Fatherhood advocate facilitates paternal involvement, positively affecting children’s and mothers’ lives

Doug Edwards, Director of Real Dads Forever, a Fatherhood Strategies Development organization, is a firestarter. Inside every father is something of value, an ember, as Edwards describes. Edwards sees it as his mission to clear away any ashes so that the embers can burst into flames, to become energy and atmosphere, to help fathers come into the space where they can truly radiate.

“I want to change the world!… More realistically and substantively I want to get dads to understand their unique and specific value and articulate it and change behavior so their relationship is meaningful to their child,” Edwards said in a 2013 interview.

Paternal involvement positively affects child development and wellness; further when fathers are positively involved in their infants’ lives, mothers’ stress decreases.

Edwards was propelled into this work nearly three decades ago when he volunteered with a development center working with teen parents.

Since then, he has worked with over 20,000 men.

When he started this work, Edwards says the national focus was on deficit and absent fathers; today, he sees more awareness and an understanding of the importance of fatherhood as it relates to the needs of the child.

Photo by Keira Burton

Real Dads Forever boasts an impressive list of clients including Centering Pregnancy, UCONN, public school systems and departments of public health.

About a decade ago, Edwards found through a father-friendly site survey,  that only 30 percent of programs enrolling new parents–whether that be at a school or through a maternity program, etc.–  asked for the father’s name.

“We don’t encourage [fathers] to step up and then we wonder why they don’t show up,” Edwards commented in a 2013 interview.

In many cases, this continues to be the trend today.

Recently, Edwards conducted a Fatherhood Friendly Site Assessment with Connecticut WIC. He investigated: Were fathers included in their policies? If so, was this being translated into their practice? Was the physical environment welcoming to fathers? Were fathers pictured in their educational and promotional materials? Edwards found that fathers literally had no chair at the table. When consults were held, there was often no chair for the father to be included in the discussion.

Photo by Anna Shvets

Edwards helped the organization implement changes specifically through staff training and professional development.   The training included sensitivity training on how to respectfully ask the question : “Where is the father?” when he is not present, taking into account many of the realities that families may be dealing with: death, incarceration, deployment, abuse, and absence under other circumstances.

Edwards suggests that those working with young families take stock of our biases as well as acknowledge and address any systemic barriers present.

Fathers are often forgotten in the experience of infant and young child death too. Through his work with the Fetal and Infant Mortality Review in Hartford, Conn., Edwards found that fathers were getting little to no support after the death of a child.

He recalls one father who shared that he listened to the heartbeat of his baby, felt his baby’s movements, sang to the baby, and attended all of the prenatal visits. Around eight months gestation, the family was involved in a car accident. The baby was born prematurely and ultimately died. The father shared with Edwards that he lost the ability to become the father he didn’t have. “My fetus knew her dad,” the father told Edwards.

Photo by Laura Garcia

It was this poignant story that led Edwards to create the curriculum, “Paternal Prenatal Early Attachment”. The program is designed for expecting couples with a focus on strengthening fathers’ capabilities to enhance their support of mothers and babies during pregnancy beyond. He has facilitated the program in Connecticut and with 17 different states for National Institute for Children’s Health Quality (NICHQ), which provides Technical Assistance for National Healthy Start.

Prenatal education offers the “biggest bang for your buck,” Edwards says of fatherhood advocacy.

“This is when [fathers] are keenly aware of something outside of themselves that’s going on,” Edwards comments. “They want to do a good job… Guys like jobs… I turn that into more than a job; I turn that into a relationship. I want them to fall in love with their unborn child and fall in love with [the mother of their child]. That’s a great setup for the child to thrive.”

Edwards’ work challenges fathers to explore and feel their own childhoods.

“This is an eye opening experience for them,” Edwards comments.

He calls it “backing into empathy.”

Edwards has watched the transformation of self described “thugs” and “black hearted” individuals to softened men when they go through the “magical epiphany” of becoming a father.

Photo by Ксения

Edwards explains that fathers gain new insights and experience out-of-body sensations due to the flood of oxytocin during the birth of a child. Skin-to-skin contact deepens this bond between father and child. [More at Facilitating the bond between children and fathers or male-identifying partners]

Reflecting on the course of his work, Edwards says “It’s just getting better with time. We didn’t have these discussions years ago.”

He highlights fatherhood legislative work in Conn., the first state to pass legislation on fatherhood.

“The Connecticut Fatherhood Initiative (CFI) is a broad-based, statewide collaborative effort led by the Department of Social Services, focused on changing the systems that can improve fathers’ ability to be fully and positively involved in the lives of their children.

First implemented after the passage of legislation in 1999, state and local partners have been working together … to make changes to policy and practice in order to better meet the needs of fathers…” [Read more here: https://portal.ct.gov/Fatherhood/Core/The-Connecticut-Fatherhood-Initiative]

Photo courtesy of the Gaynor family

Edwards was previously featured on Our Milky Way in Unsung Sheros/Heros in maternal child health.

Edwards also recently completed the Lactation Counselor Training Course (LCTC).

Breastfeeding is an opportunity to learn.

–This post is part of our 10-year anniversary series “Breastfeeding is…”

Breastfeeding is an opportunity to learn. Although breastfeeding is an ancient practice, there is still so much to learn about the lactating breast, breast function and the process of breastfeeding, especially as our modern lives continue to change.

Many current textbook depictions of the anatomy of the lactating breast are largely based on research conducted over 150 years ago, Donna T. Geddess points out in The anatomy of the lactating breast: Latest research and clinical implications.

“…Few studies have actively investigated the anatomy of the lactating breast despite the obvious importance a clear understanding of the lactating mammary gland has to both mother and infant,” Geddess writes. “Perhaps this lack of information is a part of the greater reason why many women continue to experience breastfeeding problems.”

Katherine Lee writes in Katie Hinde Championing the Fun Side of Science Through Virtual Animal Games, Thunderdome Style about Hinde’s hope to change the perception about breastmilk and quotes her saying “‘Still to this day, there is no integration between breastfeeding and milk composition and volume,’ noted Hinde. ‘In Pubmed, there are more articles about tomatoes than human breast milk.’ When they listed the human microbiome project, they didn’t include breastmilk…”

This week we present several  recent (in the last 5 years) publications that are helping to shape our understanding of infant feeding. We have also included studies that relate specifically to pregnancy as pregnancy, birth and breastfeeding are all part of a continuum.

It is important to note that research published in medical journals is not the only way to capture and develop an understanding of infant feeding experiences. For instance, Camie Jae Goldhammer,  MSW, LICSW, IBCLC, (Sisseton-Wahpeton), founder of  Hummingbird Indigenous Doula Services says that their program is proudly not rooted in “evidence”; instead, it’s a community designed program. Anecdotal evidence and indigenous knowledge and wisdom should be honored. Moreover, as with any research, we must always consider how the research is funded, who is or is not being represented, and how the research is presented. For more on equity in science, check out Increasing equity in data science and the work being done at the Urban Indian Health Institute.

 

Lactation duration and stroke risk 

In February 2022, Ziyang Ren, MD, et al released Lactation Duration and the Risk of Subtypes of Stroke Among Parous Postmenopausal Women From the China Kadoorie Biobank.

Stroke is a growing global health problem. It is the third leading cause of disability adjusted–life years (DALYs) worldwide and the first leading cause of DALYs in China, Ren, et al point out. Stroke  imposes a financial burden on patients, families, and society. The cohort study found that lactation duration significantly lowers the risk of stroke.

Up until now, most research has focused on the association between lactation and cardiovascular diseases (CVDs), but this piece lays out the association between lactation and stroke subtypes.

Specifically, the study found that parous postmenopausal women with lifetime lactation duration of at least 7 months had lower risks of ischemic stroke and intracerebral hemorrhage (ICH) compared with women who never lactated. For subarachnoid hemorrhage (SAH) though, such associations were found only in participants with lifetime lactation duration of longer than 24 months. In addition, the authors found that those with an average lactation duration per child or lactation duration for the first child of at least 7 months were less likely to develop stroke and its subtypes.

 

Marijuana exposure in utero 

Birth Outcomes of Neonates Exposed to Marijuana in Utero: A Systematic Review and Meta-analysis by Greg Marchand, et al, the largest meta-analyses on prenatal cannabis use to date, the authors  found significant increases in seven adverse neonatal outcomes among women who were exposed to marijuana during pregnancy versus those who were not exposed during pregnancy.

Photo by Solen Feyissa on Unsplash

The systematic review and meta-analysis demonstrated higher rates of low birth weight (<2500 g) and small for gestational age (<fifth percentile), lower mean birth weight, preterm delivery (<37 weeks’ gestation), higher rate of admission to the neonatal intensive care unit, poorer Apgar scores at 1 minute, and smaller head circumference in those exposed to marijuana.

The prevalence of marijuana use during pregnancy is significant, and many people cite the belief that marijuana use is relatively safe during

pregnancy. This work may help to raise awareness and be used to educate patients about adverse outcomes with the hope of improving neonatal health.

With increased marijuana legalization in mind, Kara R. Skelton, PhD and  Sara E. Benjamin-Neelon, PhD, JD, MPH in Reexamining Risks of Prenatal Cannabis Use—Mounting Evidence and a Call to Action urge states that have legalized and commercialized cannabis to retroactively prioritize protection of neonatal health.

More on cannabis during the perinatal period here.

 

Childhood obesity 

The authors of Childhood Obesity and Breastfeeding Rates in Pennsylvania Counties-Spatial Analysis of the Lactation Support Landscape examined the relationship between childhood obesity and breastfeeding rates in Pennsylvania (PA) counties, the relationship between geographic access to professional lactation support providers  (LSPs) in PA counties and breastfeeding rates, and  the relationship between geographic access to professional LSPs and childhood obesity in PA counties. They found a significant, inverse relationship between breastfeeding rates and childhood obesity prevalence at the county level and a significant, inverse relationship between the number of CLCs and the number of all professional LSPs and childhood obesity rates at the county level. Thus,  the authors conclude, the availability of breastfeeding support is significantly related to breastfeeding rates and inversely related to childhood obesity rates across Pennsylvania.

 

Measuring optimal skin-to-skin practice 

The authors of Mapping, Measuring, and Analyzing the Process of Skin-to-Skin Contact and Early Breastfeeding in the First Hour After Birth show how process mapping of optimal skin-to-skin practice in the first hour after birth using the algorithm, HCP-S2S-IA, produced an accurate and useful measurement, illuminating how work is conducted and providing patterns for analysis and opportunities for improvement with targeted interventions.

More specifically, the algorithm provides a tool to help reduce delays or decrease interruptions during skin-to-skin contact (SSC). The authors note, “Not suckling in the first hour after birth places newborns at higher risk for neonatal morbidities and mortality. Examining patterns and developing strategies for change optimizes patient outcomes.”

 

Acknowledging the social determinants of health

Pregnancy and the origins of illness (2022) by Anne Drapkin Lyerly begins by acknowledging that the COVID-19 pandemic has induced a collective trauma that is expected to be felt for generations after the virus is contained. The study of epigenetics has shown that children gestated or born during times of great tragedy, carry a genetically coded and inherited imprint of their mother’s experience with lifelong consequences to their health.

Recognizing the “maternal-fetal interface” as the “nexus of inter-generational trauma” raises the question of how we should think about this implication of maternal bodies, especially in light of the current pandemic.

The author explores the growing field of developmental origins of health and disease (DOHaD) and its use of epigenetics. Thinking about the tools of history, philosophy, and gender studies of science, the author advises we proceed with caution as we consider maternal effect science which raises several concerns that can impact practice and the well-being of mothers and consequently their children.

Namely,  there may be a tendency to ascribe blame on pregnant people for the health outcomes of their offspring that are well beyond their control. This approach doesn’t adequately weigh the effects of paternal, postanal, and other social and environmental factors that also influence the long-term health of children.

Analyzing epigenetics can eventually contribute to the erasure of the mother as a person, and further, characterizing the maternal body as an environment may excuse women from being appropriately considered in public health policies, clinical care and health research.

The author considers DOHaD research a corrective approach to near-sighted fetal origins science and urges that we expand our understanding of the gestational environment from not simply the womb, but to the broader environment in which a person gestates, marking the importance of acknowledging the social determinants of health. To best direct our efforts during the current pandemic, the author suggests shifting the focus off of maternal behavior and choices and instead focus on limiting the harm of climate change, racism, and other structural inequities.

 

Can’t get enough? 

Check out the Breastfeeding Medicine Podcat’s episode Review of a Potpourri of Research Topics with co Hosts Anne Eglash MD, IBCLC and Karen Bodnar MD, IBCLC. You can find a full list of their podcast episodes here.

Subscribe to SPLASH! Milk Science Update

Check out The International Society for Research in Human Milk and Lactation

 

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As part of our celebration, we are giving away an online learning module with contact hours each week. Here’s how to enter into the drawings:

Email info@ourmilkyway.org with your name and “OMW is 10” in the subject line.

This week, in the body of the email, tell us: What fascinates you about breastfeeding and/or what do you wonder about breastfeeding?

Subsequent weeks will have a different prompt in the blog post.

We will conduct a new drawing each week over the 10-week period.  Please email separately each week to be entered in the drawing. You may only win once. If your name is drawn, we will email a link with access to the learning module. The winner of the final week will score a grand finale swag bag.

Breastfeeding is eco-friendly.

–This post is part of our 10-year anniversary series “Breastfeeding is…”

Breastfeeding is eco-friendly.

Planetary protection has never been more crucial, and the undeniable relationship between planetary health and human health has never been more evident.

In November 2022, world leaders, policy-makers and delegates from nearly 200 countries attended the COP27 UN climate summit, held in Sharm El-Sheikh, Egypt.

Fabrication of Bodies Joined by a Molecule of Air(2022), by Invisible Flock and Jon Bausor, manufactured by MDM Props Limited in Lebanon, represented by Architect & Engineer Karim Attoui. ©Courtesy of Invisible Flock. https://invisibleflock.com/portfolio/bodies-joined/

Presenters made poignant remarks about the climate crisis we find ourselves in.

“We are on a highway to climate hell with our foot on the accelerator,” António Guterres, Secretary-General of the United Nations said.

Sherry Rehman, Minister of Climate Change, Pakistan argued that  “The dystopia has already come to our doorstep …”

Mark Brown, Prime Minister of the Cook Islands, shared, “Our survival is being held to ransom at the cost of profit and an unwillingness to act despite the ability to do so.”

On Decarbonization Day of the summit, Dr. Abla Al Alfy convened a panel of speakers who presented on the importance of the 1,000 Golden Days and the relationship between the climate crisis and mother baby health. [You can access the United Nations Egypt’s recording here which starts at 19 minutes in.]

Dr. Nevein Dous, UNICEF health specialist, covered infant mortality rates, micronutrient deficiencies, mental health challenges, among other global health challenges and called for the integration of services rather than siloing health strategies.

WHO

Frederika Meijer with UNFPA Egypt highlighted UNFPA’s work confronting medical violence and reducing the country’s cesarean section rate which soars over 60 percent.

Meijer brought light to the need to create resilient health systems that will withstand the inevitable shocks of the climate crisis.  She noted the important role skilled midwives play in the reduction of unnecessary c-sections, giving way to the work of Dr. Kawther Mahmoud, President of the Nurses Syndicate, Assistant Undersecretary for Nursing and head of the Central Department for Nursing in Egypt, who helps lead the national plan for the midwife.

Many presenters emphasized the importance of family planning counseling and the environmental and health implications of pregnancy spacing.

Dr. Naeema Al-Gasseer’s remarks drew attention to a recent WHO report which states that “Almost the entire global population (99%) breathes air that exceeds WHO air quality limits, and threatens their health.”

Dr. Camilla Kingdon, President of the Royal College of Pediatrics and Child Health, further described that 26 percent of child deaths under 5 years of age have an element of environmental cause like heat waves, water scarcity, vector-borne diseases and flooding. UNICEF has identified that air pollution will be the leading cause of death for children by 2050, she shared. Additionally, there is a clear link between air pollution and miscarriage. Dr. Kingdon went on to describe the prevalence of visible air pollution particles on the placenta.

WHO

In connection to these harrowing accounts, Healthy Children Project’s Dr. Karin Cadwell presented research on the environmental impact of powdered baby formula milks in North America. Read about that work here.

Healthy Children Project’s Dr. Kajsa Brimdyr acknowledged the mess we are in and noted how many solutions that may contribute to planetary and population health are expensive and complex. Skin-to-skin contact (SSC) in the first hour after birth though, is simple and easy, inexpensive, is appropriate for all dyads, and touts priceless benefits.

Brimdyr noted just some of the benefits: SSC in the first hour after birth decreases infant mortality by 25 percent in low birth weight (LBW) infants, decreases transfers to the NICU,  decreases maternal stress and depression, improves paternal parental stress, and allows baby to self attach to the breast improving maternal confidence in breastfeeding and increasing breastfeeding rates overall.

The effects of SSC in the first hour extend far beyond the first hours, the first days and first weeks of life. Feldman et al. (2014) followed mothers and their premature infants who had been in SSC and control groups for 10 years. They found that children who had been in the SSC group had better cognitive development, better autonomic nervous system functioning, and mother–child interactions were more reciprocal 10 years later.

Photo credit: United States Breastfeeding Committee

Silke Mader of the European Foundation for the Care of Newborn Infants (EFCNI) and her colleagues are fighting for SSC and breastfeeding support for all dyads. Mader calls for a zero separation policy which is supported by evidence even in the context of the pandemic, she reported. Mader added that fathers and partners are not second-class citizens and should be included in the policies that help shape proper parent infant bonding.

As the climate emergency becomes more and more bleak, breastfeeding is a safeguard for infant and young child health. Read our coverage on infant and young child feeding in emergencies (IYCF-E)  in Prioritizing infant and young child feeding in emergencies during National Preparedness Month and beyond and National Preparedness Month: the U.S.’s deficit in Infant and Young Child Feeding preparedness during emergencies.

COP27 held the first-ever Youth-led Climate Forum ensuring that young people have a place in the conversation about the climate crisis. More on that here.

 

More resources to explore  

RCPCH Climate Change Working Group

Baby Milk Action’s coverage on COP27

Breastfeeding can help tackle climate crisis but it’s on governments, not mums to save the world

The climate crisis is a health crisis short video

 

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As part of our celebration, we are giving away an online learning module with contact hours each week. Here’s how to enter into the drawings:

Email info@ourmilkyway.org with your name and “OMW is 10” in the subject line.

This week, in the body of the email, tell us: Where have you seen predatory marketing of breastmilk substitutes?

Subsequent weeks will have a different prompt in the blog post.

We will conduct a new drawing each week over the 10-week period.  Please email separately each week to be entered in the drawing. You may only win once. If your name is drawn, we will email a link with access to the learning module. The winner of the final week will score a grand finale swag bag.

Breastfeeding is part of a continuum. 

–This post is part of our 10-year anniversary series “Breastfeeding is…”

Breastfeeding is part of a continuum.

It has been hypothesized that starting around nine weeks of fetal development, the pattern and sequence of intrauterine movements of the fetus seem to be a survival mechanism, which is implemented by the newborn’s patterns of movement during the first hour after birth  (described as the 9 stages)  when skin-to-skin with the mother to facilitate breastfeeding.

Photo credit United States Breastfeeding Committee

This very behavior refutes the idea that breastfeeding is “an adjunct to birth” as it is generally viewed in maternity care settings in America.

Not only are human babies hardwired to progress through 9 stages and self attach to the breast, mammalian bodies are hardwired to produce milk too.

Around 16 weeks of pregnancy, the body starts to prepare for breastfeeding. This phase, called Lactogenesis I is when colostrum begins to be created. During Lactogenesis II, the secretion of copious milk follows the hormonal shift triggered by birth and the placenta delivery. After this phase, milk production must be maintained through a supply-and-demand-like system. [Neville 2001]

Even before a pregnancy is achieved, individuals are being influenced by the infant feeding culture that surrounds them, consciously or subconsciously laying a foundation for how they feel about feeding their own babies.

Pat Hoddinott’s, et al study found that women who had seen successful breastfeeding regularly and perceived this as a positive experience were more likely to initiate breastfeeding.

Exposure to prenatal breastfeeding education also affects breastfeeding outcomes. Irene M. Rosen and colleagues found that women who attended prenatal breastfeeding classes had significantly increased breastfeeding at 6 months when compared to controls.

Photo by Luiza Brain

Mode of birth and birth experiences influence infant feeding too, for both members of the dyad.

A growing body of evidence shows that birth by cesarean section is associated with early breastfeeding cessation.

Intrapartum exposure to the drugs fentanyl and synOT is associated with altered newborn infant behavior, including suckling, while in skin-to-skin contact with mother during the first hour after birth. [Brimdyr, et al 2019]

What’s more, the authors of Intrapartum Administration of Synthetic Oxytocin and Downstream Effects on Breastfeeding: Elucidating Physiologic Pathways found “No positive relationships between the administration of synthetic oxytocin and breastfeeding.” They comment, “Practices that could diminish the nearly ubiquitous practice of inducing and accelerating labor with the use of synthetic oxytocin should be considered when evaluating interventions that affect breastfeeding outcomes.”

Photo by Olivia Anne Snyder on Unsplash

In Transdisciplinary breastfeeding support: Creating program and policy synergy across the reproductive continuum, author Miriam Labbok takes a detailed look at “the power and potential of synergy between and among organizations and individuals supporting breastfeeding, the mother-child dyad, and reproductive health to increase sustainable breastfeeding support.”

Labbok points out that a paradigm shift on the issues in the reproductive continuum – family planning, pregnancy and birthing and breastfeeding– is needed.

“These are issues that are intimately, biologically, gender linked in women’s lives, and yet ones that are generally divided up to be addressed by a variety of different professional disciplines,” Labbok begins.  “Despite the impact of child spacing on birthing success, of birthing practices on breastfeeding success, and of breastfeeding on child spacing, we are offered family planning services by a gynecologist, birth attendance by an obstetrician or midwife, and baby care by a pediatrician. Having these ‘silos’ of care, each with its own paradigm and priorities, may lead to conflicting messages, and hence, may undermine the search for mutuality in goals, and collaboration.”

One such initiative looking to deconstruct siloed care is the Baby-Friendly Hospital Initiative which includes standards and goals for birthing practices, for breastfeeding-friendly communities, and guidance for birth spacing, in addition to reconfirming the original Ten Steps to Successful Breastfeeding, in recognition that breastfeeding occurs along a continuum.

Source: United States Breastfeeding Committee

1,000 Days emphasizes how breastfeeding fits within the global picture as a crucial part of a whole.

In the U.S. context, the 1,000 Days initiative recognizes comprehensive health coverage, comprehensive guidelines on nutrition during pregnancy, lactation, and early childhood for women in the first 1,000 days, paid family  and medical leave policy for all workers, and investments to ensure parents and caregivers can access good nutrition as solutions to a well nation and a well world.

 

——–

As part of our celebration, we are giving away an online learning module with contact hours each week. Here’s how to enter into the drawings:

Email info@ourmilkyway.org with your name and “OMW is 10” in the subject line.

This week, in the body of the email, please share with us some or all of your birth stor(ies).

Subsequent weeks will have a different prompt in the blog post.

We will conduct a new drawing each week over the 10-week period.  Please email separately each week to be entered in the drawing. You may only win once. If your name is drawn, we will email a link with access to the learning module. The winner of the final week will score a grand finale swag bag.

To know is to do: retired nurse dedicates time to humanitarian aid in East Africa bringing awareness to the paradox of direness and vibrancy

Some days Susan Gold, RN, BSN, ACRN misses her ignorance. Since 2003, Gold has embarked on over 30 trips to various locations in East Africa where she teaches sexual and reproductive health and offers humanitarian aid.

Recalling one of her first visits to a clinic in Nairobi, Kenya, Gold describes a young mother, around 18-years-old, who arrived holding her severely malnourished infant against her breasts infected with such severe mastitis that her skin had split. This mother had been thrown out of her home for being HIV-positive and was breastfeeding and formula feeding her baby.

[Some background: Infant feeding has been complicated by the HIV epidemic. In the early 2000s, Gold explains that HIV-positive women were taught to formula feed to lower the risk of transmission to their babies, but with little to no access to clean water, babies were becoming severely ill. What’s more, in societies where breastfeeding is the norm, exclusive formula feeding is often an indication of one’s HIV status, which remains highly stigmatized. And formula is expensive, so many mothers choose mixed feeding, increasing the rate of HIV transmission, because formula irritates the GI system and gives the virus a pathway. By 2010, WHO issued new recommendations that stated that all mothers who tested positive should receive effective antiretroviral treatment (ART) which could lower risk of transmission during exclusive breastfeeding to virtually zero. In 2016, WHO extended the recommended duration of breastfeeding for HIV-positive mothers to 24 months. Effectiveness is dependent on consistency though, and Gold explains that mothers can develop resistance because there isn’t always access to ART.]

Gold was able to give the mother antibiotics, but the care that she and her infant required was beyond what Gold could offer. Considering the dyad’s condition and Gold’s limited resources, she says she’s certain that they died.

Reflecting on the suffering she witnessed and lives lost, that’s when Gold misses her ignorance most, but she says, “To know is to do.”

“For me it’s not a news story I can ignore, it’s names and faces,” she remarks.

In 2007, Gold received a Fulbright Grant to evaluate a reproductive health curriculum for HIV-positive adolescents. In 2017, she was awarded a Mandela Washington Fellowship Reciprocal Exchange Award to collaborate with Sicily Mburu, a Kenyan physician who co-founded AIDS No More. [Read more: https://ghi.wisc.edu/talking-health-out-loud-how-volunteering-led-to-life-saving-strategies-for-teens/]

Most recently, Gold spent several weeks in Dar es Salaam, Tanzania on a Nelson Mandela Fellowship Reciprocal Exchange Fellowship Grant where she partnered with Dr. Omari Mahiza, a pediatrician at Amana Regional Referral Hospital, focusing their efforts on combating pediatric malnutrition and education on family planning.

 

Shattering stereotypes 

Gold has found that most Americans hold a “shallow view” of the continent. Her frustration with the stereotypes associated with Africa runs deep.

“It’s either starving children or a safari,” she begins. “It’s so painful for me to see that displayed so many times. There is such a tendency [in America] to dehumanize people who are not like us… We set ourselves as the standard. Their culture is not a failed attempt to be our culture. Success doesn’t have to look like us or be measured against us.”

Alongside her humanitarian work, Gold hopes to shatter the stereotypes, to bring awareness to the paradox of direness and vibrancy in East Africa.

Gold reminisces: “I love the African sun on my face, the bright colors and motion, the culture that is built around the family and friends, that you’re never expected to do it alone, the  generosity of spirit,  the sounds and smells, the warm welcomes and the optimism.”

Acutely aware of “an inherent imbalance of power” and the concept of White Saviorism, Gold uses the Swahili term Tuko sawa, which means “We are all the same”, as the foundation of her work.

We all want healthy children and families and a future with opportunities to provide long, healthy, prosperous lives, she expounds.

Beyond this core belief, Gold says that she always develops relationships with the people she works with.

“I educate myself on the origins and current status of their culture. I don’t tell people what to do, I share my experiences and expertise. I always learn from them.”

 

Doing more with less 

Ingenuity is something she’s gathered from working alongside East Africans.

For instance, Gold was struck by the engineering of incubators for very sick babies at  St. Joseph’s Hospital in Moshi, Tanzania.

If there is electricity, she explains, the heat is controlled by the number of light bulbs lit. The wood absorbs the heat, the aluminum components absorb and reflect heat, the mattress absorbs heat but also protects the baby, and the lid retains the heat but allows for monitoring of the baby. Mosquito netting is fashioned around the system.

Gold notes that Kangaroo Mother Care (KMC) is practiced for almost all premature babies, but it’s not common among sick babies. [Read about skin-to-skin efforts just north of Tanzania here:  https://www.ourmilkyway.org/skin-skin-gulu-uganda/]

 

Hunger: hidden and stark 

A recent Lancet Global Health Publication, Revealing the prevalence of “hidden hunger”, released estimates of two billion people worldwide with one or more micronutrient deficiencies, noting that this is a gross underestimate. The hunger and deficiencies that Gold and her colleagues witness are rarely hidden and often quite obvious.

A severely malnourished child holds onto one of the toy cars that Gold collects and brings for the children at the clinics.

Breastfeeding is important in the prevention of different forms of childhood malnutrition, including wasting, stunting, over/underweight and micronutrient deficiencies. Tanzania scores quite high in the World Breastfeeding Trends Initiative (WBTi) World Ranking.

Gold observes that all of the women breastfeed in the low-income neighborhoods she visits.

The struggle, she says, is getting enough nutrition for the women to sustain milk production and have energy to feed their babies. During her most recent visit, Gold reports that almost none of the 35 families had food in the home.

Reporters of the new estimates for micronutrient malnutrition point out that processed fortified foods and micronutrient powders can be an easy answer to hunger, but they don’t create sustainability of local and indigenous foods and create conflict of interest issues with industry.

Gold adds that low income community members can’t afford to buy industry developed foods consistently. Lack of access to clean water is also a barrier.

“And you can’t depend on outside groups to sustain you,” she continues.

“We didn’t see any processed food at all because there is no market for it,” Gold says of visiting seven different neighborhoods in the low income region of Dar es Salaam. Instead, small markets with locally-grown fruits and vegetables prevail, but access to protein is a challenge.

As medically indicated, ready-to-use therapeutic food (RUTF) packets of fortified peanut butter issued by UNICEF are given out through health clinics. But Gold notes that sometimes parents sell these packets for money.

 

A challenge but not insurmountable 

North of Dar es Salaam, in Moshi, Gold brings a portable printer that doesn’t require Wifi to the small hospital where she volunteers. She gifts each postpartum mother a printed 4×6 photo of herself and her baby.

“You don’t know how many of these babies are going to survive due to the high infant mortality rate.”

There’s a long moment of silence between us on the video call.

Then Gold expresses her frustration and anger,  “The world can fix this, but chooses not to.”

She urges us to educate ourselves and others. Vote for people who have a vision of the world as one world, she says.

Last month, the President signed into law H.R. 4693, the “Global Malnutrition Prevention and Treatment Act of 2021,” which authorizes the United States Agency for International Development to undertake efforts to prevent and treat malnutrition globally.

For those interested in making financial contributions or donations like baby clothes, children’s  books, or toy cars, email Gold at talkinghealthoutloud@gmail.com.

Follow Gold’s organization Talking Health Out Loud on Facebook here.

For an interesting discussion on Numeracy Bias, check out this episode of Hidden Brain. Numeracy bias is described this way: “…When you see one person suffering, you feel like, ‘Oh, I can do something for that person.’ But when you hear that a whole country has a refugee crisis, you tend not to get involved because you feel like, ‘Well, this is overwhelming. I don’t think I can do anything about this, so I’m not going to engage.’…It turns out that people who have experienced a high level of lifetime adversity are immune to this bias.”

 

Other resources

Micronutrient Deficiencies

UNICEF Child Food Poverty

UNICEF No Time to Waste

UNICEF Fed to Fail