee on it,” she said.
Building a business to help breastfeeding mothers
This gave birth to her business, Milky Express, in 2015. She serves as the company’s Chief Executive Officer, and Milky Express, boasting to be Nigeria’s first lactation company, focuses on manufacturing products that enhance both the quality and quantity of breastmilk, as well as offering lactation consultation services.
Medunoye set up a breastfeeding centre to attend to clients. “The first consult is when they are pregnant, we assess to make sure that their breasts are developing properly and if they have issues with their breasts already, such as inverted nipples, we give them products and teach them what to do so that when they eventually give birth they are knowledgeable about what to do to improve their breastfeeding experience,” she said.
Starting out had its own share of challenges. “Some of the challenges we faced included breaking into the market. People did not know what lactation products were because it was the first of its kind in Nigeria,” she said, adding that, “Getting people to be honest and open about their breastfeeding challenges was also hard. You’re having a conversation with a mother and she breaks down crying and says that when she tells people that she is having breastfeeding difficulties they say she is not a good mother, or she is not a real mother.”As the demand for her products and service grew, she realised that she needed more knowledge when she started getting requests from people with problems that she could not handle. “The more I worked with mothers I realised that many mothers had peculiar issues that I could not help because I wasn’t a professional,” she said. Some of those issues included women with hormone imbalances and mastitis, which is the inflammation of breast tissue. “So, I started to make enquiries to see how I can be certified and how I can get the knowledge that I need to help the mothers,” she said.
She took courses that would help her become a certified lactation consultant. “Once I started the business, becoming certified was the plan,” Medunoye said. Those who want to become International Board Certified Lactation Consultants (IBCLCs) must meet the preparation requirements set by the International Board of Lactation Consultant Examiners (IBLCE). To become eligible to take the IBLCE certification exam, prospective consultants must meet standards for health sciences education, lactation education, and lactation clinical experiences.
Prospective IBCLCs must complete courses in 14 subjects, including eight college courses in health sciences topics like biology, human anatomy, human physiology, infant and child growth and development, nutrition, research, sociology, and psychology. They must also complete courses in cardiopulmonary resuscitation (CPR), medical documentation, medical terminology, occupational safety, professional ethics, and safety precautions for infectious diseases. Current health care providers like doctors, nurses, midwives, and physician assistants may be exempt from these requirements.
Lactation consultants must also complete 90 hours of lactation-specific education. The third requirement for exam eligibility is clinical experience. Those who have 1000 hours of experience working with breastfeeding mothers in the five years before they take the exam do not have to complete any additional hours. Prospective IBCLCs who do not meet this requirement must complete 500 supervised hours of clinical practice with breastfeeding mothers.
Medunoye said she worked with a lactation consultant in the US for her clinical experience. She then completed her 90 hours of lactation education to earn the certificate as a Breastfeeding Specialist from the Lactation Education Resources. She then did the courses and wrote the board exam to become Nigeria’s first indigenous International Board Certified Lactation Consultant.
A growing market for lactation care
Since 2015, she estimates that she has attended to over 2,000 clients who buy her products or come to the breastfeeding centre. “I’ve worked with mothers who have had trauma with regards to breastfeeding, who are very frightened of breastfeeding, but they don’t have anyone to talk to, and when they talk to people they are mostly judgemental because they don’t want to breastfeed,” she said, adding that today people are more open about talking about their breastfeeding challenges and she also works with doctors to help both the mother and the baby.
She incorporated the company in 2017, and founded the Milky Express Breastfeeding Foundation where she works with a team of volunteers to give free eye and dental checks, infant growth checks and general health screening to people in local communities.
Since incorporation, the company now has distribution partners in Ghana, the US, South Africa, and five states in Nigeria, she said, adding that she gives public lectures on maternal and infant health and lactation. Her work has garnered international recognition, and in 2019 she was selected as an Obama Foundation Africa Leader.
She says the role of a lactation consultant is critical in all aspects of breastfeeding. “The WHO recognises the lactation consultant’s role in all things that encompasses breastfeeding, whether policy making, educating, and training… everything that has to do with breastfeeding,” she said.
Nigeria is making very slow progress when it comes to professional lactation care, when compared with pregnancy care in other countries. “Lactation care is part of your health insurance in the United States, and people go to check during pregnancy if their breasts are developing well with the changes you are expected to have while pregnant, and also if they have any issues with their nipples, such as flat or inverted nipples. And after pregnancy they go to the consultant who works with them to make sure the baby is feeding and growing well,” she said, adding that in Nigeria, professional lactation care is practically non-existent. “It is not popular in Nigeria. There are now three others who are also selling lactation products but there is no other indigenous certified lactation consultant in Nigeria.”
Getting lactation care in Nigeria has become just a little easier with organisations like Milky Express. Initiatives like Medunoye’s should be encouraged in order to boost Nigeria’s exclusive breastfeeding rates, help reduce stigma around breastfeeding challenges, and help women struggling with breastfeeding to properly care for themselves and their beautiful children. We need to increase the number of lactation consultants in Nigeria. Medunoye should be able to impart her knowledge to build the capacity of nurses and midwives to better support pregnant women once they have given birth.
Do you know of other organisations employing innovative ways to encourage and support women breastfeed? Share with us on social media!